Evra patches are contraceptive patches. They contain synthetic derivatives of the naturally occurring female sex hormones, oestrogen and progesterone.
Ethinylestradiol is a synthetic version of oestrogen and norelgestromin is a synthetic form of progesterone. These hormones are similar to the hormones that are used in combined oral contraceptives (the pill) and work in the same way.
Hormonal contraceptives like Evra work by over-riding the normal menstrual cycle. In a woman's normal menstrual cycle, levels of the sex hormones change throughout each month. The hormones cause an egg to be released from the ovaries (ovulation) and prepare the lining of the womb for a possible pregnancy. At the end of each cycle, if the egg has not been fertilised the levels of the hormones fall, causing the womb lining to be shed as a monthly period.
The hormones that are absorbed into your bloodstream from Evra patches work mainly by tricking your body into thinking that ovulation has already happened. This prevents an egg from ripening and being released from the ovaries each month.
The hormones also increase the thickness of the natural mucus at the neck of the womb, which makes it more difficult for sperm to cross from the vagina into the womb and reach an egg. They also change the quality of the womb lining (endometrium), making it less likely that a fertilised egg can implant there.
Evra patches are designed to be used for three weeks out of every four. One patch should be applied to the skin once a week, on the same day each week (known as the "Change Day"), for three weeks. During this time the hormones are absorbed from the patch through the skin and into the bloodstream, at a continuous rate. In the fourth week of the monthly cycle you don't wear a patch. During your week off, the levels of the hormones in your blood drop, which results in a withdrawal bleed that is similar to your normal period.
A new contraceptive cycle begins on the next day following your patch-free week (i.e. same day as your "Change Day"). A new patch should be applied even if you have had no bleeding in the patch-free week, or if bleeding has not yet stopped.
You will still be protected against pregnancy in your patch-free week, provided you used the previous three patches correctly, you start the next cycle of patches on time and nothing else happened that could make the patch less effective (e.g. taking certain other medicines).
- Follow the instructions in the leaflet provided with your patches carefully. Only one patch should be applied at a time. Do not cut the patches.
- The patch should be applied to clean, dry, hairless, intact, healthy skin on the buttock, abdomen, upper outer arm or upper torso, in a place where it will not be rubbed by tight clothing. It should NOT be applied to the breasts or to skin that is red, irritated or broken.
- On your "Change Day", remove the old patch and replace it with a new one in a slightly different area to avoid irritating the same area of skin.
- Avoid using make-up, creams, lotions, powders or other products on the area of skin where you are going to apply a patch, as this may stop it sticking properly. You should not use extra adhesives or bandages to hold your patch in place. If a patch has stopped sticking before a week is up, replace it with a new one and follow the instructions below regarding detached patches.
- Used patches should be placed in the disposal sachet provided and put in a waste bin. They must not be flushed down the toilet.
Ideally, you should start using Evra on day one of your menstrual cycle (the first day of your period). This will protect you from pregnancy immediately and you won't need to use any additional methods of contraception.
You can also start using the patch at any other time in your cycle if your doctor is reasonably sure that you are not pregnant. However, if you do this you won't be protected from pregnancy straight away and you will need to use additional contraception, e.g. condoms (or not have sex) for the first seven days.
If you have given birth and are not breastfeeding, you can start using this patch four weeks after the birth. You will be protected against pregnancy immediately and do not need to use extra contraception. If you start using it later than four weeks after giving birth, you will need to use extra contraception (or not have sex) for the first seven days.
If you are starting the patch immediately after a miscarriage or abortion at under 20 weeks, you will protected against pregnancy immediately. If you start using it more than seven days after the miscarriage or abortion, you should use extra contraception for the first seven days.
If you are starting the patch after a miscarriage or abortion at more than 20 weeks, you should start using the patch on day 21 after the abortion/miscarriage, or on the first day of the first period you get afterwards. You will need to use extra contraception for the first seven days of using the patch.
Medicines and their possible side effects can affect individual people in different ways. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect. The following are some of the side effects that are known to be associated with Evra:
- Irritation, redness or itching of the skin at the patch application site.
- Nausea and vomiting.
- Abdominal pain.
- Breast tenderness and enlargement.
- Weight changes.
- Retention of water in the body tissues (fluid retention).
- Vaginal thrush (candidiasis).
- Change in menstrual bleeding, usually lighter periods or sometimes stopping of periods.
- Menstrual spotting or breakthrough bleeding.
- Decreased sex drive.
- Rise in blood pressure.
- Skin reactions.
- Irregular brown patches on the skin, usually of the face (chloasma).
- Steepening of corneal curvature, which may make contact lenses uncomfortable.
- Disturbance in liver function.
- Blood clots in the blood vessels (e.g., DVT, pulmonary embolism, heart attack, stroke).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with Evra, please read the information provided with the medicine or consult your doctor or pharmacist.
This contraceptive pill will not protect you against sexually transmitted infections, so you may still need to use condoms as well.
Evra should be used with caution in:
- Women aged over 35 years.
- Women whose parent, brother or sister had a heart attack or stroke caused by a blood clot before the age of 45.
- Women with a parent, brother or sister who has had a blood clot in a vein (venous thromboembolism), e.g. in the leg (deep vein thrombosis) or in the lungs (pulmonary embolism) before the age of 45.
- Women who are obese.
- Women with diabetes mellitus.
- Women with high blood pressure (hypertension).
- Women with heart failure.
- Women who use a wheelchair.
- Women with a history of inflammation of a vein caused by a superficial blood clot (thrombophlebitis).
- Women with anaemia caused by a hereditary blood disorder where abnormal haemoglobin is produced (sickle cell anaemia).
- Women with a history of severe depression, especially if this was caused by taking the pill in the past.
- Women with a history of migraines.
- Women with inflammatory bowel disease, e.g. Crohn's disease or ulcerative colitis.
- Women with a personal or family history of raised levels of fats called triglycerides in the blood (hypertriglyceridaemia).
- Women with raised levels of the hormone prolactin in their blood (hyperprolactinaemia).
- Women with an undiagnosed breast lump or gene mutations that are associated with breast cancer, e.g. BRCA1.
- Women with a history of irregular brown patches appearing on the skin, usually of the face, during pregnancy or previous use of a contraceptive pill (chloasma). Women with a tendency to this condition should minimise their exposure to the sun or UV light while taking this contraceptive.
Evra should NOT be used in:
- Women who are breastfeeding (the combined pill shouldn't be taken until weaning or for six months after birth).
- Women who have ever had a blood clot in a vein (venous thromboembolism), e.g. in the leg (deep vein thrombosis) or in the lungs (pulmonary embolism).
- Women with blood disorders that increase the risk of blood clots in the veins, e.g. antiphospholipid syndrome or factor V Leiden.
- Women having sclerosing treatment for varicose veins.
- Women with two or more other risk factors for getting a blood clot in a vein, e.g. family history of deep vein thrombosis or pulmonary embolism before the age of 45 (parent, brother or sister), obesity, smoking, long-term immobility.
- Women who have ever had a heart attack, stroke or mini-stroke caused by a blood clot in an artery.
- Women with angina, heart valve disease or an irregular heartbeat called atrial fibrillation.
- Women with moderate to severe high blood pressure (hypertension).
- Women who smoke more than 40 cigarettes per day.
- Women over 50 years of age.
- Women with severe diabetes, e.g. with complications affecting the eyes, kidneys or nerves.
- Women with two or more other risk factors for getting a blood clot in an artery, e.g. family history of heart attack or stroke before the age of 45 (parent, brother or sister), diabetes, high blood pressure, smoking, high cholesterol levels, obesity, migraines.
- Women who get migraines with aura, severe migraines regularly lasting over 72 hours despite treatment, or migraines that are treated with ergot derivatives.
- Women with breast cancer or a history of breast cancer (although the pill can be used if you have been free of cancer for five years and you don’t want to use non-hormonal methods of contraception).
- Women with abnormal vaginal bleeding where the cause is not known.
- Women with a long-term condition called systemic lupus erythematosus (SLE).
- Women with a history of excess of urea in the blood, causing damaged red blood cells (haemolytic uraemic syndrome).
- Women with active liver disease, e.g. liver cancer, hepatitis.
- Women with a history of liver disease when liver function has not returned to normal.
- Women with disorders of bile excretion that cause jaundice (e.g. Dubin-Johnson or Rotor syndrome).
- Women with gallstones.
- Women with a history of jaundice, severe itching, hearing disorder called otosclerosis, or rash called pemphigoid gestationis during a previous pregnancy, or previous use of sex hormones.
- Hereditary blood disorders known as porphyrias.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using Evra and inform your doctor or pharmacist immediately.
The patient information leaflet (PIL) is a leaflet containing specific information about medical conditions, doses and side effects. You can download a copy of the PIL here:
Patient Info Leaflet