Contraception: Combined contraceptive patch

The patch stops the ovaries from releasing an egg each month (ovulation).

It also:

• thickens the mucus in the cervix (neck of the womb); this makes it harder for sperm to move through it and reach an egg
• makes the lining of the uterus (womb) thinner so it is less likely for a fertilised egg to be able to implant into the womb and create a pregnancy.

If the combined patch is always used perfectly, according to instructions, it’s over 99% effective.

This means that less than one in 100 women who use the combined patch will get pregnant in one year.

If the combined patch is not always used according to instructions, about nine in 100 patch users will get pregnant in one year.

If you’re healthy, don’t smoke and there are no medical reasons for you not to take the combined contraceptive patch you can use it until you’re 50 years old.

However not everyone can use the combined patch.

The combined patch might not be suitable if:

• you smoke and are 35 years old or over
• you’re 35 years old or over and stopped smoking less than a year ago
• you’re very overweight
• you take certain medicines
• you’re breastfeeding a baby less than six weeks old

The combined patch might not be suitable for you if you have now or had in the past:

• Thrombosis (blood clots) in any vein or artery or a member of your immediate family had thrombosis when they were younger than 46 years old
• Heart disease or a stroke
• Systemic lupus erythematosus with positive antiphospholipid antibodies
• Hypertension (raised blood pressure)
• Migraine with aura
• Breast cancer or you have the gene that’s associated with breast cancer
• Liver or gall bladder disease
• Diabetes with complications
• You’re immobile for a long period of time or use a wheelchair
• You’re at high altitude (more than 4,500m) for more than a week.

Some of the advantages of the patch are:

• it usually makes your bleeds regular, lighter and less painful
• it gives you the choice not to have a monthly bleed
• it may reduce symptoms of PMS (premenstrual syndrome)
• it can sometimes improve acne
• it may reduce symptoms of endometriosis
• it may help with symptoms associated with polycystic ovarian syndrome (PCOS).
• it reduces the risk of cancer of the ovary, uterus, and colon.

There are some serious possible side effects (see risks).

In addition: 

• you may get temporary side effects at first including headaches, nausea, breast tenderness and mood changes
• you might get some skin irritation at the site of the patch; applying the patch to clean dry skin and rotating the site of the patch might reduce this problem
• the patch may increase your blood pressure
• the patch doesn’t protect you from sexually transmitted infections, so you may want to use condoms as well
• breakthrough bleeding (unexpected vaginal bleeding on patch taking days) and spotting is common in the first few months of using the patch.

There are some risks associated with using the combined patch. These include:

Blood clots

The combined contraceptive patch increases the risk of:

• Deep vein thrombosis (blood clot in the leg)
• Pulmonary embolus (blood clot in the lung)
• Stroke
• Heart attack

These risks are very small. Your doctor or nurse will ask you questions to check whether you could be at higher risk of these conditions before deciding if it is suitable to prescribe you the patch.

Cancer

Research suggests that combined contraceptive patch users appear to have a small increased risk of being diagnosed with breast cancer compared to non-users of hormonal contraception. This risk reduces with time after stopping the patch and is undetectable ten years after stopping.

Research suggests there’s a small increase in the risk of developing cervical cancer with longer use of the combined patch. This reduces over time after stopping the patch.

You must see a doctor straight away if you have any of the following:

• pain in the chest, including any sharp pain which is worse when you breathe in, breathlessness, or coughing up blood
• painful swelling in your leg(s)
• weakness, numbness, or bad ‘pins and needles’ in an arm or leg
• unusual headaches or migraines that are worse than usual
• sudden problems with your speech or eyesight

If you develop any new conditions, tell your doctor or nurse so they can check it’s still safe for you to use the patch.

If you go into hospital for an operation or have an accident which affects the movement of your legs, tell the doctor you’re taking the combined patch. You may need to stop using the patch or need other treatment to reduce the risk of developing thrombosis. There are other contraceptive methods you can use instead.

You can normally start taking the combined contraceptive patch at any point in your menstrual cycle.

There is special guidance if you have just had a baby, abortion or miscarriage.

You can start the patch any time in your menstrual cycle if you’re sure you’re not pregnant.

If you start the patch:

• On the first day of your period, you’ll be protected from pregnancy immediately.
• Up to, and including, the fifth day of your period, you’ll be protected from pregnancy immediately.
• At any other time in your menstrual cycle, you’ll need to avoid sex or use additional contraception, such as condoms, for the first seven days of using the patch.

If you have a short menstrual cycle with your period coming every 23 days or less, starting the patch as late as the fifth day of your period may not give you immediate contraceptive protection. This is because you may ovulate (release an egg) early in your menstrual cycle. You may wish to talk to your doctor or nurse about this and whether you need additional contraception for the first seven days.

If you start the patch after having had unprotected sex or after taking emergency contraception please do a pregnancy test three weeks after the last time you had unprotected sex.

The combined patch is designed to give you a withdrawal bleed once a month. A withdrawal bleed isn’t the same as your period. It’s caused by you not taking hormones during a patch-free break.

Most instructions tell you to take a seven-day patch-free break but you can choose to shorten this break, or to miss it and not have a withdrawal bleed.

Missing or shortening the break could help you if you get heavy or painful bleeding, headaches, or mood swings on patch-free days. It may also increase how effective the patch is as a contraception.

• One patch per week for 21 days then no patch for the next four or seven days (21/4 or 21/7). This is the standard way to use the patch. You’ll usually have a withdrawal bleed during the patch-free break. Start using the patch again on the fifth or eighth day even if you’re still bleeding.
• One patch per week for nine weeks (three packs of patches) then no patch for the next four or seven days (63/4 or 63/7). This is called extended use or tricycling. You’ll usually have a withdrawal bleed during the patch-free break. Start using the patch again on the fifth or eighth day even if you’re still bleeding.
• One patch per week with no break. This is called continuous patch use. You won’t have a withdrawal bleed but you may still get some breakthrough bleeding (unexpected vaginal bleeding on days that the patch is being used), which may be occasional or more frequent. Any bleeding you get is likely to reduce over time if you keep using the patch continuously.
• One patch per week for at least 21 days. If you get breakthrough bleeding (unexpected vaginal bleeding on days that the patch is being used) that’s unacceptable to you for three-four days, then remove your patch for four days. This is called flexible extended use. Apply a new patch on the fifth day, even if you’re still bleeding. This can help manage the bleeding. Use one patch per week for at least 21 days before taking your next break.

If you're late applying a new patch after a patch-free break, if the patch comes off when it's not a patch-free break if you've kept a patch on for too long, follow the instructions below:

Restarting after a patch free break

If it's less than eight full days since you removed your last patch:

• apply a new patch now
• continue using the patch as normal

If it's eight or more full days since you removed your last patch:

• apply a new patch now
• keep the new patch on until the day you usually change it
• use condoms or avoid sex for the next seven days
• You may need emergency contraception and a follow-up pregnancy test if you had unprotected sex in or after the patch-free break. Talk to a doctor, nurse or pharmacist as soon as possible.

Up to 48 hours since the patch came off OR patch left on for up to 48 hours too long

• Apply a new patch as soon as possible
• Keep the new patch on until the day you usually change it.

If you’re in the first week after a patch-free break, you don’t need additional or emergency contraception, as long as you’ve used the patch correctly every day so far this week and in the week before the patch-free break.

If you’re in any other week, you don’t need additional emergency contraception as long as you've used the patch correctly for the previous seven days.

48 hours or more since the patch came off or patch left on for 48 hours or more too long

• Apply a new patch as soon as possible
• Keep the new patch on until the day you usually change it
• Use condoms or avoid sex until a patch has been worn for seven days in a row
• If you are due to start a patch-free break in the next seven days, don't take the break.

You might need emergency contraception now and a pregnancy test in three weeks if:

• you’re in the first week after a patch-free break and
• you had unprotected sex this week or during the patch-free break.

If you’re in any other week, you don’t need emergency contraception as long as you’ve used the patch correctly for the previous seven days.

Some medicines may make the combined patch less effective. These include some of the medicines used to treat HIV, epilepsy and tuberculosis (TB), and the complementary medicine St John’s Wort. These are called enzyme-inducing drugs. If you take these medicines, it’ll be recommended that you change to a different method of contraception or that you use additional contraception, such as condoms.

Always tell your healthcare professional that you’re using the combined patch if you’re prescribed any medicines.