Contraceptive patch (Evra)

What is the Evra contraceptive patch?

• The contraceptive patch is a small, sticky patch you wear on your body to prevent pregnancy.
• It’s sometimes known by its brand name, Evra.
• When it’s used correctly, it’s more than 99% effective.
• In everyday life, the pill may not be taken perfectly all the time. This typical use lowers its effectiveness to 93%.
• The patch usually makes periods lighter, regular and less painful.
• You can use the patch to help control when you get any bleeding.
• You can choose not to have any periods at all.

How does the contraceptive patch work?

• The patch releases the hormones oestrogen and progestogen through the skin and into the bloodstream.
• This stops the ovaries releasing an egg each month (ovulation).
• It thickens the mucus in the cervix (entrance to the womb) so sperm can’t get to an egg to fertilise it.
• It thins the womb lining so it’s hard for a fertilised egg to implant there.

For more information on the ingredients in the Evra patch, see: SHL.UK contraceptives ingredients

How effective is the contraceptive patch?

• The patch is over 99% effective when always used correctly.
• Not everyone uses the patch correctly all the time. For example, you might forget to change it on time or forget to put on a new patch after a break. This is called ‘typical use’ and can mean the patch is less effective. Around 7 in 100 typical patch users will become pregnant in a year.
• There is some evidence that the patch is less effective for people who weigh more than 14 stone (90kg).

Using the contraceptive patch

You stick the contraceptive patch on your body. Most areas of the body are suitable. (See Where's the best place to put a contraceptive patch? in the FAQs below.)

If you start using the patch during the first 5 days of your period, you’ll be protected from pregnancy straight away.

If you start using the patch after the 5th day of your period, you won’t be protected from pregnancy for the first 7 days. Use condoms if you have sex during this time.

You wear each patch for 7 days and then replace it with a new one. After 21 days (3 patches) you take the patch off and have a 7-day break with no patches. You’ll likely have a withdrawal bleed (see What is a withdrawal bleed? in the FAQs below) during this time. You put on a new patch on the 8th day even if you’re still bleeding.

Tailored patch use

There are also other ways of using the contraceptive patch. You can have a 4-day break or you can miss out the break altogether so you don’t have a bleed.

There are no known risks from shortening or missing the break or from not having withdrawal bleed. It’s up to you what you prefer.

Missing the break can be associated with a lower risk of pregnancy. It can also help people who get painful bleeding, headaches or mood changes during the patch-free break. You can miss the break every month, occasionally or not at all. It’s your choice.

Ask your patch provider if you’d like more information about different ways to use the patch. You can also read more at: Guide to tailored combined hormonal contraceptives (PDF)

Things to consider when using the Evra patch

• The contraceptive patch does not prevent you from getting sexually transmitted infections (STIs) so you may want to use condoms too.
• You need a clinical consultation before being prescribed the contraceptive patch. This is to make sure it’s medically suitable for you. This can be done by your GP, at a sexual health service or through the SHL.UK online contraception service. During your consultation, give as much information as possible about your health and any medication you take.
• If you’re aged over 35 and smoke or vape, or gave up within the last year, the contraceptive patch might not be suitable for you.
• The patch might not be suitable for you if you’re aged over 50, very overweight, take certain medications or have recently given birth.
• The patch won’t usually be suitable if you’re at higher risk of deep vein thrombosis or cardiovascular disease, have migraines with aura or have certain other medical conditions.
• Some medicines reduce the effectiveness of the patch. If you’re prescribed medicine when using the patch, tell your doctor and they can advise whether it will affect the patch.
• Depending on where you wear it, the patch might be seen by other people.

Benefits of the contraceptive patch

• You only have to remember to change it once a week.
• It often makes periods, lighter, regular and less painful.
• You can control when you get your period and choose not to have a monthly bleed if you don’t want one. Talk to your healthcare professional for more information or see above: Using the contraceptive patch.
• The hormones don’t have to be absorbed by your gut, so the patch is not affected if you’re sick or have diarrhoea.
• It may reduce the risk of cancer of the ovary, uterus, and colon.
• It can help manage symptoms in people with fibroids, adenomyosis and endometriosis.
• Using the patch to regulate your bleeding pattern can be helpful for people with irregular periods such as those with polyendocrine metabolic ovarian syndrome (PMOS) - previously called PCOS.
• It may reduce menopausal symptoms.
• Your fertility will return to whatever is normal for you once you stop using the patch.

Possible side effects and risks of the patch

Some people might get side effects when using the contraceptive patch, including:

• Skin irritation. It can help to put each new patch in a different position from the previous patch.
• Breakthrough bleeding and spotting in the first few months of using the patch. This is unexpected bleeding separate from your usual withdrawal bleed.
• Breast tenderness, headaches, nausea, and mood swings. These usually stop within a few months as your body adjusts to the hormones in the patch.

There are also some rare risks to be aware of:

• A small increased risk of developing blood clots. Your consultation will assess any risk factors related to this.
• A small increased risk of breast and cervical cancers compared to people who don’t use hormonal contraception. The increased risk reduces over time after stopping the patch and is eventually undetectable. Whether using the patch or not, everyone is advised to check their breasts or chest regularly. And cervical screening (a smear test) can help detect any changes that could lead to cancer.

Forgetting a patch

Forgetting a new patch after a break

If you forget to put on a new patch after a patch-free break, put one on as soon as possible.

If it’s less than 8 days since you took off your last patch, you’ll still be protected from pregnancy.

If it’s 8 or more days since you took off your last patch:

• Put on a new patch as soon as possible.
• Change the new patch on your usual patch-change day.
• If you have sex, use condoms until you’ve worn a patch for 7 days in a row.
• If you had condomless vaginal sex during your patch-free break, you may need emergency contraception or a pregnancy test. Talk to a nurse, doctor or pharmacist.

Forgetting to change a patch

If you forget to change your patch, what to do depends on how long it’s been left on.

If it’s been on less than 48 hours too long:

• Take it off and put on a new patch.
• Change the new patch on your usual patch-change day
• You’ll still be protected from pregnancy.

If the patch has been left on for more than 48 hours too long:

• Take it off and put on a new patch.
• If you were due to start a patch-free break in the next 7 days, don’t take the break.
• Change the new patch on your usual patch-change day.
• If you have sex, use condoms until you’ve worn a patch for 7 days in a row.
• Talk to a nurse, doctor or pharmacist about whether you need emergency contraception.
• If you live in an area covered by the SHL contraception service, you can do an online consultation to check if you need emergency contraception.

If you’re not sure what to do after forgetting patches:

• Keep using the patch.
• Use condoms if you have vaginal sex.
• Contact your GP, sexual health clinic or pharmacist for advice.
• Or, if you live in an area covered by the SHL contraception service, you can do an online consultation to check if you need emergency contraception.

Where can I get the contraceptive patch?

Free contraceptive patches online from SHL

If you’re 16 or over and your London borough is part of our contraception service you can have a consultation and order the patch for free from SHL.

1. Register or Log in
2. Take our online consultation
3. If the contraceptive patch is right for you, we’ll post it to you or you can collect it from selected pharmacies or ParcelShops

Free contraceptive patches from London health services

• You can get the contraceptive patch for free from these places, even if you’re under 16:
• All London sexual health clinics
• Some GP surgeries (if you’re registered with them)
• Some young people’s services

Buy contraceptive patches

• You can buy the contraceptive patch from many online and high street pharmacies
• Prices vary and there may be delivery charges
• You still need to have a consultation to check the patch is right for you

How often will I need a review?

When you first start using the patch, your patch provider will check your blood pressure and weight to make sure the patch is ok for you.

You’ll need a review at least once a year to monitor your blood pressure, weight and general health. Some services may ask you to have a review sooner or more often than this.

Your review may be done online, by phone or at a face-to-face appointment. This depends on what your patch provider offers. To do a review online or by phone you’ll need to be able to give your current weight and a recent accurate blood pressure reading.

Your review is also a chance for you to ask any questions you have. But you can contact your GP, a sexual health clinic or your patch provider at any time if you have any questions or concerns. You don’t need to wait until your review.

Is the contraceptive patch right for me?

• The contraceptive patch could suit you if you’re happy to make contraception part of your weekly routine and can remember to change your patch every week. An added benefit is that it’s one of the best contraceptive methods for period control. It helps make your periods regular, lighter and less painful. Patch users can skip having a monthly bleed if they want to – either occasionally or every month.
• Most patch users only need to have a review once a year. If you can check your weight and blood pressure yourself, you can often have your review online or over the phone.
• If you need STI protection or sometimes make a mistake with your patch, you’ll need to be happy using condoms too. You may sometimes need emergency contraception too. It’s helpful to have a few places you know you could get this quickly. This could include ordering the emergency pill online from SHL.
• Like any hormonal contraception the contraceptive patch can have side effects that may be positive or negative for you. If you’re unhappy with any side effects, talk to your healthcare professional. They may be able to help or they can support you to change to a different method of contraception. Your patch provider will also talk to you about the rare but serious risks associated with the patch. Some people may have conditions that mean they can’t use the patch.
• If the patch is not right for you, you might be interested in long-acting reversible contraception. This is more effective and protects against pregnancy for longer. This includes the implant (lasts 5 years), the hormonal coil (lasts 3 to 8 years) and the injection (lasts 3 months). Periods usually become lighter, shorter or less painful when using these methods. They can stop completely for some people – but bleeding patterns can sometimes be unpredictable.
• The copper coil is a non-hormonal, long-acting option that lasts for 5 or 10 years. This may not be suitable if you have heavy or painful periods as it can make periods longer, heavier or more painful for some people.
• Flexible options that you need to remember more regularly include the combined pill or the vaginal ring (NuvaRing), and progestogen-only pills. These are all available by post from SHL.

This Brook tool can help you consider the best contraception for you.

Helpful links

• Contraceptive patch - NHS
• The patch | Contraception Choices
• The Contraceptive Patch - Brook

Sources

Combined Hormonal Contraception | CoSRH

FSRH CEU Guidance: Recommended actions after incorrect use of CHC (2020, amended July 2021) | CoSRH

UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) | CoSRH