Let’s Talk Contraception: Contraceptive Patches

Ortho EvraIs there a topical birth control available, you ask? No contraceptive cream or ointment has been developed yet, but yes, there is a patch that can be applied to your skin that is almost 99 percent effective at preventing pregnancy.


Patches are easy to use, discreet, and provide excellent birth control.


It’s called a transdermal patch and there is only one available by prescription in the United States. The Ortho Evra patch (or the generic version, called Xulane) is a small, sticky plastic patch that you apply to your skin: one patch each week for three weeks and then no patch for one week before you start the cycle again. While you wear a patch, it releases both a progesterone hormone, norelgestromin, and an estrogen hormone, ethinyl estradiol. This hormone combination is absorbed through your skin and enters your bloodstream to prevent pregnancy, much like oral birth control pills. It is discreet and can be worn comfortably and confidently during bathing, showering, swimming, and exercising without fear of its falling off. As a matter of fact, the patch has been rigorously tested in many situations, and these studies have shown that when applied properly, the patch loosens or falls off less than 2 percent of the time.

Contraceptive patches come in boxes of three for each month. To use a patch, you open a packet and apply one patch to clean, dry, intact (not irritated or injured) skin. It is recommended to apply it to areas on the buttocks, abdomen, upper torso but not breasts, or outer part of upper arm. It should not be applied to areas where it could be rubbed off, such as under a bra strap. Most users apply the patch the first day of their period or the Sunday after the start of their period. When you initially start using the patch, you will need to use a back-up contraceptive method such as a condom for the first seven days. If you are switching to the patch from birth control pills or the vaginal ring, you apply your first patch on the day you would usually start your next pill pack of pills or insert your next vaginal ring. In that case you do not need to use a back-up method of birth control.

After wearing the patch one week, you remove it on the same day as you first applied it and put a new patch on a different area of skin. This patch is worn the second week, then it is removed on the same day the next week and the third patch is applied. The next week that patch is removed and you remain patch-free for the week, when you usually have your period. After the free week, you apply your new cycle of patches on the same day to start the next three weeks on, one week off cycle. It’s important to change and apply the patches on the same day each week for continuous contraceptive coverage. Of course these contraceptive patches do not protect you from sexually transmitted diseases or HIV.

You should check to see that your patch is in place on a daily basis. If a patch does loosen or fall off, and if it has been less than 24 hours and the patch is still sticky, you can just reapply it in the same place or put on a new patch. If the patch has been off for more than 24 hours or you’re not sure, you must use a new patch, and then this will be the day that you count as the first day of a new week. You must also use a back-up contraceptive method for the next seven days. If you need to use a new patch and find that you need an extra patch for that month, replacement patches are available at a pharmacy by prescription from your health care provider.

Contraceptive patches are easy to use, discreet, and provide excellent birth control. They do not interfere with sexual intercourse and allow spontaneity in sexual relationships. They are 92 to 99 percent effective when used properly. Decreased effectiveness is usually due to a patch falling off and not being replaced, forgetting to change the patch on time, or using a previously opened packet or one that was not stored at room temperature. There is concern that patches may not work as well in overweight users. Once you decide to remove the patch or stop using it, your fertility quickly returns to normal.

Because the hormones in the patch are absorbed through your skin, more of the hormones are available to get in your bloodstream, and this may cause side effects especially related to higher levels of  the estrogen hormone circulating in your system. Side effects that may go away with time include headaches, spotting, mood changes such as depression, or irritated skin. But some side effects can increase your risk for more serious events, such as blood clots in legs and lungs, heart attacks, or strokes. Because of this, the FDA has included a warning for the patch that recommends women over 35 who smoke should not use this type of birth control. Also, if you smoke, or have a history of high blood pressure, heart attacks or strokes, liver disease, or breast cancer, you should not use the patch. A good medical history and check-up, including blood pressure, with your health care provider is important before you start using the patch.

Prices for Ortho Evra or Xulane may be slightly higher or comparable to birth control pills, and could be covered by your insurance or Medicaid. If you are interested in a convenient, easily reversible birth control that does not include taking a daily pill, talk to your health care provider or Planned Parenthood about the contraceptive patch.


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15 thoughts on “Let’s Talk Contraception: Contraceptive Patches

    • Hi Brett! Some other countries might have hormonal birth control (HBC) available over the counter, but in the United States, HBC, including the contraceptive patch, is only dispensed with a prescription.

  1. So when used consecutively for 3 weeks, are you still protected during your “patch free” week? Then when you put the patch back on after the “patch free” week are you still protected, or do you have to wait for 7 days again?

    • The first time you use the patches, you need time for the medication to enter your system to provide protection, hence the 7 days (or more). After that, If you use the patch as directed, applying one patch each week and then no patch for one week, then applying a new patch after the patch free week and continuing on, 3 weeks with a patch on and one week patch free, you are protected. It’s just like birth control pills, 3 weeks of active pills, then. One week of placebo pills, when you usually have your period. But be sure to read all the directions and follow them exactly if a patch loosens or falls off for awhile etc.

  2. I just had a baby in June and started the patch back up in August… My husband an I have had unprotected sex during week one/patch one…but then two days later I was due to change to my week2/patch 2 of birth control… could I still get pregnant during that two day span?

  3. I’ve had the patch on to avoid getting my period. Just 2 weeks ago I started “breakthrough” bleeding while on the patch? I took it off on a day I normally change it but I didn’t put a new one on yet. Does this count as the free week? Ive changed it every week for the past 6 months without taking 4th week off each month. I started bleeding even more during the week I actually had it off after bleeding/spotting. It’s been 2 weeks and I’m still bleeding. So my first question is am I protected during the week I finally took it off (after 6 months of continuous use) and my second question is- is it normal that I had more bleeding once I took off the patch because I was bleeding while on the patch but now I’m bleeding without it.

    • The author of this article isn’t comfortable dispensing medical advice over the Internet, so the best course of action might be to talk to a health care provider in person. Breakthrough bleeding can be a common side effect when using birth control continuously. Also, when you go a week without the patch (or pill or ring … depending on the type of birth control you are using), it is expected to go into withdrawal bleeding as if you were having a period.

  4. I love the Xulane (patch) because in simple words it is easy to use. BUT! it does NOT stay in place all the time. What I mean by this is the following; If you plan to go to the beach and enjoy the water… not such a good idea. This also applies to pools, and showers. Further more, I and many women (as I’ve been reading reviews) have been dealing with a nasty rash where the patch has been place. It is itchy and when the patch comes off… well… it’s kinda disgusting, for there will probably be red pumps all over where the patch was placed and of course dry skin after. However, I still prefer Xulane over other contraceptives. In conclusion, it is really up to you if you are willing to deal with the caveats of Xulane.

  5. So as soon as i already pass the seven days process, and I’ve used the patch for over a year now and i love it. But i want to know when i take off my old patch and put a new one on right away can you still have unprotected sex that same day with the new patch ? Or do you have to wait.

    • Hi Ayala, I am not a doctor and cannot provide medical advice – for specific questions about your patch, it’s best to contact your health care provider, or call Planned Parenthood at 602-277-7526 to schedule a consult.

      There is great info about the patch on our website: https://www.plannedparenthood.org/learn/birth-control/birth-control-patch-ortho-evra. It also provides instructions what to do if you forget to put on your patch. If I understand your question correctly, if you change your patch and put on your new patch right away, you should be protected against pregnancy. But, the patch does not protect against STD transmission, so it’s always a good idea to use condoms as well.

  6. On my off week can i put the patch on and not get my period. I have an important event and would rather not be on my period.

    • Hi Ava! Good question. Yes, using the patches back to back without skipping a week will allow you to delay your period. It is possible you’ll experience breakthrough bleeding, but every user is different. You can read more about continuous contraception here.

  7. My patch fell off on Tuesday and I realized my patch loose on Wednesday. My patch change day should be Saturday, I quickly re-apply a new patch on Wednesday afternoon but I replaced in different place on my body. I changed a new one again on Saturday because is my schedule change patch dated. My period come on time as always every month of 20th, but this month period came three day After the replacement. Period continuously bleeding red and I changed a new patch occur on my schedule on Saturday. Question, when my period will be stop and am I not doing right when replace a new patch? What should I do now? Thank You!!!

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