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Ortho Evra (contraceptive patch)By Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/ortho-evra/MY01006
Ortho Evra is a contraceptive patch for women that contains the hormones estrogen and progestin. To use Ortho Evra, you apply the small patch to your skin once a week for three weeks. On the fourth week, you don't use a patch — which allows menstruation to occur.
Ortho Evra works similarly to combination birth control pills. Ortho Evra prevents pregnancy by releasing hormones into your bloodstream that suppress ovulation, keeping your ovaries from releasing an egg. Ortho Evra also thickens cervical mucus to keep sperm from reaching the egg.
Ortho Evra is the only contraceptive patch that's approved by the Food and Drug Administration (FDA) in the U.S. To use Ortho Evra, you'll need a prescription from your health care provider.
Ortho Evra doesn't offer protection from sexually transmitted infections (STIs).
Why it's done
Ortho Evra is used to prevent pregnancy. Ortho Evra has some advantages over other types of birth control:
- It eliminates the need to interrupt sex for contraception or seek partner compliance
- It doesn't require daily attention
- It provides a steady dose of hormones
- It can be removed at any time, allowing for a quick return to fertility
Ortho Evra isn't appropriate for everyone, however. Your health care provider may recommend against using Ortho Evra if you:
- Are age 35 or older and smoke
- Have chest pain or a history of heart attack, stroke or severe high blood pressure
- Have a history of blood clots
- Have a history of breast, uterine or liver cancer
- Weigh more than 198 pounds (90 kilograms)
- Have liver disease, migraines with aura, or diabetes-related complications of the kidneys, eyes, nerves or blood vessels
- Have unexplained vaginal bleeding
- Developed yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or previous use of hormonal contraceptives
- Are about to be immobilized for a prolonged period due to major surgery
- Are sensitive to any components of Ortho Evra
In addition, tell your health care provider if you:
- Are breast-feeding or recently gave birth, had a miscarriage or an abortion
- Have breast lumps, fibrocystic disease, an abnormal mammogram or a family history of breast cancer
- Have epilepsy, diabetes, or gallbladder, liver, heart or kidney disease
- Have high cholesterol or triglycerides
- Have irregular periods
- Have depression
- Have skin conditions, such as psoriasis or eczema
An estimated 9 out of 1,000 women will get pregnant during the first year of typical use of Ortho Evra.
Ortho Evra doesn't offer protection from sexually transmitted infections (STIs).
Side effects of Ortho Evra may include:
- An increased risk of blood-clotting problems, heart attack, stroke, liver cancer, gallbladder disease and high blood pressure
- Breakthrough bleeding or spotting
- Skin irritation
- Breast tenderness or pain
- Menstrual pain
- Nausea or vomiting
- Abdominal pain
- Mood swings
- Weight gain
- Muscle spasms
- Vaginal infections and discharge
- Fluid retention
Recent studies have shown that Ortho Evra causes a higher level of estrogen to circulate in the body than do combination birth control pills. As a result, you may have a slightly higher risk of estrogen-related adverse events, such as blood clots, while taking Ortho Evra than if you took combination birth control pills.
How you prepare
You'll need to request a prescription for Ortho Evra from your health care provider. Your health care provider will review your medical history and check your blood pressure. Talk to your health care provider about any medications you're taking, including nonprescription and herbal products.
What you can expect
To use Ortho Evra:
- Consult your health care provider about a starting date. If you're using Ortho Evra for the first time, wait until the day your period starts. If you use the first-day start, you'll apply your first contraceptive patch on the first day of your next period. No backup method of contraception is needed. If you use the Sunday start, you'll apply your first patch on the first Sunday after your period starts. Use a backup method of contraception for the first week.
- Choose an area to apply the patch. You can place Ortho Evra on your buttocks, upper outer arm, lower abdomen or upper body. Don't put it on your breasts or in a place where it will be rubbed, such as under a bra strap. Apply to skin that's clean, dry and intact. Avoid areas of the skin that are red, irritated or cut. Don't apply lotions, creams, powders or make-up to the skin area where the patch is or will be placed. If skin irritation develops, remove the patch and apply a new patch to a different area until your next change day.
- Apply the patch. Carefully open the foil pouch. Use your fingernail to lift one corner of the contraceptive patch. Peel the patch and the plastic liner away from the pouch, then peel away half of the protective clear lining. Be careful not to cut, alter or damage the patch. Apply the sticky surface of the patch to your skin and remove the rest of the liner. Press down firmly on top of the skin patch with the palm of your hand for about 10 seconds, making sure that the edges stick well. Leave the patch on for seven days. There's no need to take it off to bathe, shower, swim or exercise.
- Use one patch a week for three weeks. Apply a new contraceptive patch to your body each week — on the same day of the week — for three consecutive weeks. Apply each new patch to a different area of skin to avoid causing irritation. After you remove a patch, fold it in half with the sticky sides together, place it in a sturdy container, and throw it in the trash. Don't flush it down the toilet. Remove any adhesive that remains on your skin with baby oil or lotion.
- Check the patch regularly to make sure it's still in place. If the patch becomes partially or completely detached and can't be reapplied, replace it with a new patch immediately. Don't reapply a patch if it's no longer sticky, it becomes stuck to itself or another surface, or it has other material stuck to it. Don't use other adhesives or wraps to hold the patch in place. If your patch becomes partially or completely detached for more than 24 hours, apply a new patch and use a backup method of contraception for one week.
- Skip the patch on the fourth week. Don't apply a new patch during the fourth week, when you'll have your period. After the fourth week ends, apply a new patch.
- If you're late applying a new patch, use backup contraception. If you're late applying Ortho Evra in your first week or more than two days late in your second or third week, apply a new patch immediately and use a backup method of contraception for one week.
Consult your health care provider as soon as possible if you have:
- Sharp chest pain, sudden shortness of breath or coughing up blood, which can be signs of a blood clot
- Persistent pain in your calf or other signs of a blood clot in your leg
- Sudden partial or complete blindness or other signs of a blood clot in your eye
- Crushing chest pain or other signs of a heart attack
- Sudden severe headache, problems with vision or speech, or numbness in an arm or leg, or other signs of stroke
- Yellowing of the skin or whites of the eyes, possibly accompanied by fever, fatigue, loss of appetite, dark urine or light-colored bowel movements
- Severe trouble sleeping, fatigue or feeling sad
- Severe abdominal pain or tenderness
- Breast lumps
- Two missed periods or other signs of pregnancy
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- Zieman M. Overview of contraception. http://www.uptodate.com/home/. Accessed Nov. 9, 2012.
- Hatcher RA, et al. Contraceptive Technology. 20th ed. New York, N.Y.: Ardent Media; 2011:343.
- Burkman RT. Transdermal contraceptive patch. http://www.uptodate.com/index. Accessed Nov. 14, 2012.
- Dore DD, et al. Extended case-control study results on thromboembolic outcomes among transdermal contraceptive users. Contraception. 2010;81:408.