Evra contraceptive patches
- EVRA is intended for women of fertile age. The safety and efficacy has been established in women aged 18 to 45 years.
- The decision to prescribe EVRA should take into consideration the individual woman's current risk factors, particularly those for venous thromboembolism (VTE), and how the risk of VTE with EVRA compares with other CHCs.
Pharmacist - M.B.A. (Public Health) D.I.C.
Evra contraceptive patches
What is Evra patch? Evra is a brand name…
What is Evra patch?
- Evra is a brand name for the contraceptive patch that's available in the UK. It's a transdermal patch that continuously releases two hormones - an oestrogen and a progestogen - that are absorbed through your skin into your bloodstream and work like the pill. You wear one patch a week for three weeks, followed by a week off.
What is Evra patch used for?
- Preventing an unwanted pregnancy (contraception or birth control).
- Evra patch can be a good contraceptive option if you don't want to think about contraception every day or every time you have sex.
- Evra is most often prescribed for young women who don't have any major health issues. It's not suitable for women who have an increased risk of getting a blood clot, including women over 35 who smoke.
- Evra is more than 99% effective when used correctly. It's not affected by vomiting or diarrhoea, but can be affected by some medicines. It's less effective in women who weigh over 90kg.
- Evra patch won't protect you against sexually transmitted infections; you'll still need to use condoms for that.
- The most common side effects include headaches, feeling sick, breast tenderness and mood changes.
- Breakthrough bleeding, spotting and missed periods can be common in the first few months. See your doctor if this persists. If you don't have a period for two consecutive months, do a pregnancy test before applying a new patch.
- Blood clots are a rare but serious side effect of Evra.
How does Evra patch work?
- Evra patches contain two active ingredients, ethinylestradiol and norelgestromin. These are synthetic versions of the naturally occurring female sex hormones, oestrogen and progesterone.
- The hormones in Evra are similar to the hormones used in contraceptive pills and work in the same way. They over-ride your natural menstrual cycle and work mainly by stopping your ovaries from releasing an egg each month (ovulation). They also increase the thickness of the natural mucus at the neck of the womb, making it more difficult for sperm to cross from the vagina into the womb, as well as thinning the womb lining (endometrium), making it more difficult for any successfully fertilised eggs to implant there.
- You apply one patch once a week for three weeks, then have a week off. During your patch-free week the levels of hormones in your blood fall and you'll usually get a withdrawal bleed that's like your period.
Who shouldn't use Evra patch?
The contraceptive patch is not suitable for all women. You shouldn't use it if you:
- are over 35 and you smoke, or you stopped smoking less than a year ago
- are very overweight (BMI more than 35)
- have ever had a blood clot in your leg (deep vein thrombosis) or lungs (pulmonary embolism)
- have ever had a heart attack, angina, stroke or mini-stroke
- have very high blood pressure (hypertension) or vascular disease
- have heart valve disease or an irregular heartbeat called atrial fibrillation
- have a blood disorder that increases your risk of blood clots, eg antiphospholipid syndrome or factor V Leiden
- have severe diabetes with complications affecting the eyes, kidneys or nerves
- suffer from migraines with aura
- have breast cancer now or have had it in the last five years
- have liver disease, eg liver cancer, severe cirrhosis
- have gallbladder disease
- have ever had jaundice, itching, a hearing disorder called otosclerosis, or a rash called pemphigoid gestationis, when pregnant or when taking the pill before
- have a rare metabolic disorder called porphyria.
Your doctor may need to weigh up the risks and benefits of using Evra patch if you have various other conditions, including those below. If two or more of these apply your doctor will usually recommend that you use a different type of contraception:
- You are 35 years or older.
- You smoke.
- You are overweight.
- You have high cholesterol levels.
- You have high blood pressure (hypertension).
- You have diabetes.
- Your parent, brother or sister had a heart attack, stroke or blood clot in the leg (deep vein thrombosis) or lungs (pulmonary embolism) before the age of 45.
- You use a wheelchair.
- You have a long-term condition called systemic lupus erythematosus (SLE).
- You have Crohn's disease or ulcerative colitis.
- You have a history of migraines.
- You have an undiagnosed breast lump or gene mutations that are associated with an increased risk of breast cancer, eg BRCA1.
- You weigh 90kg or more, because the patch may be less effective in larger ladies.
Can I use the patch if I'm breastfeeding?
- Evra is not the preferred method of contraception for women who are breastfeeding, because the oestrogen in it can reduce the amount of breast milk you produce. If you do decide you want to use it you shouldn't start until at least six weeks after the birth, when breastfeeding is fully established.
How do I use Evra patches?
You apply one patch once a week, on the same day each week, for three weeks. You then have a week without wearing a patch. During this week you'll usually get a withdrawal bleed that's similar to your normal period. Apply a new patch after seven days even if you haven't stopped bleeding.
You'll still be protected against pregnancy in your patch-free week, provided you used the previous three patches correctly, you start the next cycle of patches on time and nothing else happened that could make the patch less effective (eg taking certain other medicines.
- Follow the instructions in the leaflet provided with your patches carefully. Only one patch should be applied at a time. Do not cut the patches.
- Apply each patch to a clean, dry, hairless, intact, healthy area of skin on the buttock, abdomen, upper outer arm or upper torso, in a place where it won't be rubbed by tight clothing. DO NOT apply it to your breasts or to skin that is red, irritated or broken.
- When you change the patch, remove the old patch and replace it with a new one in a slightly different area to avoid irritating the skin.
- Don't apply make-up, creams, lotions, powders or other products to the area of skin where you're going to stick a patch, as they can stop it sticking properly. Don't use extra adhesives or bandages to hold your patch in place. If a patch has stopped sticking before a week is up, replace it with a new one and follow the instructions below regarding detached patches.
- Do not flush used patches down the toilet. Dispose of them in a bin, in the sachet provided.
- In theory, your patch shouldn't come off in the shower, bath, hot tub or sauna, or during swimming or exercise.
When can I start using the patch?
- Check with your doctor because this depends on personal circumstances, such as if you're changing from another form of contraception, or if you're starting it after having a baby or following a miscarriage or abortion.
- Your doctor will also advise on how soon you'll be protected against pregnancy. For some women this will be as soon as they apply their first patch, but most women need to use condoms (or not have sex) until they have worn a patch for seven days.
What if my patch comes off?
- Check your patch daily to make sure it is still attached. If it comes off partially or fully for less than 48 hours and is still sticky, re-apply it to the same place. If it has lost its stick, replace it with a new patch immediately. You don't need to use extra contraception if the patch was on correctly for seven days before it came off. Change the patch as usual on your usual change day.
- If the patch comes off partially or fully for more than 48 hours or you don't know when it came off, you may not be protected. Start a new patch cycle by applying a new patch straight away and use an extra contraception, eg condoms, or don't have sex, for seven days. Change the new patch after seven days - you may now have a new patch change day. If you had unprotected sex in the week before your patch fell off get advice about whether you need emergency contraception.
What if I forget to apply a patch?
- If you forget to change your patch on your usual change day, change it as soon as you remember, then carry on as before. You may now have a new patch change day.
- If you apply the new patch less then 48 hours late and you wore the previous patch correctly for a week, you don't need to use extra contraception.
- If you apply the new patch more than 48 hours late you will not be protected against pregnancy. Use extra contraception, eg condoms, for the next seven days.
- If you forget to apply a new patch on time after your seven day break, apply a new patch as soon as you remember. You may now have a new patch change day.
- If you apply the new patch less then 48 hours late and you wore a patch correctly before your patch-free week, you'll still be protected and don't need to use extra contraception.
- If you apply the new patch more than 48 hours late you will not be protected against pregnancy. Use extra contraception, eg condoms, for the next seven days. If you had unprotected sex in your patch-free week, you may need emergency contraception (the morning after pill). Ask for medical advice.
What are the side effects of Evra patch?
The following are some of the side effects that may be associated with Evra patch. Just because a side effect is stated here doesn't mean that everyone using this contraceptive will experience that or any side effect. Medicines affect people in different ways.
Common side effects include:
- Feeling sick.
- Abdominal pain.
- Breast pain or tenderness.
- Slight bleeding or spotting between periods in the first few months.
- Lighter periods or sometimes stopping of periods.
- Mood changes. However, there's no evidence that the patch causes depression.
- Skin irritation or itching where you apply the patch.
Other possible side effects include:
- Fluid retention. However, there's no evidence that the patch causes weight gain.
- Change in sex drive.
- Rise in blood pressure.
- Skin reactions.
- Increased risk of getting a blood clot in an artery, which could cause a stroke or a heart attack.
- Increased risk of getting a blood clot in a vein, such as a deep vein thrombosis (clot in the leg) or pulmonary embolism (clot in the lungs). But the risk is still small - each year between 6 and 12 women out of every 10,000 using Evra patch will get this type of blood clot, compared with 2 women out of every 10,000 not taking the pill, and 29 out of every 10,000 women who are pregnant.
The risk of getting a blood clot in a vein is temporarily increased if you're immobile for long periods of time, for example if you have a major accident or major surgery. You'll need to stop using the patch four to six weeks before planned surgery, and also if you're confined to bed or have a leg in plaster. You shouldn't start using it again until at least two weeks after you are fully mobile.
The risk of blood clots is also increased if you're travelling for long periods of time where you will be sat still (particularly flights over three hours). Ask your doctor or pharmacist for advice on using travel stockings, calf exercises or aspirin.
As with other hormonal contraceptives, it's possible that using the contraceptive patch may slightly increase your risk of being diagnosed with breast cancer. Research into this is still ongoing, but the risk doesn't go up the longer you use the patch, and goes back to normal ten years after you stop using it.
Women who use the patch for longer than five years may also have a small increase in the risk of being diagnosed with cervical cancer, which again goes back to normal ten years after you stop using it.
Can I use other medicines with Evra patch?
Before you start using Evra patches make sure you tell your doctor or pharmacist if you're already taking any other medicines, because some medicines can make it less effective at preventing pregnancy. For instance, if you regularly take any of the medicines below the patch probably won't work for you, so you'll usually need to use a different form of contraception:
- certain antiepileptic medicines, such as carbamazepine, oxcarbazepine, perampanel, phenobarbital, primidone, phenytoin or topiramate
- some medicines for HIV, such as cobicistat, efavirenz, nevirapine or ritonavir
- the antifungal griseofulvin
- the antibiotics rifabutin or rifampicin for tuberculosis
- the herbal remedy St John's wort (Hypericum perforatum).
If you're prescribed a short course (up to two months) of any of these medicines this can also make the patch less effective, and your doctor will usually recommend that you temporarily use a different form of contraception. If you want to keep using Evra, talk to your doctor about what to do. You'll also need to use an extra method of contraception (eg condoms) for as long as you take the extra medicine and for at least four weeks after stopping it.
Evra patch is not usually recommended if you're taking the antiepileptic medicine lamotrigine.
While you're using Evra it's a good idea to check with your doctor or pharmacist before you take any other new medicines, but some key points are:
- Antibiotics (other than rifampicin or rifabutin - see above) won't make Evra less effective and it's fine to take a course - you don't need to use extra contraception.
- If you need to take emergency contraception while you're using Evra patch, for example because you're late applying a patch, be aware that the ellaOne brand (containing ulipristal) can make Evra less effective. If you take this type of emergency contraception while using Evra patches you should use extra contraception, such as condoms, for 14 days after taking it.