Estrogen and Progestin (Transdermal Patch Contraceptives)

Cigarette smoking increases the risk of serious side effects from the contraceptive patch, including heart attacks, blood clots, and strokes. This risk is higher for women over 35 years old and heavy smokers (15 or more cigarettes per day) and in women who have a body mass index (BMI) of 30 kg/m 2 or more. If you use the contraceptive patch, you should not smoke.

🔔 Why is this medication prescribed?

Estrogen and progestin transdermal (patch) contraceptives are used to prevent pregnancy. Estrogen (ethinyl estradiol) and progestin (levonorgestrel or norelgestromin) are two female sex hormones. Combinations of estrogen and progestin work by preventing ovulation (the release of eggs from the ovaries) and by changing the cervical mucus and the lining of the uterus. The contraceptive patch is a very effective method of birth control, but it does not prevent the spread of human immunodeficiency virus (HIV; the virus that causes acquired immunodeficiency syndrome [AIDS]) and other sexually transmitted diseases.

🔔 How should this medicine be used?

Transdermal estrogen and progestin contraceptives come as a patch to apply to the skin. One patch is applied once a week for 3 weeks, followed by a patch-free week. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use the contraceptive patch exactly as directed.

If you are just starting to use the Twirla brand estrogen and progestin contraceptive patch, you should apply your first patch on the first day of your menstrual period. If you are just starting to use the Xulane brand estrogen and progestin contraceptive patch, you may apply your first patch on the first day of your menstrual period or on the first Sunday after your period begins. If you apply your first patch after the first day of your menstrual period, you must use a backup method of birth control (such as a condom and/or a spermicide) for the first 7 days of the first cycle. Talk to your doctor or pharmacist to find out when in your cycle you should start using your contraceptive patch.

When changing your patch, always apply your new patch on the same day of the week (the Patch Change Day). Apply a new patch once a week for 3 weeks. During Week 4, remove the old patch but do not apply a new patch, and expect to begin your menstrual period. On the day after Week 4 ends, apply a new patch to start a new 4-week cycle even if your menstrual period has not started or has not ended. You should not go more than 7 days without a patch.

Apply the contraceptive patch to a clean, dry, intact, healthy area of skin on the buttock, abdomen, upper outer arm, or upper torso, in a place where it will not be rubbed by tight clothing. Do not place the contraceptive patch on the breasts or on skin that is red, irritated, or cut. Do not apply makeup, creams, lotions, powders, or other topical products to the skin area where the contraceptive patch is placed. Each new patch should be applied to a new spot on the skin to help avoid irritation.

Do not cut, decorate, or change the patch in any way. Do not use extra tape, glue, or wraps to hold the patch in place.

Each brand of estrogen and progestin contraceptive patches should be applied following the specific directions given in the manufacturer’s information for the patient. Read this information carefully before you start using estrogen and progestin contraceptive patches and each time you refill your prescription. Ask your doctor or pharmacist if you have any questions. The following general directions can help you remember some important things to do when you apply any type of estrogen and progestin contraceptive patch:

1. Tear open the pouch with your fingers. Do not open the pouch until you are ready to apply the patch.
2. Remove the patch from the pouch. Be careful not to remove the clear plastic liner as you remove the patch.
3. Peel away half or the larger part of the plastic liner. Avoid touching the sticky surface of the patch.
4. Apply the sticky surface of the patch to the skin and remove the other part of the plastic liner. Press down firmly on the patch with the palm of your hand for 10 seconds, making sure that the edges stick well.
5. After one week, remove the patch from your skin. Fold the used patch in half so that it sticks to itself and dispose of it so that it is out of the reach of children and pets. Do not flush the used patch down the toilet.

Check your patch every day to make sure it is sticking. If the patch has been partially or completely detached for less than one day, try to reapply it in the same place immediately. Do not try to reapply a patch that is no longer sticky, that has stuck to itself or another surface, that has any material stuck to its surface or that has loosened or fallen off before. Apply a new patch instead. Your Patch Change Day will stay the same. If the patch has been partially or completely detached for more than one day, or if you do not know how long the patch has been detached, you may not be protected from pregnancy. You must start a new cycle by applying a new patch immediately; the day that you apply the new patch becomes your new Patch Change Day. Use backup birth control for the first week of the new cycle.

If the skin under your patch becomes irritated, you may remove the patch and apply a new patch to a different spot on the skin. Leave the new patch in place until your regular Patch Change Day. Be sure to remove the old patch because you should never wear more than one patch at a time.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.