The Basics

The patch - Ortho Evra - is a reversible prescription method of birth control. It is a thin, beige, plastic patch that sticks to the skin. A new patch is placed on the skin of the buttocks, stomach, upper outer arm, or upper torso once a week for three weeks in a row. No patch is used in the fourth week. The patch releases synthetic estrogen and progestin to protect against pregnancy for one month.

The hormones in the patch work by preventing a woman's ovaries from releasing eggs (ovulation). They also thicken the cervical mucus, which keeps sperm from joining with an egg. The hormones also thin the lining of the uterus. In theory, this could prevent pregnancy by interfering with implantation of a fertilized egg. But there is no scientific evidence that this occurs.

The patch works best when it is changed on the same day of the week for three weeks in a row. Pregnancy can happen if an error is made in using the patch — especially if

• it becomes loose or falls off for more than 24 hours
• the same patch is left on the skin for more than one week

If either of these things happens, follow the directions in your package insert, and call your clinician.

Effectiveness

The patch is a very effective reversible method of birth control. With typical use, although no studies have yet been published, it is assumed that the patch will be more effective than the pill — eight out of every 100 pill users become pregnant with typical use. Fewer than one woman out of every 100 women who use the patch will become pregnant with perfect use.**

The patch may be less effective for women who weigh more than 198 pounds.

Certain medicines and herbs may make the patch less effective. These include

• the antibiotic rifampin. Other antibiotics do not make the patch less effective.
  
• certain anti-fungals that are taken orally for yeast infections
  
• certain anti-HIV protease inhibitors
  
• certain medicines used to treat seizures, mental illness, or headache
  
• St. John's wort

Talk to your clinician about the medicines you already take before you get a prescription for any method of birth control.

The patch does not protect against sexually transmitted infections. Always use a latex or female condom with the patch to reduce the risk of infection.

Advantages

The patch protects against pregnancy for one month. And it does not involve taking a daily pill.

Using the patch is simple, safe, and convenient.

Many women who use the patch have more regular, lighter, and shorter periods. And a woman's ability to become pregnant returns quickly when use of the patch is stopped.

The patch does not interfere with having sex, and may improve a woman's sex life. Some women say they feel free to be more spontaneous because they do not have to worry about becoming pregnant.

Results of long-term studies won't be available for some time, but researchers assume that the non-contraceptive advantages associated with the patch are similar to those known to be associated with the pill.

These health benefits may include some protection against

• irregular menstrual cycles
• infection of the fallopian tubes (pelvic inflammatory disease), which often leads to infertility
• ectopic pregnancy (in the fallopian tubes)
• noncancerous breast growths
• ovarian cysts
• pelvic inflammatory disease, which often leads to infertility when left untreated
• cancer of the ovaries
• cancer of the lining of the uterus
• troublesome menstrual cramps
• iron deficiency anemia that results from heavy menses
• acne
• premenstrual symptoms, as well as related headaches and depression
• excess body hair
• osteoporosis — loss of bone mass
• vaginal dryness and painful intercourse associated with menopause

Possible Side Effects

As with all medications, there may be some undesirable side effects for some women taking combined hormone contraceptives. However, the patch is much safer than pregnancy and childbirth for healthy women - except among smokers age 35 and older.

Side effects that usually clear up after two or three months of use include

• bleeding between periods
  
• breast tenderness
  
• changes in mood
  
• headache
  
• nausea - rarely, vomiting

Other possible side effects may include

• change in sexual desire
  
• depression
  
• skin reaction at the site of application

Women with a history of depression may not be able to continue to use the patch if their depression worsens.

See your clinician right away if any problem develops while using the patch. Remember to tell any other clinician you may see that you are using the patch.

Possible Complications

Serious problems do not occur very often. In general, using the patch is much safer than pregnancy and childbirth. Combined-hormone contraception users have a slightly greater chance of certain major disorders than nonusers. The risk is increased by being age 35 or older, smoking, and by having conditions associated with heart attack, such as diabetes, high blood pressure, or high cholesterol, and certain inherited conditions that increase the risk of blood clotting.

More estrogen is absorbed from the patch than from some other hormonal methods. The risks of heart attack, stroke or blood clots in the lungs are rare for the patch, the pill, and the ring.  There could be a slight increase in risk for blood clots in the legs for the patch users.  But that hasn't been proven.

The most serious complication of combined-hormone use is having a blood clot in the legs, lungs, heart, or brain. Women on combined hormones who have major surgery or who have a leg immobilized - because they are confined to bed or have a cast - seem to have a greater chance of having blood clots. It is important to tell your surgeon that you are using the patch when planning a major operation. Follow your clinician's advice about when you can start using the patch again.

Rarely, women who use combined-hormone methods develop high blood pressure. Very rarely, they develop liver tumors, gallstones, or jaundice (yellowing of the skin or eyes).

Combined-Hormone Contraception and Breast Cancer
The most recent research suggests that the use of combined-hormone methods has little, if any, effect on the risk of developing breast cancer.

Serious problems usually have warning signs. Report any of these signs to your clinician as soon as possible:

• eye problems such as blurred or double vision
  
• pain in the abdomen, chest, or arm
  
• severe headaches
  
• sudden shortness of breath or spitting up blood
  
• unusual swelling or pain in the leg
  
• worsening depression
  
• yellowing of the skin or eyes (jaundice)
  
• a new lump in your breast
  
• unusual heavy bleeding from your vagina
  
• no period after having a period every month

Who Can Use the Patch

Most healthy women can use the patch.

You should not use the patch if you

• are 35 or older and smoke cigarettes
  
• have certain inherited blood clotting disorders
  
• have certain vascular conditions associated with diabetes mellitus
  
• have controlled high blood pressure and smoke cigarettes
  
• have had blood clots or vein inflammation
  
• have had an abnormal growth or cancer of the breast
  
• have had a heart attack or stroke
  
• have had migraine headaches with aura
  
• have had serious heart valve problems
  
• have a severe liver disease or have had growths on the liver
  
• have uncontrolled high blood pressure
  
• need prolonged bed rest after major surgery
  
• think you might be pregnant

Some patch users may need close medical supervision if they have

• a body weight of 198 pounds or more
  
• diabetes - not associated with vascular conditions
  
• experienced jaundice (yellowing of the skin) during previous birth control use
  
• gallbladder disease
  
• high cholesterol or slightly increased blood pressure
  
• a high risk for heart disease
  
• a parent or sibling who has had a heart attack or stroke before age 55
  
• a seizure disorder that requires taking anticonvulsant medication
  
• unexplained bleeding from the vagina

Getting the Patch

Consult a clinician about using the patch. The clinician will discuss your medical history with you, check your blood pressure, and give any other medical exam that you may need. If the patch is right for you, the clinician will give you a prescription. Follow the instructions on the package.

You will place one new patch on the skin of the buttocks, stomach, upper outer arm, or upper torso once a week for three weeks in a row. You will not put on a patch for the fourth week.

• Store the patch at room temperature and keep it sealed until you apply it.
• Consider the first day you apply the patch as "patch change day."
• Gently tear the package along the top and side edges.
• Peel the foil pouch apart and open it flat. Then peel the patch and plastic layer off the foil liner.
• Next, peel half of the clear plastic away from the patch itself — do not touch the sticky part.
• Apply the sticky half of the patch to a clean and dry area of skin on the buttocks, stomach, upper outer arm, or upper torso — never on the breasts.
• Remove the other half of the plastic and press the full patch to the skin with your palm for 10 seconds.
• Check your patch every day to make sure it is sticking in place.
• Remove it after one week. Reapply a new patch once a week on "patch change day" of the second and third weeks.
• After removal, fold the patch in half so that it sticks to itself, seal it in plastic bag, and throw it out in the trash — do not flush.

During the one-week break, you will usually have your menstrual period. You may still be bleeding when it is time to apply a new patch. This is normal, too. But a new patch must be applied one week after the last one was removed - on "patch change day" - or pregnancy may occur.

If you apply your first patch within five days after the start of your period, you are protected immediately.

If you apply your first patch more than five days after the start of your period, use another method of birth control if you have vaginal intercourse during the first week — protection will begin after seven days.

Starting the Patch After Pregnancy
After childbirth, wait at least two weeks before applying the patch. Use a backup method for seven days if you have not yet gotten your period.

The patch may reduce the amount and quality of milk in the first six weeks of breastfeeding. Also, the milk will contain traces of the patch's hormones. If you are breastfeeding, wait at least six weeks after childbirth to apply the patch. Use a backup method for seven days if you have not yet gotten your period.

You can start using the patch immediately after having an abortion. Use a backup method of birth control for seven days if you start the patch

• more than five days after a vacuum aspiration abortion
  
• more than seven days after taking mifepristone