Evra Patch

What are Evra Patches?

The Evra patch is a branded contraceptive treatment that releases hormones into the body through the skin to stop pregnancy from occurring.

Evra patches are a type of combined contraception because they contain synthetic versions of both oestrogen and progesterone. Specifically, they contain a progestogen called norelgestromin and an oestrogen called ethinylestradiol. Unlike the combined pill, which is usually taken daily, Evra transdermal patches are replaced weekly, followed by a 7-day break, which can make them a more convenient option for some people.

The patch is more than 99% effective when it is used correctly, but when typical use is considered, such as forgetting to change the patch, the NHS states it is closer to being 91% effective. This means that each year, 9 out of 100 people who use the patch will get pregnant.

While there are several combined oral pills available to help prevent pregnancy, Evra is the only contraceptive patch that is licensed in the  USA and UK.

How Do Evra Patches Work?

Evra patches work similarly to the combined pill, except they are applied to the skin each week rather than swallowed as a tablet every day. The patches are approximately 4.5 cm by 4.5 cm and contain a synthetic oestrogen and progestogen, which are released through the skin into the body.

These hormones work together to stop pregnancy by:

1. Hindering ovulation: The primary function of Evra transdermal patches is to suppress the release of hormones that cause ovulation (the monthly release of a mature egg from the ovaries)
2. Obstructing sperm: Cervical mucus is thickened to make it difficult for sperm to travel to the womb and fertilise an egg
3. Thinning the endometrium: By affecting the womb lining, the Evra patch reduces the chances of a fertilised egg implanting itself

This three-pronged action of ovulation prevention, thinning of the womb lining, and sperm inhibition greatly reduces the chances of becoming pregnant, provided the Evra patch is used correctly.

How Long Does the Evra Patch Take to Work?

Evra patches start working immediately to prevent pregnancy if you start using them on day 1 of your period (when you experience your first bleed that month). Should you decide to begin on any other day, it’s recommended to speak to a clinician about temporarily using additional non-hormonal forms of contraception.

How to Use Evra Patches

Evra patches are applied to the skin each week for 3 weeks, followed by a patch-free week, during which you should get a withdrawal bleed similar to a period.

To apply the patch, you should:

1. Open the foil sachet by tearing along the edge.
2. Firmly grasp a corner of the patch and gently remove it from the foil sachet.
3. Peel away half of the clear protective covering on the patch, being careful not to touch the sticky surface.
4. Apply the patch to your skin.
5. Remove the other half of the protective covering.
6. Press down firmly on the patch with the palm of your hand for 10 seconds, making sure all the edges are stuck well to your skin.

When to Change Evra Patches

Evra patches should be worn for exactly 7 days before being removed and replaced with a new one. Repeat this process for a further 2 weeks until you reach day 21. From days 22 to 28, do not wear a patch. You should experience a withdrawal bleed at this time.

Once the patch-free week has ended (on day 29), apply a new patch and continue the process. You should do this even if you are still bleeding. It’s important to rotate your application site every week to avoid skin irritation.

Where to Put Evra Patches

Evra patches should be applied to a clean, dry, hair-free area of the skin that is not rubbed by tight clothing, and never on your breasts. Suitable areas are:

• Buttock
• Abdomen
• Upper outer arm
• Upper back

You should apply the patch exactly as instructed by a clinician.

While wearing an Evra contraceptive patch, you can shower, exercise, and swim as normal without the patch coming off. You should check that the patch is still in place after participating in any of these activities.

When Can I Start the Evra Patch?

It’s recommended to start using Evra transdermal patches on day 1 of your period (when you first notice a bleed), as this will ensure you are protected from pregnancy immediately. If you begin on any other day, speak to your clinician about temporarily using a non-hormonal form of contraception (such as condoms).

How to Switch to the Evra Patch From a Contraceptive Pill

If you switch to Evra from a combined contraceptive pill, you should:

• Wait until you get your period.
• Apply your first Evra patch during the first 24 hours of your period.
• If you apply it after day 1, use condoms until day 8 when you change your patch.

If you switch from a progestogen-only or mini pill to Evra, you should:

• Apply your first patch any day after stopping the mini pill.
• Use condoms until day 8, when you change the patch.

Extended Use of Evra Patches

Evra patches can also be applied for extended use to delay your period. If you use it in this manner, you will wear an Evra patch for 9 weeks, followed by a patch-free break of 4 or 7 days. However, this is called a tailored regimen and considered off-label use because it does not follow the prescribed patch instructions.

If you’re thinking about using Evra patches in this way, you should consult your clinician before commencing treatment. Other medications are available to delay your period.

What to Do if Your Evra Patch Falls Off

Should the patch become loose, lift at the edges or fall off, you should not try to re-stick it with tape. If it does come away completely, your next course of action depends on how long it has been missing.

• Less than 24 hours: Try to reapply the patch where possible. If it is no longer sticky, has stuck to itself or another surface, or it’s the second time it has become loose or fallen off, apply a new one immediately. You should not need to use any other forms of contraception, and your patch change day should be the same.
• More than 24 hours: Start a new four-week cycle straight away by putting on a new patch. You will now have a new day 1 and a new patch change day. As a precaution, you will need to use a barrier method of contraception, such as condoms, for the first week of your new cycle.

What Happens if I Forget to Change My Evra Patch?

If you forget to change your patch:

At the start of a patch cycle (day 1)

• Apply the first patch of your new cycle as soon as you remember. You will have a new “Patch Change Day”.
• Use a non-hormonal contraceptive, like condoms, for 7 days.

In the middle of your patch cycle (week 2 or 3) and up to 48 hours late

• Apply a new patch as soon as you remember.
• Put your next patch on your normal “Patch Change Day”.
• You do not need to use extra contraception.

In the middle of your patch cycle (week 2 or 3) and 48 hours or more late

• You must start a new 4-week cycle by putting on a new patch. You will now have a new “Patch Change Day” and a new day 1.
• You will need to use an extra contraception method, like condoms, for 7 days.
• Contact your clinician if you think you may be pregnant; they may recommend emergency contraception.

At the end of your patch cycle (week 4)
If you forget to remove your patch:

• Remove the patch as soon as you remember.
• Start your next cycle on your normal “Patch Change Day”, the day after day 28.

How to Stop Using Evra Patches

You can stop using the Evra patch whenever you want, with no need to “wean” yourself off it. Some people have reported experiencing irregular or little-to-no menstrual bleeding when ceasing treatment. This is particularly the case within the first 3 months of stopping, or if their periods were irregular before starting Evra.

What is the Difference Between Evra Patches and the Combined Contraceptive Pill?

How Effective is the Evra Patch?

If the Evra patch is used correctly, it is more than 99% effective at preventing pregnancy.  However, with typical use, such as forgetting to change the patch, it is closer to 91% effective, meaning 9 out of 100 people will get pregnant each year using the Evra patch.

Compliance with the method of contraception can play a key role in its efficacy. One study found that people were more likely to comply with the contraceptive patch than the combined pill.

Evra Patch Side Effects and Cautions

Although the Evra transdermal patch is considered safe and well-tolerated, side effects or other adverse reactions can still occur. Having a clear understanding of what you may experience is crucial before commencing treatment, so we recommend familiarising yourself accordingly. If you have any questions, our specialist clinicians are happy to help.

Side Effects of Evra Patches

Like any medication, the Evra patch can have potential side effects, although not everyone experiences them. Possible Evra patch side effects include:

Please note that this is not a complete list of potential Evra patch side effects. More details can be found within the Patient Information Leaflet that comes with the medication.

You should discuss any concerns about side effects with a healthcare provider. Alternatively, you can report any Evra side effects to the Medicine and Healthcare products Regulatory Agency’s (MHRA) Yellow Card Scheme.

Can the Evra Patch Cause Blood Clots?

Like all combined contraception methods, there is a slightly increased risk of developing a blood clot when using Evra. This risk may be higher than with some combined pills.

Potential signs of a blood clot include:

• Severe headaches
• Coughing up blood
• A sudden numbness or weakness, especially down one side
• Chest pain, pressure, or discomfort
• Swelling in one leg
• Rapid breathing or unexplained breathlessness

The table below outlines the possible risks of developing a blood clot when using combined contraception:

It’s important to note that the overall risk of a blood clot occurring while administering the Evra patch is still low, although it is at its highest when in the first year of treatment or if you’re restarting combined contraception after a break of 4 weeks or more. The risk also increases if you:

• Are overweight
• Have an immediate family member who has had a blood clot in their leg, lung, or other organ
• Need an operation and are going to be off your feet for a while
• Are over 35
• Gave birth less than 3 weeks ago

When you stop using Evra transdermal patches, your risk of a blood clot returns to normal within a few weeks. If you have any concerns, please speak to your clinicians before starting the medication.

Evra Patches and Breast Cancer

While breast cancer has been discovered in more women who take combined contraceptives such as Evra patches, it is unknown whether this is caused by the treatments themselves or because individuals using the medication are examined more often, so there is a better chance of the condition being spotted.

After stopping combined contraceptives for 10 years, the additional risk of developing breast cancer will be the same as that of people who have never taken the medications.

Who Can Use Evra Patches?

Evra patches are intended for people aged 18 to 45, but may not be suitable for everyone. You should not use Evra contraceptive patches if you:

• Have or have had a blood clot in a blood vessel
• Have a blood-clotting disorder
• Need an operation or will be off your feet for a while
• Have had a heart attack, stroke, or angina
• Have had a migraine with an aura
• Are allergic to any of the ingredients in an Evra patch
• Have or have been told you might have breast, womb, cervical or vaginal cancer
• Know your liver does not function properly
• Have vaginal bleeding and do not know why

Before using Evra patches, you should let a clinician know if you are:

• Pregnant or think you might be
• Are over 35 years old and smoke
• Very overweight
• Breastfeeding
• Taking any other medications – prescribed, over-the-counter or herbal

The Evra patch may be less effective for people who weigh over 90 kg. It is important you let your clinician know if you are more than 90 kg, as they may suggest an alternative method of contraception.

While most combined oral contraceptives contain lactose, Evra transdermal patches do not. This may make the treatment more suitable for people with certain sugar intolerances. Always consult a clinician before starting a new treatment.

Evra Patches and Other Medications

Before using the Evra patch, you should tell the clinician if you are taking any other prescribed, over-the-counter, or herbal medicines.

Do not use Evra if you have hepatitis C and are taking any medicines that contain:

• Dasabuvir
• Glecaprevir
• Ombitasvir
• Paritaprevir
• Pibrentasvir
• Ritonavir
• Sofosbuvir
• Velpatasvir
• Voxilaprevir

Some medicines can also stop Evra patches from working properly. These include:

• Antiretroviral medicines used to treat HIV or hepatitis C
• Griseofulvin or rifampicin
• Anti-seizure medications (barbiturates, topiramate, phenytoin, carbamazepine, primidone, oxcarbazepine, and felbamate)
• Bosentan
• St. John’s Wort

Evra can also make these medications less effective:

• Ciclosporin
• Lamotrigine

Most antibiotics are considered safe to use with Evra transdermal patches and will not interfere with their effectiveness. The main exceptions to this rule are rifampicin and rifabutin, which impact enzymes in the liver.

Pregnancy and Breastfeeding

Evra patches should not be used if you are or think you may be pregnant. If you fall pregnant while using the medication, stop it straight away and speak to a clinician. You should also seek medical advice if you’re planning to have a baby before commencing treatment.

Do not use Evra patches if you are currently breastfeeding or plan to do so. If you are considering contraception while breastfeeding, speak to a clinician or midwife about suitable options.

Frequently Asked Questions About Evra Patches