What Should You Know About the Ortho Evra Patch?

How Does the Ortho Evra Patch Work and What are the Pros and Cons?

Contraceptive patch
What should you know about the Ortho Evra patch for birth control?. IAN HOOTON/Science Photo Library/Getty Images

Your doctor may have recommended the Ortho Evra patch or you may have read about this option for birth control. How does the birth control patch work and what are some of the advantages and disadvantages relative to other methods of contraception? What are the possible side effects?

Basics

The Ortho Evra Patch is the first weekly form of hormonal birth control. It is a discreet and reversible type of prescription contraception that comes in a 4x4-cm thin, smooth, beige, plastic patch that sticks to a woman’s skin.

How Is It Used?

The Ortho Evra Patch consists of patches which you place on your skin for 7 days for three consecutive weeks each month. The fourth week you do not need to put on a patch, and during this time you will usually get your period.

This is similar to many types of combination birth control pills, with the exception that you take pills for 21 days (and possibly a placebo for the last 7 days) instead of applying a patch each week for those 21 days.

The patch can be worn on one of four different areas of the body including your:

  • Upper outer arm
  • Abdomen
  • Buttocks
  • Upper torso (front or back, excluding your breasts)

It does not matter which of these locations you use, but a woman should wear the patch on a different area of her body each week. You may choose the location to place your patch based on your wardrobe choices and what feels best to you.

How Does It Work?

The Ortho Evra patch is designed to continuously release a steady flow of synthetic estrogen (ethinyl estradiol) and a type of progestin (norelgestromin) through the skin and into the bloodstream to protect against pregnancy for 7 days (which is why a woman must replace it after each week).

The Ortho Evra patch contains the same types of hormones found in the pill.

    Advantages

    There are several advantages of using the Ortho Evra patch relative to other forms of birth control. These include:

    • The patch is simple, convenient, and safe
    • With the patch, you don't have to take a daily pill, so it’s one less thing to think about each day
    • The patch is usually comfortable and discreet
    • It is reversible and the ability to become pregnant returns quickly after stopping use
    • You can do everything you normally do, and know that the patch is right there, doing its job
    • The Ortho Evra Patch does not interfere with having sex and can allow for more spontaneity
    • Many who use the patch report having regular, lighter, and shorter periods
    • Ortho Evra easily adheres to the skin and does not prevent activities such as bathing, showering, swimming, and exercising
    • You can use your patches to skip your period

    Non-Contraceptive Advantages

    We now know that there are several non-contraceptive benefits of combination birth control pills, and this likely holds true for the Ortho Evra patch as well. Some of these additional benefits may include protection against:

    • Ovarian cysts
    • Ovarian cancer
    • Hirsutism (excess facial hair)
    • Ectopic pregnancy
    • Premenstrual dysphoric disorder and depression
    • Uterine cancer
    • Noncancerous breast tumors
    • Acne
    • Menstrual migraines
    • Anemia (iron deficiency that results from heavy periods)
    • Osteoporosis

    Disadvantages

    Compared with other forms of birth control, the patch may result in:

    • Changes in sexual desire
    • Worsening of depression for those who have a history of depression
    • Skin reactions at the site of patch application

    Side Effects

    There is a low incidence of side effects for those women who choose to use the Ortho Evra patch, but it is important to be familiar with these before starting treatment. Fortunately, many of these side effects will improve or disappear after you have been using the patch for two to three months. Possible side effects include:

    • Mood changes
    • Headaches
    • Bleeding between periods
    • Breast tenderness
    • Nausea (sometimes with vomiting)

    Warnings

    While many of the pros, cons, and side effects of the Ortho Evra patch are similar to traditional birth control pills, there are a few important differences as well.

    The hormones which enter the bloodstream via patches are removed from the body differently than those from pills taken by mouth.

    Women who use the birth control patch are exposed to around 60 percent more estrogen than those who take a typical birth control pill. This increased estrogen exposure may increase the risk of side effects for those using the patch.

    Related to this increased estrogen level, the risk of blood clots in the legs (and the subsequent risk of pulmonary embolism which can occur when clots break off and travel to the lungs) may be higher with the patch when compared to a typical birth control pill containing 35 mcg of estrogen. The risk of blood clots is about twice as high on the patch as with a typical birth control pill, but the overall risk of blood clots is relatively low with either method.

    There is also a slightly higher risk of breast tenderness on the patch relative to that on the birth control pill.

    Who Can Use It?

    The Ortho Evra patch is a safe method of birth control for many women, though there are times when a different form of birth control is preferred.

    The patch is not recommended for women who:

    • Are over the age of 35 and smoke cigarettes
    • Have had a heart attack or stroke
    • Have uncontrolled high blood pressure
    • Have had an abnormal growth or cancer of the breast
    • Have controlled high blood pressure and smoke cigarettes (learn more about birth control pills/patches and high blood pressure)
    • Have had blood clots (venous embolism) or a pulmonary embolism
    • Have liver disease or liver growths
    • Have had serious heart valve problems
    • Have certain inherited blood clotting disorders
    • May be pregnant

    How to Obtain

    The Ortho Evra patch is available only by prescription and requires a medical evaluation and blood pressure reading from a physician. Many physicians also recommend an up to date Pap smear before prescribing hormonal contraception.

    Cost

    Prices vary, but the typical cost for the patch is between $30 and $40 a month (plus the expense of having a medical examination in order to obtain the prescription.) In many communities, Medicaid covers the cost for this contraceptive method. A woman should check with her private health insurance policy as coverage for birth control varies.

    Effectiveness

    The Ortho Evra Patch is 92 percent to 99.7 percent effective in preventing pregnancy. This means that with perfect use, less than 1 out of every 100 women who use the patch will become pregnant. With typical use, 8 out of every 100 women who use the patch will become pregnant.

    Certain medications can decrease the effectiveness of the birth control pills or patches. This includes drugs such as commonly used antibiotics so it's important to talk to your doctor about any medications you are taking as well as any new medications which you may be prescribed after starting the patch.

    The patch might be less effective for overweight women (those who weigh more than 198 pounds.)

    The effectiveness of the Ortho Evra Patch can also be lowered due to user error. A woman may be more at risk for pregnancy if:

    • The patch falls off and is not replaced within 24 hours
    • A woman forgets to change the patch each week
    • If the patch is not stored at room temperature
    • If the patch is not kept keep sealed until it is applied
    • The woman tries to reapply a patch that is no longer sticky, has been stuck to itself or another surface, has other material stuck to it, or has become loose and fallen off before.

    What if Your Ortho Evra Patch Falls Off?

    In research studies, less than 2 percent of patches came off and less than 3 percent of patches loosened. If the patch has been off for less than 24 hours, you can usually reattach it (as long as it is still sticky.) If it has been over 24 hours, you will need to use a new patch. You should also use a back up form of birth control for the rest of the month.

    If you forget to change your patch, instructions will vary depending on which patch you are using (1, 2, or 3,) but it is wise to use a back up form of birth control for the entire month.

    Learn more about the guidelines on exactly what to do if your patch falls off or if you forget to change it.

    Using the Patch to Stop Your Period

    One of the advantages of birth control pills is that they can sometimes be used to stop your period allowing you the freedom to skip your period during an upcoming vacation, for a special event or even hiking in grizzly bear country. Learn more about how to skip your period on the Ortho Evra patch.

    What About Showering or Swimming?

    You should be able to shower or swim without problems while using the Ortho Evra patch. If you patch does fall off, however, make sure to reapply a patch within 24 hours. When this occurs, it may be preferable to use a new patch (make sure to get a replacement from your pharmacist) rather than re-using the patch which fell off, since it may no longer stick to your skin.

    Bottom Line

    The Ortho Evra patch provides yet another form of hormonal contraception in which you only need to think about your birth control once a week. There are several advantages as well as some disadvantages of using hormonal contraception.

    Your estrogen levels may be higher when using the patch than with a typical birth control pill. Since the risk of blood clots increases with estrogen dose, it's important to be aware of this potential risk.

    Like birth control pills, the Ortho Evra patch offers no protection against sexually transmitted diseases. If you may be at risk for STDs, it's important to always use condoms along with your birth control patches.

    Sources:

    Galzote, R., Rafie, S., Teal, R., and S. Mody. Transdermal Delivery of Combined Hormonal Contraception: A Review of the Current Literature. International Journal of Women’s Health. 2017. 9:315-321.

    Raymond, E., Burke, A., and E. Espey. Combined Hormonal Contraceptives and Venous Thromboembolism: Putting the Risks into Perspective. Obstetrics and Gynecology. 2012. 119(5):1039-44.

    Continue Reading