Evra

How does Evra work?

Evra works in a similar way to the combined pill. It contains norelgestromin and ethinylestradiol which are synthetic versions of the hormones progesterone and estrogen. These hormones are released into the bloodstream to prevent ovulation from occurring each month, overriding your natural menstrual cycle. They also work by thinning the womb lining and thickening the cervical mucus to make it difficult for sperm to enter. 

How effective is Evra?

Evra is more than 99% effective when it's used correctly. Factors which can affect it include forgetting to change the patch on time or starting a new one too late after your 7 day break. It has the advantage over the pill of not being affected by vomiting and diarrhoea and you don't need to remember to take it everyday. 

When does Evra start to work?

If you apply the patch within 24 hours of getting your period then it will start to work straight away. You can apply it after the first day of your period but you won't be fully protected against pregnancy for the first 7 days. In this case, you will need to use a condom or diaphragm during this time period. 

Evra for non-contraceptive purposes

While Evra is used primarily for preventing pregnancy, it also has the advantage of making your periods lighter, regular and less painful, alleviating the symptoms of PMS. This may also provide relief for women with endometriosis. 

How long does Evra last?

Each contraceptive patch lasts for one week. After each week, you remove the patch and apply a new one until you reach week 4. This is where you have a week off from the patch and have your period. 

Can I use Evra for period delay?

You can use Evra for period delay in the same way as the combined pill. Instead of having a patch free week at the end of the third week in your cycle, remove the third patch and apply a new one right away. This will then be day one of your patch cycle so you should continue to use the patch for a further 3 weeks. Ensure that you remove your third patch on time and replace it with a new one. Leaving it on too long will leave you at risk of pregnancy as each patch only lasts for one week. 

Active ingredients

The active ingredients contained in Evra are: norelgestromin and ethinylestradiol. 

Inactive ingredients

The other ingredients are: backing layer: low-density pigmented polyethylene outer layer, polyester inner layer; middle layer: polyisobutylene/polybutene adhesive, crospovidone, non-woven polyester fabric, lauryl lactate; third layer: polyethylene terephthalate (PET) film, polydimethylsiloxane coating.

When to start Evra

The best time to start Evra is on the first day of your period as you will be protected from pregnancy right away. You can apply your first patch later in your cycle but if you do, you'll need to use an additional barrier method of contraception for the first 7 days of using Evra. 

How to use Evra

Each Evra patch is worn for 7 days. When you reach day 8, remove it and apply another one right away. You should do this for 3 weeks in a row before having a 7 day break. This is when you have your withdrawal bleed- similar to your period. After the 7 days, ensure you apply a new patch on time. 

Where to put the patch

The patch can be applied to an area of skin which is clean, dry and relatively hair free. Avoid areas with sore, irritated or sensitive skin or where tight clothing  would rub against it. Do not apply the patch to your breasts. 

What should I do if the patch falls off?

The patch is unlikely to peel off or get dislodged as it's very sticky. You can have a bath or shower as usual and this won't cause it to come off. It also shouldn't be affected by swimming or using a sauna or hot tub. If it does fall off, the action you should take will depend on how long the path has been off for. 

If it has been less than 48 hours: 

• Reapply it if the stickiness is still intact 

• If the patch is no longer sticky then discard it and apply a new one

• Continue using the patch as usual and change it on the same day as usual 

• If you were using the patch correctly for the previous 7 days your contraception will not be affected 

• If you are near the beginning of your cycle and you have only been using the patch for 6 days or less, your protection may be affected. In this case, use an additional barrier method of contraception for the next 7 days  

If it has been more than 48 hours: 

• Apply a new patch right away and treat this as day one of your cycle- so you will use the patch for another 3 weeks before having the 7 day break 

• Use an additional barrier method of contraception for the next 7 days

• If you have had sex in the past couple of days, see your GP or pharmacist right away as there is a risk of pregnancy. They can issue you with emergency contraception if necessary. 

What to do if you forget to take the patch off

Each patch lasts for 7 days. Leaving it on too long will have the same effect as it falling off or forgetting to replace it on time. If you have forgotten to remove the patch, the action you should take next depends on where you are in your cycle and how long the patch has been left for. 

Week one or two- 48 hours or less:  

• If the patch has been on for no longer than 8 or 9 days, remove it and apply a new one 

• Remove the new one on the usual day- as if you had replaced it on time 

• Your contraception will not be affected 

Week one or two- more than 48 hours:  

• Remove the expired patch and apply a new one as soon as you can 

• Restart your patch cycle and treat this as day one- leaving the new patch on for 7 days before changing it 

• Use additional contraception, such as condoms or a diaphragm, for the next 7 days 

• If you have had sex in the past couple of days, see a GP or pharmacist as you will be at risk of pregnancy 

Week three: 

• If you forget to remove your patch on time in the third week of your cycle, take it off as soon as possible 

• Start your patch free week and apply your next patch on your usual scheduled day; as if you had removed your patch on time 

• You won't have a full patch free week and your contraception will not be affected 

• You might still get your withdrawal bleed but you may not. This is normal in this instance and does not mean you are pregnant

What to do if you forget to apply a patch on time

After you remove the patch at the end of the third week, you will apply a new one 7 days later. If you forget, what you should do next will depend on how many days late you are in applying the patch.  

• If it has been less than 48 hours since you were due to apply the patch, put on a new one right away. Take note of the day of the week as this will be your new patch start and change day. Your contraception will not be affected

• If it has been more than 48 hours, follow the same procedure and use an additional barrier method of contraception for 7 days, such as condoms or a diaphragm. If you have had sex during your patch free week, you may need emergency contraception and should see your GP or pharmacist right away 

Each Evra patch contains 6mg of norelgestromin and 600mg of ethinylestradiol which is released steadily over 7 days.

Common side effects include: 

• Headaches 

• Nausea 

• Breast tenderness 

• Thrush 

• Mood changes 

• Depression 

• Anxiety 

• Dizziness 

• Migraine 

• Abdominal pain 

• Bloating 

• Vomiting 

• Diarrhoea 

• Acne 

• Skin irritation 

• Rash

• Itching 

• Muscle spasms 

• Breast pain 

• Lumps or breast enlargement 

• Spotting between periods 

• Period pain 

• Vaginal discharge 

• Skin irritation after patch removal 

• Tiredness 

• Feeling unwell

• Weight gain 

Uncommon side effects may include: 

• Allergic reaction 

• Hives 

• Water retention 

• High levels of fats in the blood 

• Insomnia 

• Lack of sex drive 

• Eczema 

• Skin redness 

• Breast secretion 

• PMS 

• Vaginal dryness 

• Swelling 

• High blood pressure 

• Increased appetite 

• Hair loss 

• Photosensitivity 

Rare side effects may include: 

• Blood clots 

• Breast, cervical or liver cancer 

• Blisters or ulcers where the patch has been in contact with the skin 

• Benign tumours in the breast or liver 

• Fibroids in the womb 

• Feels of anger or frustration 

• Increased interest in sex 

• Abnormal taste 

• Difficulty tolerating contact lenses 

• Hypertensive crisis 

• Gallbladder or colon inflammation 

• Abnormal cervix cells 

• Chloasma 

• Gallstones 

• Jaundice 

• Abnormal blood sugar or insulin levels 

• Skin rash with red nodules on the shins and legs 

• Scaly, flaky, itchy and red skin 

• Vaginal discharge 

• Swelling in arms, hands, legs or feet 

Contraindications

Do not use Evra if: 

• You have ever had a blood clot

• You have ever had a heart attack or stroke 

• You have ever had angina 

• You have a condition which affects your blood clotting 

• You are due to have an operation or will be off your feet for a long time 

• You have very high blood pressure

• You have severe diabetes with blood vessel damage 

• You have a very high level of fat in the blood 

• You have ever had a migraine with aura 

• You are allergic to any of the ingredients in Evra 

• You have ever experienced breast, cervical, womb or vaginal cancer 

• If you have ever had liver tumours or liver disease 

• You have unexplained vaginal bleeding 

Seek advice from a doctor before using Evra if any of the following apply to you: 

• Inflammatory bowel disease 

• Systemic lupus erythematosus 

• Haemolytic uraemic syndrome 

• Sickle cell anaemia 

• Hypertriglyceridaemia 

• You need an operation or need to be off your feet for a long time 

• You have recently given birth 

• Superficial thrombophlebitis 

• Varicose veins

Drug Interactions

Certain medications can interfere with the way Evra works, causing it to be less effective: 

• HIV medications 

• Epilepsy medications 

• Hepatitis C medications 

• Griseofulvin 

• Rifabutin 

• Rifampicin 

• St John's wort

Evra vs the pill

Evra works in a similar way to the pill to prevent unwanted pregnancies and produces the same side effects and risks. The Evra patch is not affected by vomiting and diarrhoea like the pill and you do not have to worry about remembering to take it every day. 

Evra vs NuvaRing

While Evra is a brand of the contraceptive patch, NuvaRing is a form of contraception called the vaginal ring. It is a soft, plastic ring which is inserted into the vagina. Both contraceptives release estrogen and progesterone into the body in order to prevent pregnancy. NuvaRing lasts for 21 days once it's been inserted, so you do not need to think about it for 3 weeks until it's time to remove it. It does have a risk of falling out and may not be comfortable for women who don't want to touch their vagina. However, the patch can cause skin irritation and can also fall off occasionally. Which method is best for you will depend on what you are comfortable with. 

Alternatives to Evra

Other forms of combined hormonal contraceptives include the pill and vaginal ring. These type of contraceptives are not suitable for all women however, as they increase the risk of experiencing blood clots. While this is rare, if you have certain medical conditions or medical history, combined hormonal contraceptives will not be safe for you to use. The mini pill is a progesterone only alternative which is safe for most women to use. Barrier methods of contraception include condoms, diaphragm or caps and the contraceptive sponge. These are non- hormonal and produce no side effects. Long-term reversible methods of contraception are the IUD (copper coil), IUS (hormonal coil), implant and injection. The injection lasts for 13 weeks, the implant for 3 years and the coil for 5-10 years depending on the type. 

How big is the contraceptive patch?

Each Evra patch is 20cm and is square shaped. It appears similar to an adhesive plaster.

Will I still be protected against pregnancy during my patch free week?

What does the patch look like?

The patch looks similar to an adhesive plaster and is beige in colour. You can apply it to any area of your body which is dry and hair free but you should not apply it to your breasts. The drawback to using Evra is that the patch is visible on your skin and will not blend in with darker skin tones. 

Will the patch irritate my skin?

The patch can cause skin irritation but this can be minimised by applying it to a different area of the body each time. For example, if you placed it on your lower back one week, you may want to apply it to the stomach or bum the next week. Ensure you don't apply it to areas which tight clothing rub against, like the waistband of your jeans. This can increase the risk of skin irritation and may cause the patch to fall off. 

Is the patch less effective than the pill?

The patch is just as effective as the combined pill, being over 99% effective when it is used correctly. This involves applying and changing it on time and replacing it if it does fall off. The patch is also affected by the same medications as the pill but because the hormones are not passing through your digestive system, vomiting will not cause Evra to be less effective. 

Will Evra stop my periods?

Evra stops ovulation from occurring so you won't have a natural period while you are using Evra. During your patch free week, you will have a withdrawal bleed similar to your period. Some women using the patch won't always bleed every month. If this happens more than 2 months in a row then you may want to visit your GP to ensure you are not pregnant. 

Sources

NHS> The Contraceptive Patch https://www.nhs.uk/conditions/contraception/contraceptive-patch/

NHS> The Combined Pill https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/

Web MD> Transdermal Contraceptive Patch https://www.webmd.com/sex/birth-control/birth-control-transdermal-patches