Contraceptive Patch

Sexual and Reproductive Health

What is the contraceptive patch?
The contraceptive patch is a small, thin, beige sticky patch that releases two hormones (oestrogen and progestogen) into your body through your skin to prevent pregnancy. It is typically 5cm x 5cm. It is currently not available in Malta.

How does the contraceptive patch work?
The contraceptive patch releases a daily dose of hormones through the skin into the bloodstream. Each patch lasts for 1 week and you can change the patch every week for 3 weeks, then have a week without it.

It prevents pregnancy by:

  • Inhibiting ovulation.
  • Thickening the cervical mucus, which makes it difficult for sperm to move through the cervix and reach the egg.
  • Making the lining of your uterus thinner so it is less likely for a fertilised egg to implant itself.


How effective is the contraceptive patch?
When used correctly, it is over 99% effective at preventing pregnancy.

Where can I put the contraceptive patch?
You can stick the patch directly onto your skin, on most areas of your body. Changing the position of each new patch helps to reduce the chance of skin irritation. The skin must be clean, dry, and not hairy. You should not stick the patch onto:

  • Sore or irritated skin.
  • Areas where it may get rubbed off by tight clothing.
  • Your breasts.


How do I use the patch?
There are different ways you can use it. Always discuss the following options with your medical practitioner and see which way is best for you.

Standard Way
Apply a new patch once a week, every week for 21 days. Then you should stop applying a patch for the next 4 or 7 days. You should have a withdrawal bleed during the patch-free break. Start a new patch on the 5th or 8th day, even if you are still bleeding.

Extended Use or tricycling
Apply a new patch once a week, every week for 9 weeks, then no patch for the next 4 or 7 days. You should have a withdrawal bleed during patch-free break. Start a new patch on the 5th or 8th day, even if you are still bleeding.

Continuous patch
Apply a new patch once a week, every week continuously without a break. You won’t have a withdrawal period, but you may still get some bleeding. This bleeding is likely to reduce by time.

Flexible extended use
Apply a new patch once a week, every week for at least 21 days. If you don’t want to get a period for 3-4 days, then have a four-day patch-free break. Apply a new patch again on the 5th day even if you are still bleeding.

Am I protected during patch-free days?
Yes, you are protected. You may not need free days and may continue with the patch without breaks.

When do I start the patch?
You can start the patch any day you want if you are not pregnant. If you start the contraceptive patch:

  • On the 1st day of your period - you are protected from pregnancy immediately.

or

  • From the 1st day of the period till the 5th day of the period - you are protected from pregnancy immediately. However, it is recommended to speak to your medical practitioner for advice on whether you need additional contraception in view of your cycle.

or

  • At any other time in your menstrual period - you need additional contraception (e.g. condoms) for the first 7 days of using the patch.


What if the patch falls off or is applied incorrectly?
The contraceptive patch should stay on, even after a shower, bath, hot tub, sauna, or swim. It is very sticky. If it does fall off, you should consider:

  • How many days the patch was on before it came off.
  • How long it has been off.

Scenario 1:
If it has been less than 48 hours or has been left on for up to 48 hours too long.

  • Stick it back as soon as possible (if it is still sticky).
  • If it does not stick, remove the old one and put another new patch. Do not try to hold in place with a plaster or a bandage.
  • If you have been with it for 7 days before it came off, you are protected against pregnancy, as long as the patch has been used correctly.
  • However, if you have been with it for 6 days or less, you should use additional contraception (such as condoms) for another week.

Scenario 2:
If it has been off for 48 hours or more OR the patch has been left on for 48 hours or more too long, or you do not remember how long it has been there, apply a new patch as soon as possible and start at Day 1 (as a new cycle). Use additional contraception for the next 7 days or avoid sex.

If you have a patch-free break to begin in the next 7 days, omit it.

What are the advantages of the contraceptive patch?

  • You do not have to think about it every day, even if you have been vomiting or have diarrhoea.
  • You can wear it in the bath, when swimming or while playing sports.
  • Decreases heavy or painful periods; makes periods more regular.
  • Very easy to use.
  • Does not interrupt sex.
  • It can help with premenstrual symptoms.
  • Reduces the risk of ovarian, uterus and bowel cancer.
  • Reduces the risk of fibroids, ovarian cysts and non-cancerous breast disease.


What are the disadvantages of the contraceptive patch?

  • May be visible.
  • May cause skin irritation and soreness.
  • Temporary headaches, nausea, breast tenderness and mood changes.
  • Irregular bleeding.
  • Some medicines may make the patch less effective (speak to your medical practitioner before taking any new medicines that might interact with your contraceptive patch).
  • You need to remember to replace the patch every week.


What are the risks of the contraceptive patch?
All risks should be discussed with your medical practitioner before starting a new contraceptive. There is a high risk for blood clots (deep vein/artery thrombosis) if:

  • It is your first year of using the patch.
  • You smoke.
  • You are overweight.
  • You are unable to move (immobile) or use a wheelchair.
  • You have severe varicose veins.
  • You have diabetes.
  • You suffer from migraines.
  • You have a close family member who has had a heart attack, stroke or a blood clot before the age of 45 years.

Research also suggests that contraceptive patch users are of a small increased risk of breast cancer and cervical cancer.

It is important to speak to your doctor as soon as you experience the following symptoms:

  • Chest pain.
  • Painful swelling in your leg(s).
  • Weakness and numbness in the arm or leg.
  • Unusual headaches or migraines.
  • Sudden slurring of speech or other speaking difficulties.
  • Eyesight problems.

N.B. Always mention that you are using the contraceptive patch to your doctor, even in emergency situations.

Who can use the patch?
Not everyone can use the patch. Your medical practitioner needs to know your medical history and other information related to illnesses. If you do not have any of the following conditions or any other medical reasons, you can make use of the patch. However, the patch may not be suitable for you if:

  • You smoke and are over 35 years of age.
  • You are 35 years and over and stopped smoking less than a year ago.
  • You are overweight or more than 90kgs.
  • You are taking certain medication.
  • You are breastfeeding a baby less than 6 weeks old.
  • You are immobile for a long period of time (such as using a wheelchair).
  • You are at high altitude (more than 4,500 m) for more than a week.
  • You have/had or any of your immediate family members have/had:
    • Thrombosis in a vein or artery before 45 years of age.
    • Heart disease or stroke.
    • Heart abnormalities.
    • Hypertension.
    • Circulatory problems.
    • Migraine aura.
    • Breast cancer or you have a gene that is associated with breast cancer.
    • Diabetes with complications.


Can I bleed when I start the contraceptive patch?
Yes, bleeding is very common at first. Make sure that you are using the patch according the instructions. If you are bleeding more than normal or it is something you are not comfortable with it, speak to your medical practitioner.

Can I switch to another method of contraception?
Yes, but preferably finish the cycle of the patch. If you do not want to wait until this time speak to your medical practitioner for advice and guidance accordingly.

Can I get pregnant when I remove the contraceptive patch?
When you stop the patch, your fertility comes back to what is normal for you. You may not have periods immediately, but you should get it back in a few months.

Can I put a contraceptive patch after a miscarriage?
You can start applying the contraceptive patch immediately after a miscarriage.

I have just had a baby. When can I start the contraceptive patch?
You can usually start to use the patch from the 21st day after you gave birth if you are not breastfeeding. If you started after 21 days, you need additional contraception such as condoms to protect you from pregnancy or avoid sex completely for the next 7 days. The ring may affect your breast milk production. Therefore, you should not start the patch before the baby is 6 weeks old.

Do I gain weight?
Research has not shown that you will gain weight with the contraceptive patch. Weight gain may be due to fluid retention and other reasons beyond the use of the patch.

How often should I go for a check-up?
Your medical practitioner will guide you as to your next appointment. Your doctor may need to check to your blood pressure and weight once a year.

However, do not wait for the next appointment if:

  • You think you may be pregnant.
  • Could have an STI or HIV/AIDS.
  • Experience severe pain in lower abdomen.
  • You have bleeding or another symptom mentioned in risks of the contraceptive patch.


If I have the contraceptive patch, am I protected from Sexually Transmitted Infections?
No, only male and female condoms (when used correctly and consistently) protect you from STIs.