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Evra – The Contraceptive Patch

The Evra patch is a female hormonal contraceptive which has been available in the UK since the early 2000s and marketed by Janssen-Cilag. The active ingredients preventing pregnancy are released into the blood via transdermal absorption – in other words, you stick the patch on one of several areas on your body where it will stay for a number of days during which the hormones are gradually released before the patch is renewed. In the UK, an estimated one percent of women using contraception rely on ‘the Patch’, which measures only just shy of 2 inches by 2 inches.

How does Evra work?

Each of the light pink patches contains synthetic versions of two naturally occuring female sex hormones – ethinylestradiol (an estrogen) and norelgestromin (a progestogen), making it a so-called combined contraceptive. Its action therefore is similar to the active principle of the combined oral contraceptive pill (COCP).

Evra works by interfering with the normal mentrual cycle during which the levels of sex hormones change, which triggers ovulation and the monthly period. Simply speaking, the hormones in Evra simulate pregnancy which suppresses ovulation and therefore no egg is released from the ovaries. Furthermore, they cause a change in the consistency of the mucus at the neck of the womb (cervix) which would make it harder for an egg to nest.

Evra is designed to be used over a four week period thus mimicking a natural menstrual cycle. One patch is applied weekly for three weeks followed by a one week break during which a withdrawal bleed similar to a normal period will occur. The contracpetive protection will still be given during this patch-free interval provided you have used it correctly throughout your cycle.

Evra PatchPrices from £55.00 for 3 months supply

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How should I use Evra?

To start contraception with the Evra Patch, you should ideally apply it on the first day of your monthly cycle, i.e. the first day of your period. This will deliver immediate protection against unwanted pregnancy. It is possible to start using Evra at any other day throughout your cycle provided that you are not pregnant and bearing in mind that alternative non-hormonal contraceptives such as condoms must be used for the first seven days.

Before applying Evra for the first time, please read the patient leaflet carefully for full instructions. Stick the patch on either one of your buttocks, upper outer arms, the upper torso (not on the breasts) or the abdomen ensuring the area is clean and dry (do not use body lotion on that area to ensure the patch can stick properly), hairless and that the skin is intact and not broken or otherwise irritated. On your patch change day, which will be exactly the same day each week, remove the current patch and replace it with a fresh one that you will apply to a slightly different spot to avoid potential skin irritation.

The patch will stick on during swimming, exercise, in the sauna or bath. Forther information on what to do if the patch does come off before it is due to be renewed can be found below. Do not apply more than one patch at a time.

After three patches, i.e. three weeks of use, you’ll have a one week break during which withdrawal bleeding will occur. If you have previously used the combined oral contraceptive pill, you will already be familiar with this dosaging regime.

Please do not discard the used patches by flushing them down in the toilet as this will release the remaining hormones into the ground water. Dispose of them properly by placing them in the provided disposal sachets and put them in the bin.

What if I forget to apply a new patch?

It is a good idea to set yourself a reminder on your phone or in your diary to alert you when you need to change your patch or when to apply the first patch of your new cycle after the seven day break. If for one reason or another, you forget applying a new patch on time, protection against unwanted pregnancy will not be given.

If you forgot to put on a new patch after your patch-free interval, apply it as soon as possible. For the first week of this cycle, you will need to use a non-hormonal contraceptive method such as condoms in addition to the patch. If you had unprotected sex during your patch-free week, please consult your doctor as emergency contraception such as the morning after pill might be indicated. Please also note that your patch change day will now also be a different day of the week.

If you forgot to replace your old patch with a new one throughout your three week patch rhythm, change it as soon as you can. Provided this happens within 48 hours of the usual time frame, you do not need to use supplementary contraception. If more than 48 hours have elapsed before you remember to apply a new patch, protection against unwanted pregnancy is no longer given, so use additional contraception for the next seven days. Start a whole new four week patch cycle, i.e. apply a fresh patch once for 3 weeks, followed by your seven day break.

What if the patch comes off before it is due to be changed?

The adhesive in Evra is designed to last for a week and even if you play sports, swim, have a bath or similar, the patch should stay in place. If it does come off before it is due to be changed however, do not try to stick it back on using surgical tape or plasters but simply replace it with a new one right away. If the patch came off for more than 24 hours, apply a new one and use alternative contraception for the following seven days. You will start a new four week cycle, i.e. three consecutive weeks of wearing a patch followed by a seven day break.

Who should not use Evra?

If you have recently given birth, are currently breastfeeding or would like to start using the patch following a miscarriage or abortion, please consult your doctor as to whether Evra is suitable for you.

Given the fact that both contraceptives contain the same kind of active ingredients, the risks of Evra are similar to those of the combined oral contraceptive pill. Evra may slightly increase the risk of blood clotting in the lungs or legs, especially in obese women or smokers. If you need to have surgery requiring an extensive bedbound recovery or if you break a limb and need to have it put in a cast, inform your doctor that you use Evra as you may have to stop treatment temporarily.

If you weigh more than 15 stone (90kg), Evra is not a suitable method of contraception for you.

Furthermore, you should inform your doctor about your medical history to the best of your knowledge when seeking a prescription for Evra and let him or her know of any past or present medical conditions, especially diabetes, hypertension, varicose veins, kidney or liver disease as well as any information about disease that may run in your family, particularly cancer or stroke.

Do not use Evra if you are or suspect that you might be pregnant. If you are breastfeeding, you need to start until weaning or for at least six month after birth before you can start treatment with Evra.

Does Evra have any side effects?

Like any medication, Evra may have potential side effects. Generally speaking, they are mild and temporary, however if you are concerned at all, please speak to your doctor or pharmacist about further information. A full list of side effects that have been reported to date can be found in the patient leaflet. If you experience any severe reaction, stop using Evra and seek medical advice. The most common side effects of the contraceptive patch are:

• Headaches
• Mood swings
• Vaginal discharge
• Nausea
• Tender or enlarged breasts
• Spotting

Interactions with other medicines

Inform your prescriber of all medicines and supplements you are taking prior to seeking a prescription for Evra as some medications or health products may interfere with the treatment. Some drugs, such as barbiturates, antiepileptics, ritonavir, modafinil, rifampicin, rifabutin or St John’s wort accelerate the absorption of the hormones in Evra which might make it less effective. Therefore, if you take any of these medicines at the long term, the contraceptive patch might not be suitable for you and you should discuss alternative contraception options with your doctor.

Evra – Pros and Cons

The contraceptive patch is a safe, effective and convenient method of contraception, especially for women who find it bothersome having to take a pill each day or who have trouble remembering to do so. As the hormones are transmitted via the skin rather than via the digestive tract, the dosage is lower, which is beneficial especially if you tend to suffer from nausea due to the Pill. The effectiveness of oral contraceptives is affected by diarrhoea or vomitting – with Evra, you do not need to worry about these factors.

On the other hand however, Evra might get detached without you realising. This is very rare though. The adhesive in the patch can irritate the skin, so if yours is very sensitive or prone to eczema or allergies, you may find that Evra is not suitable for you. If seek contraception and suffer from irregular, heavy or painful periods, the Pill might be a better choice for you since it controls mentruation in a more effective way than ‘the Patch’.

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