Try Xulane birth control patch for an alternative to the pill

The Xulane patch (formerly known as Ortho Evra) is FDA approved, as effective as the pill and very easy to use as it’s changed only once a week. No more daily pill taking!

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Reviewed by Dr Yasmin Aghajan, MD

Information last reviewed 07/04/19


What is Xulane?

Xulane is a contraceptive patch, similar to a Band-Aid, which is applied to the skin to effectively prevent pregnancy. It contains a synthetic combination of the female hormones progestin (norelgestromin) and estrogen (ethinyl estradiol) that are absorbed into the bloodstream through the skin to prevent ovulation. Xulane contains hormone medication similar to birth control pills but with a dose that is around 60 percent higher. The patch can also be prescribed for irregular periods, menstrual cramps or endometriosis.

How does the Xulane patch prevent pregnancy?

Xulane works in numerous ways to help protect against unwanted pregnancy. Its main function is to stop the release of an egg from the ovaries during the menstrual cycle (ovulation). In cases where an egg has been released, it thickens the vaginal mucus to prevent the sperm from reaching the egg (fertilization), as well as changing the lining of the uterus to prevent a fertilized egg from attaching to the womb (implantation).

How effective is the Xulane patch for birth control?

When used correctly, Xulane patches are just as effective as birth control pills in preventing pregnancy. Research shows that 9 out of 100 women fell pregnant in one year with ‘typical use’ of Xulane whereas 3 out of 1000 women reported pregnancy through ‘perfect use’ in one year.

Through proper use, Xulane patches are 91-98 percent effective, however, they may prove to be less effective if worn improperly or if the user is concurrently taking other medications such as:

  • Certain antibiotics
  • Antifungal medications
  • HIV medications
  • Anti-seizure medications
  • St. John’s Wort

You must wait a period of 7 days after applying the Xulane patch before it can be completely protective against pregnancy. Meanwhile, it may be advisable to use another form of contraception as a back-up, such as the male condom.

How long does it take for Xulane to come out of your system?

The length of time it takes for Xulane to come out of your system will vary from woman to woman. You will most likely get your period within a few days of taking off the patch. For most women, fertility should return within a few weeks, however, this can in some cases happen almost immediately or, on the other hand, take several months.


Active ingredients

The active ingredients in Xulane patches are the hormones norelgestromin and ethinyl estradiol.

Inactive ingredients

The inactive ingredients in Xulane patches are: polyisobutene adhesive, crospovidone, mineral oil, non-woven polyester fabric, oleyl alcohol and dipropylene glycol.

Which ingredients can cause an allergic reaction?

Xulane patches rarely cause severe allergic reactions, however, it might cause some skin irritation as the patch is worn for a significant amount of time. The patch does contain mineral oil and oleyl alcohol which can be a skin irritant. 


How to use the Xulane patch

Be sure to carefully follow the directions on the information label before using the Xulane patch. You can also refer to the following steps on how to correctly apply the patch:

  • Carefully peel open the foil pouch and remove its contents.
  • Peel away half of the clear plastic, taking care not to touch the sticky surface with your fingers.
  • Apply the exposed sticky part of the patch to clean, dry skin before removing the remaining part of the plastic and attaching the entire patch to the skin.
  • Press firmly onto the patch using your palm for around 10 seconds, ensuring that the entire patch bonds to the skin.
  • Run your fingers over the entire surface of the patch to smooth out any wrinkles around the patch.
  • Be sure to check the patch every day to make certain that the edges are sticking correctly.

Where can I put the Xulane patch?

Ideal parts of the body where the Xulane patch can be applied include the lower abdomen, back, upper arm or buttocks where it will not rub against tight clothing. Wherever you decide to apply the patch, ensure that the area is clean and dry and leave it there for a period of 7 days. Be sure to change the location of the patch each time you apply a new one.

Do not apply the patch on the breast or on damaged, broken or irritated skin. Do not use any lotions, creams, oils or powders at the patch site as this may reduce adhesiveness and cause the patch to become loose or fall off.

How often should I change the Xulane patch?

Depending on your doctor’s instructions, you will either apply the patch on the first day of your period or on the first Sunday after your period begins.

The patch method operates on a 4-week cycle. A new patch must be applied on the same day every week for a period of 3 consecutive weeks. On the fourth week you go patch-free before starting a new cycle. You should get your period during the patch-free week, also known as a withdrawal bleed, although this may not always occur. Do not allow more than 7 days to pass before repeating the cycle.

Do not wear more than one skin patch at a time. Do not cut, damage or alter the Xulane patch in any way as this may impair the efficacy of the contraceptive.

Side Effects

What are the side effects from Xulane?

Some of the most common side effects brought about by hormonal contraceptives, including Xulane are:

  • Breast discomfort, swelling or pain
  • Nausea
  • Skin irritation, redness or swelling at the patch site
  • Stomach pain
  • Menstruation pain
  • Vaginal bleeding between periods
  • Mood and anxiety disorders

If you do experience any of the above symptoms, do not stop using Xulane. Such issues will usually subside as your body adjusts to the contraception, however, if the problem persists or worsens, you should seek medical advice.

Less common yet adverse reactions from Xulane include:

  • Blood clots
  • Heart attack
  • Stroke
  • Liver problems
  • Severe headaches or migraines
  • Swelling of hands, ankles or feet
  • Breast lumps
  • Depression

Remove the patch and seek immediate medical attention if you experience any of the above symptoms.


Do not smoke whilst using Xulane patches, especially if you are aged 35 or over.

Grapefruit and its derivatives may interact with Xulane to cause unwanted side effects. It is, therefore, important not to use or consume any products containing grapefruit.

Xulane patches will not protect you from sexually transmitted diseases. Using a condom is the only way to obtain protection from such diseases.

The patch may also be less effective for women who weigh more than 198 pounds. Always consult your doctor to determine whether Xulane patches are the right contraceptive method for you.


Before using the Xulane patch, you must inform your doctor of your full medical history. You may be unsuited to the patch if you have any of the following:

  • Allergies to ethinyl estradiol, norelgestromin, estrogen or any other ingredients.
  • Blood clotting disorders
  • High blood pressure
  • Abnormal breast exam
  • High cholesterol
  • Cancer
  • Diabetes
  • Heart problems
  • Migraines or headaches
  • Stroke
  • Unexplained vaginal bleeding

Xulane patches must not be used during pregnancy. If you think you may be pregnant, inform your doctor immediately. If you have just given birth or had a miscarriage, speak with your doctor, who will advise you on what type of contraception is best for you.

It is also advised to take caution when using Xulane whilst breastfeeding as the estrogen may reduce breast milk production. Small amounts of the hormones may also be present in the milk, which may produce undesirable effects on the nursing infant.

Drug Interactions

Some medications can make Xulane patches less effective. Inform your doctor of any other medications you are taking, both prescribed and over-the-counter, as well as any herbal or vitamin supplements, especially:

  • Acetaminophen, ascorbic acid (vitamin C) or lamotrigine
  • Thyroid medication
  • Antifungal medicine including fluconazole, itraconazole, ketoconazole or voriconazole
  • Cholesterol-lowering medicines including atorvastatin or rosuvastatin
  • HIV or AIDS medicines including atazanavir, etravirine, indinavir
  • Products containing St John’s Wort

Treatment Options

Alternative Treatment Options

While the Xulane patch is a worthwhile contraceptive method for many women, it is not suited for all. There are a wide range of effective options available on the market for those wanting an alternative birth control method. If you are unsure of which option is best for you, always speak with your doctor or a healthcare professional for advice.

Hormone-based Contraceptives

Implant (Implanon or Nexplanon)

This is a small rod inserted into the skin, typically in the upper arm and is over 99 percent effective in preventing pregnancy for up to 4 years. It is estrogen-free and therefore suitable for women who cannot use estrogen-based contraception. It is a fairly low-maintenance method that is safe for smokers as well as those with diabetes.

Some women have reported irregular menstrual cycles as well as dizziness, headaches, acne breakouts and hair loss as a result of the implant.

Shot (Depo-Provera)

This is an injectable solution containing the hormone progestin that is 94 percent effective in protecting against pregnancy for 3 months. It is a great alternative for women who do not want to take a pill every day and because it is estrogen-free, it is also a viable option for those who are breastfeeding.

Most women may experience changes, particularly during the first year, including heavier menstrual bleeding and spotting in between periods as well as weight gain.

Intrauterine Device (Mirena, ParaGard, Skyla, Liletta and Kyleena)

This is a small T-shaped device that is placed in the uterus and is 99 percent effective in preventing pregnancy for 3 to 12 years, depending on the type. Women have reported reduced cramps and lighter periods and it is also suitable for smokers as well as those with diabetes or hypertension.

There is a risk of the device slipping out or pushing through the uterus wall, increasing the risk of infection.

Barrier Method Contraceptives

Cervical Cap (FemCap)

This is a silicone cup that is inserted into the vagina and works by preventing sperm from reaching the uterus. It is recommended that spermicide be used in conjunction with the cap for it to be most effective. It is a prescription-free option that can also be used while breastfeeding.

The cup is 79-86 percent effective in typical use and can cause some vaginal irritation. Many women have a hard time inserting the cup and it can be pushed out of place during intercourse. It cannot be used by women who are allergic to spermicide or silicone.

Male/Female Condom

The male condom is a latex sheath that is put over the man’s erect penis to prevent the sperm from meeting the egg. With typical use, it is around 85 percent effective and there is a risk of the condom splitting or slipping off during intercourse.

The female condom is a pouch that is inserted into the vagina and helps to prevent pregnancy by retaining sperm during intercourse. However, in typical use it has proven 79 percent effective and can cause irritation as well as reduce sensitivity in some users during intercourse.

Both contraceptives are prescription-free and effectively protect against STIs.


Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

  1. Baby Center, ‘Birth Control Patch’, Baby Center, 2016, https://www.babycenter.com/0_birth-control-patch_1289811.bc#articlesection1, (accessed 25th April 2019).
  2. C. Multum, ‘Ethinyl Estradiol and Norelgestromin (Transdermal)’, Drugs.com, 2018, https://www.drugs.com/mtm/ethinyl-estradiol-and-norelgestromin-transdermal.html, (accessed 24th April 2019).
  3. Center for Young Women’s Health, ‘Hormone Patch (Ortho-Evra/Xulane)’, Center for Young Women’s Health, 2019, https://youngwomenshealth.org/2013/01/16/hormone-patch/, (accessed 25th April 2019).
  4. Crown, ‘Contraceptive Patch’, NHS, 2018, https://www.nhs.uk/conditions/contraception/contraceptive-patch/#at-a-glance-facts-about-the-patch, (accessed 23rd April 2019).
  5. Mylan Pharmaceuticals Inc., ‘The Xulane Patch’, Xulane, Author, 2017, https://www.xulane.com/, (accessed 23rd April 2019).
  6. N. Gustin, ‘The Birth Control Patch (Xulane), Single Care, 2019, https://www.singlecare.com/blog/birth-control-patch-xulane-contraceptive/, (accessed 24th April 2019). 
  7. National Institutes of Health, ‘Xulane – Norelgestromin and Ethinyl Estradiol Patch’, DailyMed, Author, 2018, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=adcf17ef-e60b-48a4-9478-3998dab2bbbd&audience=consumer, (accessed 23rd April 2019).
  8. RxList, ‘Xulane’, Author, 2017, https://www.rxlist.com/xulane-drug.htm#description, (accessed 26th April 2019).
  9. WebMD, ‘Does Xulane Patch, Transdermal Weekly Interact with other Medications?’, WebMD, 2019, https://www.webmd.com/drugs/2/drug-166145/xulane-transdermal/details/list-interaction-medication, (accessed 25th April 2019).
  10. Ziff Davis, ‘Xulane’, Everyday Health, 2019, https://www.everydayhealth.com/drugs/xulane, (accessed 23rd April 2019).

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