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Contraceptive Patch (Ortho Evra)

  • Deepi Brar
  • Posted March 11, 2013

What is a contraceptive patch?

The Ortho Vera patch is a reversible method of birth control that delivers the same hormones as the pill. It's up to 99 percent effective at preventing pregnancy. The patch comes in a package of three, enough for one month of birth control. Individual patches are also available in case a patch is damaged or comes off. They look like beige squares measuring a little less than two inches on each side.

Could it work for me?

If you're currently on the pill or a good candidate for it, the patch may be an attractive option. One advantage to the patch is that you don't have to remember to take a pill every day. This might be a better alternative if you have a hard time sticking to a daily routine.However, the patch is not for everyone. If you weigh more than 198 pounds, for example, the patch may not work for you because it may not deliver enough hormones to stop ovulation.

How does the patch work?

Just like combination birth control pills, the patch delivers two hormones, in this case norelgestromin (a form of progestin) and ethinyl estradiol (a form of estrogen). Instead of taking a daily pill, you wear a weekly hormone patch on your body. The hormones enter your bloodstream through your skin. Acting together, the hormones prevent pregnancy mainly by suppressing ovulation. They also change the mucus around the cervix (the opening of the uterus) in ways that may prevent sperm from entering, and produce changes in the endometrial lining of the uterus that may make it more difficult for a fertilized egg to implant in the uterus. However, the patch does not protect against sexually transmitted diseases.

How do you use it?

You can stick the patch on your abdomen, buttocks, upper body (front or back, except breasts), or outer side of the upper arms. It's best to change the location slightly each week to avoid skin irritation, but always place it on one of these four spots. After three weeks, you take the fourth week "off" and wear no patch. A few days into your "off" week, you'll have your period. (This is just like the week of placebo pills in a pack of birth control pills.)

The patch must be worn on clean, dry skin. Avoid applying lotion, oil, or makeup near it. You shouldn't write on it or decorate it, or move it during the week either -- doing any of those things could damage it and reduce its effectiveness. According to the manufacturer, the patch is designed to stay on even when you shower, swim, exercise, or do other daily activities. However, using a sauna, hot tub, or treadmill may increase the amount of estrogen released by the patch.

How effective is the patch?

With typical use, the patch is somewhat more effective than the pill. Based on three large clinical trials, about one woman out of 100 became pregnant while using the patch for a year.

As always, tell your health care provider about all the medicines and supplements you are taking. Certain medications and herbs can interact with hormonal contraceptives and make them less effective, including some drugs for seizures (such as phenytoin, also called Dilantin, or phenobarbital, also called Luminal), headaches, or mental illness, some oral antifungals (for yeast infections), and the antibiotic rifampin. Also, the herb St. John's wort, which is used to treat mild depression, may decrease the effectiveness of hormonal contraception. If you need to take any of these medicines, you may experience breakthrough bleeding (bleeding at times other than your period); if so, you will need to use a backup contraception method.

In addition, vitamin C, acetaminophen (Tylenol), and atorvastatin (Lipitor) can increase the amount of hormones in your body. Several protease inhibitors for HIV can cause significant changes (increases and decreases) in the amount of hormones in the bloodstream.

What if my patch comes off?

If your patch has been loose (on any edge) for less than 24 hours, try to stick it back on. If it won't stick properly, you'll need to replace it with another until your current week is up, then change it again on your regular day. If it's been loose for longer than 24 hours, or you're not sure about its effectiveness, you'll need to start a new cycle immediately. Starting a new cycle will also reset your regular weekly patch change day. For users of the pill, this should sound like familiar advice.

What are the side effects of the patch?

Some women may develop itchiness or redness on their skin where the patch is applied. The most common side effects observed in clinical trials are breast tenderness, headache, nausea, upper respiratory infections (such as colds), menstrual cramps, and abdominal pain. In some trials, 2.4 percent of women decided to stop using the patch because of nausea or vomiting, skin irritation, breast symptoms, headache, or emotional changes.

Other common side effects are similar to those of the pill and other estrogen-progestin combination contraceptives; these include swelling, weight changes, vision changes, rash, yeast infections, depression, and jaundice (yellowing of eyes or skin due to liver problems). It's common for periods to become shorter and lighter, and you may also notice spotting or "breakthrough bleeding."

If you smoke (especially if you're over 35), have had a blood clot or stroke before, or have high blood pressure that's not under good control (or over 140/90), you should avoid combination hormone birth control methods such as the pill and the patch, because the estrogen in them increases your risk of blood clots that can cause stroke and heart attack. Also, if you have a family history of clotting disorders, such as deep vein thrombosis or Factor V Leiden deficiency, some doctors advise genetic testing to rule it out in your case before starting any estrogen therapy. Because of the steady delivery of hormones, the patch gives 60 percent more estrogen than the typical pill, which may increase your risk of blood clots and other side effects even if you are not normally considered at high risk.

The hormones in the pill and patch can increase blood pressure, causing hypertension in some women. They can also raise LDL ("bad" cholesterol) and triglycerides, and women with high lipid (blood fat) levels or a family history of premature heart disease should have their levels checked. The hormones can also worsen glucose intolerance, so women with risk factors for diabetes (pre-diabetes, diabetes in pregnancy) should be tested and monitored. Some women with diabetes have dramatic changes in blood glucose levels when they start hormonal contraceptives.

On the plus side, taking combination hormones decreases your risk for endometrial and ovarian cancer. Now for the bad news: Some experts say that taking estrogen supplements of any type may increase the risk of breast cancer if you have a family history of it, although this is controversial. Some studies have found a slightly higher breast cancer risk among pill users, especially among younger women, but the risk tends to normalize 10 years after going off the pill. The most recent studies though show this type of birth control has little effect on the risk of developing breast cancer. And according to one major study, if you test positive for human papillomavirus, or HPV, being on the pill for five years or more may triple your risk of developing cervical cancer, so regular Pap tests are important to catch this cancer early.

If you have breast cancer (past, present, or suspected) or unexplained vaginal bleeding, you may be advised to avoid all forms of hormonal birth control. The patch also may not be right for you if you have heart disease, liver or gallbladder disease, lupus, diabetes with vascular disease, severe migraines, or other conditions. Estrogen affects milk production, so if you are breastfeeding you may want to try a progesterone-only or hormone-free option, especially because the patch contains even more estrogen than most contraceptive pills.

How can I get the patch?

Since it contains the same hormones as the pill, the patch is available by prescription only. If you're interested, talk to your doctor or health care provider to find out if it's a good choice for you. It costs about $50 for a monthly supply of three patches. Many insurance plans now cover the cost of prescription contraceptives, but if you don't have insurance you may be able to get it at a subsidized price at community or university clinics.

If you want an even more "hands-off" birth control while keeping your pregnancy options open, consider a monthly ring (NuvaRing), quarterly progestin shot (Depo Provera), three-year progestin implant (Implanon), or the five-year intrauterine system (the Mirena IUS, an intrauterine device, or IUD, that releases progestin). All these options contain hormones. For a low-maintenance option without hormones, consider the intrauterine device or IUD, which can be left in place for up to 10 years.

References

Ortho-McNeil Pharmaceutical Inc. Ortho Evra Full U.S. Prescribing Information

OrthoEvra.com: Frequently Asked Questions.

Planned Parenthood: Birth Control Patch (Ortho Evra). 2010

FDA: Questions and Answers for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women last updated 6/22/2010

Moreno, et. al. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet, 2002 Mar 30; 359(9312) 1085-92

NCI Factsheet: Contraception and Cancer 5/4/2006

Cardiovascular Research Foundation: Birth Control Pills (Professional View)

Emily Herndon, MD and Miriam Zieman, MD, New Contraceptive Options. American Family Physician, Feb 15, 2004.

Drugstore.com: Ortho Evra

Palo Alto Medical Foundation. Birth control: the patch.

Sellers TA, et al. The role of hormone replacement therapy in the risk for breast cancer and total mortality in women with a family history of breast cancer.

Medscape General Medicine. Special concerns of women with systemic autoimmune disease.

Mayo Clinic. Depo Provera. January 6, 2010

Mayo Clinic. FDA approves implantable contraceptive.

Planned Parenthood. Birth Control Patch (Ortho Evra). February 2008.

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