The contraceptive patch is a 5 square-centimeter sticky patch which contains estradiol and norelgestromin. It is to be applied once a week, on the same day of the week, for three weeks. The fourth week is kept free to allow a regular withdrawal bleed to occur.
The initial application is recommended to be on the first day of the menstrual cycle, so that it is immediately protective against pregnancy in that cycle. If used within the first five days, it appears to be equally effective, but some experts recommend that additional protection be used for seven days if the patch is not applied on the first day.
After a week from the first application, the patch must be changed. All changes should be on the same day of each week. After the fourth (patch-free) week is over, the first patch of the next cycle must be applied on the same day as before, irrespective of the day when bleeding begins or ends. At no time is should the woman be without a patch for more than seven days.
The contraceptive patch does not normally come off even if the woman swims, bathes, or sweats.
Site of application
The patch should be applied by pressing gently down on a skin area which is clean, dry, not too hairy, and intact, for 10 s. The abdomen, gluteal region, lateral aspect of the upper arm, or the upper part of the torso, is a suitable site. The breast region should be avoided, as should inflamed or sore skin. The site of application should not be subjected to any other chemical.
It is best to alternate between different sites each week to minimize the chances of irritation. Similarly, the patch should not be used where there is a chance of friction by tight-fitting clothing. If skin irritation occurs, the patch may be applied on another area, and changed on the usual day.
The patch should be used intact, and no additional adhesive techniques should be used. Used patches are folded on themselves and disposed in the waste bin.
If the patch comes off
It is best to check the patch to make sure it is properly adherent, especially at the edges. If it shows signs of coming off, immediate reapplication is advised. If it is no longer sticky, or it has become adherent to another surface, a new patch is used, but it should be changed again on the same day of the week as before.
If it comes off for less than 48 hours, but it has been on for seven days already (the first Patch Week is complete), it should be reapplied as above, and contraceptive efficacy is unchanged. If it has been off for longer than this, or it came off before the first seven days were completed, another method of contraception should be used for seven days in addition to the application of a new patch.
The date of the new patch is now the first day of the new cycle, and further changes should be on the same day each week. If the woman has had intercourse in this period when the patch was off, she may have conceived.
If the patch is not removed at the right time, but has remained on for up to 48 hours longer, it should be changed as usual. The next patch change day remains unchanged. The contraceptive efficacy is the same.
If it has been on for more than 48 hours too long, a new patch should be applied, and the date should be marked as the new patch change day. This is now considered to be the beginning of a new patch cycle, and the patch should be changed weekly for the next three weeks.
Additional contraception should be used for the first seven days. The possibility of conception exists if the woman had unprotected sex during the period when the old patch was on after seven days.
If the patch remains on after the third week, it should be removed as soon as the woman remembers. The next patch should be applied on the scheduled day, even though it has not been seven days without a patch. Contraceptive protection is unaffected.
If the woman forgets to restart the patch cycle after the fourth week, she should apply one as soon as she remembers. If it has been up to 48 hours delayed, contraceptive efficacy is unchanged. After this period, seven days of back-up contraception should be used, and the patch change day rescheduled.
Two patches should never be used together.
Reviewed by Susha Cheriyedath, MSc