How does the birth control patch work?

What is the birth control patch?

The birth control patch is a type of hormonal contraception. You put a sticky patch onto your skin for a week before taking it off and applying a new one. The patch slowly releases the same kind of hormones you’d find in the contraceptive pill, but through your skin. The medication gets into your body in a similar way to other kinds of patches, like nicotine replacement patches and hormone replacement therapy (HRT) patches.

Are you missing out on a great contraceptive for you?

Only around 5% of people using contraception in the US aged 15-49 choose methods such as birth control patches, injectables or vaginal rings – this is despite some evidence suggesting that women who use the patch find it easier to fit into their routine than those using the pill. “If you find it tough to remember a daily pill, but you want a contraceptive with very similar effectiveness, the patch is worth considering,” says Dr Ann Nainan, Healthily expert.

How does the birth control patch work?

The patch releases a daily dose of hormones (estrogen and progestin) through your skin into your bloodstream to prevent pregnant. It works by:

• stopping you from releasing an egg each month
• making your cervical mucus thicker – which means it’s trickier for sperm to get into your uterus
• making the lining of your uterus thinner – which makes it harder for a fertilized egg to settle there and develop into a pregnancy

How effective is the birth control patch?

“The patch is as effective as combined oral contraceptives(COCs) at preventing pregnancy,” says Dr Ann.

• it’s around 91% effective with typical use – that is, for the average woman who sometimes forgets it or finds that other issues get in the way of using it as advised. That means about 9 in 100 women will become pregnant in the first year of using it
• if you use the patch consistently and correctly every time, its effectiveness goes up to 99.7 % – that means that fewer than 1 in 100 women will become pregnant in the first year of using it
• its effectiveness might be reduced if you weigh 90 kg or more, or if you have an increased body mass index (BMI)

How to use the birth control patch correctly

“In each month you have 3 weeks when you wear a patch and 1 week when you don’t wear a patch,” says Dr Ann. “This break allows your body to have a ‘withdrawal bleed’ which is similar to a period.”

Your doctor will prescribe the patches and explain how and when to start taking them. This will depend on:

• the type of patch you’re using
• the length of your menstrual cycle
• any other contraception you’re using (if any)
• whether you’ve just taken emergency contraception

Always read the leaflet that comes with your patches and speak to your doctor if you’re not sure how to use them.

Here’s the routine you’ll usually follow:

• when you apply your first patch, this counts as day 1 of your patch cycle
• you wear this patch for 1 week, then you change it for a new patch
• use a new patch every week for 3 weeks until you reach your patch-free week when you don’t wear a patch
• once your patch-free week has ended, it’s important that you apply a new patch even if you’re still having your withdrawal bleed or if you haven’t bled, as this starts your new patch cycle
• always try to stick each new patch onto a different area of skin to avoid the skin in 1 area becoming irritated – don’t stick the patch to your breasts

What’s the difference between types of birth control patches?

“There are two brands of birth control patches available in the US – the Xulane patch and the Twirla patch,” says Dr Ann. “In the UK, the patch's brand name is Ortho Evra.”

• all patches work in the same way in your body
• you wear the Evra, Xulane or Twirla patches on your belly, butt, or upper back, and you can also wear the Xulane and Evra patches on your upper outer arm

What are the benefits of the birth control patch?

There are many advantages to using the contraceptive patch.

Lifestyle pros

• you put a patch on once a week, so it can be more convenient than remembering to take a pill every day
• it doesn’t interfere with sex so you can enjoy yourself and not have to worry about contraception
• it can make your periods regular and easy to predict
• if you’re using Xulane or Evra patches and you don’t want to have a bleed in a particular month, you can keep using the patches instead of having a patch-free week. Speak to your doctor for advice and to discuss if this is suitable for you

Health pros

• Unlike the contraceptive pill which works by being absorbed through your gut, the patch doesn’t become less effective if you vomit or have diarrhea because it’s your skin that’s absorbing the hormones
• the hormones in patches can also help with period pain and make your periods less heavy
• the patch may also help lessen or prevent conditions such as acne, ectopic pregnancy, plus ovarian cancer or cancer of the uterus. Talk to your doctor about what the benefits might be for you

What do women say about the benefits?

In a review of studies comparing birth control methods, women using the patch said they used it more consistently than women using the daily pill.

What do other women say?

• Miriam, 26, from Texas, US, has used the patch for years. She tells HealthCentral: “I have to remember to change the patch every week, but I don’t have to think about it every day. I can still go swimming, play sports, etc. And if I’m vomiting or have diarrhea… it still works, unlike the birth control pill.”
• Aliyah Tianna says on YouTube: “I personally have never had any problems when I’m sweaty or in the water…I think within the 5 years that I’ve been using it, it’s come off maybe 2 or 3 times and I can usually catch it.”
• YouTuber JC Couch says: “With the patch, I love it so much. It is very convenient and effective for me…I don’t have tiredness, depression or mood changes.”

What are the disadvantages of the birth control patch?

There can be disadvantages to using the patch that can put some women off using it.

Lifestyle cons

• other people can see it and some women prefer to keep their choice of contraception private

Effectiveness cons

• it may come off your skin or only be partly attached to your skin and so be less effective
• although you can have a hot tub, sauna, bath or shower when wearing a birth control patch and it shouldn’t come off, staying in the water for 30 mins can make it more likely the Twirla will come loose
• it doesn’t work as well if you weigh more than 90 kg

Health cons

• after stopping using the patch it may take a few months for your periods to return to normal (although you can become pregnant straight away after stopping them)
• it doesn’t protect you against sexually transmitted infections (STIs), so you may need to use condoms, too
• some medicines may make the patch less effective at preventing you from getting pregnant. These include some medicines used to treat HIV, epilepsy and some antibiotics such as rifampicin. Complementary medicines such as St John’s Wort may also affect the patch. Always check with your doctor and let them know about any medicines you’re taking
• you have to remember to change it regularly. If you find this hard, you might prefer to use a long-term birth control method like a copper intrauterine device (IUD) or contraceptive implant

Birth control patch side effects explained

Most of the time, the patch doesn’t lead to any serious side effects but it can occasionally cause:

• breast discomfort – studies have shown this can happen in around 1 in 5 people (which means that it doesn’t happen for 4 in 5 people). It usually improves over time
• irregular bleeding – about 1 in 5 people experience this when they first start using the patch. It usually settles down after the first 3 months. Do let your doctor know if you have any irregular bleeding.
• nausea
• headache
• skin irritation – just under 2% of people in 1 study gave up the patch because they got a reaction around the site of the patch. Try applying it to a different part of your body when you’re changing it
• mood changes

Birth control patch risks explained

• blood clots – when you use the birth control patch, it may increase your risk of developing a [blood clot](/sexual-health/how-does-the-birth-control-patch-work/#Who can’t use the patch) in a vein or artery. The risk is up to 6 times greater than for people who don’t use hormonal contraception – but the overall risk is still very low for most people. There’s some evidence that this risk might be higher with the patch than with other types of contraception containing the same hormones, such as the combined contraceptive pill – but other studies haven’t found this

• breast and cervical cancers – there’s a small increased risk of being diagnosed with breast or cervical cancer when using the patch. This risk reduces with time after you’ve stopped using the patch

Your doctor will examine you, and talk to you about your health and your family history, to make sure the patch is safe for you.

What do women say about the disadvantages?

• “Overall, it’s a great birth control method to try despite some itchiness sometimes from where the patch is located,” says LetsHangOut on YouTube channel The Lady’s Guide
• “I did kind of get mood swings, though, I was just a bit more angry and sad…but after a while it did balance out,” says Sasha from the YouTube channel, SashaArella
• Jalisa May comments on the HoneyLea Birth Control YouTube series: “I had the patch it does what it's supposed to do but my experience was not so good. I had severe mood swings… ugh it was horrible”
• Crystal Rose comments on the HoneyLea Birth Control YouTube series: “The patch has been by far my favorite. For the first 3 months I had a headache every now and then, and I did have spotting”

Who can’t use the patch?

“Although the patch is simple to use and very effective, it isn't suitable for everyone,” says Dr Ann. Your doctor or nurse will ask you questions about your health and any medicines you may be taking to see if it’s the right choice for you. You may not be able to use the patch if:

• you're pregnant
• you're breastfeeding a baby less than 6 weeks old
• you're very overweight
• you smoke and are age 35 or over, or you're 35 or over and stopped smoking less than a year ago
• you're taking medicines to treat tuberculosis (TB), HIV or epilepsy

You might also not be able to use the patch if you have or have had:

• blood clots in an artery or vein, or someone in your immediate family (such as your parent, brother or sister) had a blood clot before they were 45. Some medical conditions such as systemic lupus erythematosus (SLE) that can increase your chances of having a blood clot
• a heart problem or high blood pressure
• breast cancer or if you have any genetic mutations, such as BRCA1/2, that increase your risk for breast cancer
• migraines
• liver disease

How to maximize your birth control patch effectiveness

If you use your birth control patch in the right way, the more effective it is.

Tips for remembering to change your patch

“These ideas can help you to get into a new routine,” says Dr Ann.

• see if your healthcare provider or patch brand offers a reminder service and if they do, sign up for it
• set a weekly alarm reminder on your phone – and block out a calendar appointment to make sure you have time planned in to apply your new patch
• make a note on your calendar when you need to change your patch
• ask your partner to remind you to change your patch – they could use a phone reminder, too
• keep your patches in a place where you’ll see them regularly, like your bedside table or next to your toothbrush. Don’t keep them in the fridge or freezer and keep them away from direct sunlight

Reduce the chance of your patch falling off

“Check your patch every day to make sure it’s still stuck properly to your skin and not coming loose,” says Dr Ann.

• stick your patch to an area of your body that’s clean, dry and free of hair – avoid skin where there is any type of lotion or make-up
• don’t stick it to an area that has a wound
• avoid putting your patch on where it can be rubbed by clothes such as underwear or the waistband of your pants

What should I do if a patch falls off or I forget to take my patch off?

It depends on the patch you’re using and where you are in your patch cycle – so it’s best to read the leaflet that comes with your patches. Your doctor will give you information on what you need to do if your patch falls off, partially falls off or if you forget to take it off. Always check with your doctor as soon as possible if you’re not sure what to do.

If you think you might be pregnant, or there was a window of time you weren’t protected by your patch, do a pregnancy test.

How to change from a patch to another type of contraception

The advice varies on where you are in your patch cycle and which patch you’re using. It’s best to discuss this with your doctor.

How to get the patch

You’ll need to get a prescription to get the birth control patch.

• in the US – you can get a prescription from your doctor or nurse at your doctor’s office, health clinic or, in some places, you can get a prescription directly from your pharmacist. You may be able to get your birth control patches during your appointment or straight afterwards at a drugstore or pharmacy. Each pack has 3 patches and it lasts for 1 month (or 3 weeks, if you’re using Xulane or Evra patches and choose to use the patch to skip your withdrawal bleed).

With most US health insurance plans the birth control patch is free, or you may qualify for programs such as Medicare that pay for your birth control. With the Affordable Care Act, many insurance plans now cover all methods of birth control, including the contraceptive patch, at little or no cost to you

• in the UK – you can get contraception including the patch for free, including if you’re under 16, from your local contraception clinic, sexual health or GUM (genitourinary medicine) clinic, and some GP surgeries. After you’ve used the patch for 3 months your doctor or nurse will arrange a follow-up appointment and if all is working well and you’re happy to keep using the patch, you’ll have a check-up appointment every year after that

When to see a doctor

See a doctor or healthcare professional if you’re thinking about starting the birth control patch or you want to talk about other contraception options.

See a doctor urgently if you:

• have, or you find out you have, any of the conditions that mean the birth control patch isn’t suitable for you
• forget to change your patch or your patch falls off or is starting to fall off
• feel that your patch is starting to affect your mood
• get any vaginal spotting, vaginal bleeding between your periods or bleeding after sex
• have any headaches
• notice a lump in your breast, any nipple changes or skin changes around your nipples, or any lumps in your armpit

Go to the emergency department if you have any of the following:

• sudden back or jaw pain along with nausea, sweating, or coughing up blood
• chest pain or discomfort
• unexplained pain in your leg
• difficulty breathing
• a sudden, very bad headache, or headaches that are different, worse, or happen more often than usual
• drooping of one side of your face
• weakness or numbness in your arm or leg
• sudden problems with speech or eyesight
• yellowing of your skin or eyes
• severe pain in your belly or stomach or you’re vomiting

Your health question answered

How long can I use the patch for?

You can keep using the birth control patch up until you’re 50 years old. After that, you should switch to a non-hormonal method such as the copper IUD, or the mini pill or birth control implant. Your doctor can discuss these options with you.