Important things to know before using a birth control patch

Birth control patches are just as effective as pills and easy to use


What is a birth control patch?

A birth control patch (often also called a contraceptive patch) is a patch that is applied externally to the skin and releases hormones (estrogen and a form of progestogen called progestin) in order to prevent you from getting pregnant. Two big U.S. FDA approved brands in the domestic market are Xulane and Twirla, and they are available upon prescription, just like all other regular birth control medications.

The two hormones in the birth control patch act together to prevent your ovaries from releasing eggs (ovulation) and they increase cervical mucus, which blocks more sperms from moving into the uterus. The hormones also make the uterus lining thinner, which decreases the chance of a fertilized egg getting implanted there. So, it’s really a three-way approach to lowering the likelihood of getting pregnant. 

Similar to conventional birth control meds, the hormonal effect of the patch also helps make the menstrual cycle more regular and lighter. It also can improve PMS symptoms and acne and may increase protection against ovarian cysts, pelvic inflammation and ovarian cancer.

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There also are some mild to moderate side effects though. Several large studies have shown that about 17% of women using the patches experienced nausea and 22% reported breast engorgement and pain. About 10% also experience menstrual cramps. It appears these side effects largely are limited to the initial months of using the patch and in most cases disappear after three months of use, as the body has grown accustomed to the hormone infusion. All these side effects are similar to contraceptive pills since both methods are based on the same hormones (the only difference being oral vs. skin delivery). 

How effective are birth control patches?

The patches are just as effective as birth control pills. If used exactly as prescribed, they prevent pregnancies in 99.7% of cases, and even the typical observed use, i.e., how women use them on a regular basis, it’s ~93% effective. These numbers are comparable to birth control pills. 

How to use the birth control patch and when to first use it?

The convenient thing about the patch is that you’ll only need to put it on once a week, and not take it daily like the pill. So, after seven days of having the patch on your skin, you can remove it and replace it with a new one. After three weeks (that is 3 patches, each one week), you don’t use a patch for the one week (to give the body a rest) and then restart the cycle all over. 

The patch typically is put on the upper arm, lower abdomen, buttocks, or lower back. The patches are very resilient to water and sweat and won’t come off easily, but very rarely (about a 2% chance) that can happen. If so, try to reattach the patch or use a new one as soon as you can. Bear in mind that if you go without a patch for longer than 24 hours you’ll you’re your pregnancy protection. 

If you think you’d like to give birth control patches a try and obtained a prescription from your doctor, it doesn’t matter which day of your cycle you start using the patch. There may be some irregular menstrual bleeding during the first months of patch use — for example, you may even experience two bleedings within one month — but this is no reason to worry. 

Initially, during the first week of patch use its effectiveness hasn’t fully ramped up, so you should use additional protection (condoms, etc.) and abstain from sex during that week just to be on the safe side. 

Set up a fixed routine where you replace your patch on the same weekday every week. The patch should be changed regardless of where you currently stand in your cycle, i.e., whether you are bleeding or spotting or not.

What to do when I missed a patch change?

In case you were wearing your current patch for longer than seven days, that’s no reason to freak out. There’s a grace period of a couple of days where the patch still provides some protection. However, this shouldn’t be exploited. So, be careful to strictly change the patch after seven days. If you do miss a patch change, replace the old patch once you have noticed and continue your usual patch routine. 

For example, if you are one day late on the patch change, your next scheduled patch change will still be six days from now, not seven. Just to be safe, if you missed a patch, use a condom or be abstinent for about week, as this allows your birth control protection to be fully restored by the new patch. If you have missed a patch or patch change for longer than 48 hours, you may want to seek medical advice, as emergency contraception may be required.

How will my period be affected?

As mentioned, the menstruation cycle gets lighter and most likely even shorter as a result of using the patch. Irregular bleeding in the first few weeks is normal. Eventually, your cycle will get into a routine of no bleeding during the three consecutive weeks of patch use, followed by a light period in the fourth week when you don’t have a patch on. This is called withdrawal bleeding. If you want to avoid the latter, talk to your doctor about using the birth control patch continuously instead of skipping each fourth week.


Sibai, Baha M., et al. “A Comparative and Pooled Analysis of the Safety and Tolerability of the Contraceptive Patch (Ortho EvraTM/EvraTM).” Fertility and Sterility, vol. 77, 1 Feb. 2002, pp. 19–26,, 10.1016/S0015-0282(01)03264-2. Accessed 12 Mar. 2020. 

Zieman, Miriam, et al. “Contraceptive Efficacy and Cycle Control with the Ortho EvraTM/EvraTM Transdermal System: The Analysis of Pooled Data.” Fertility and Sterility, vol. 77, 1 Feb. 2002, pp. 13–18,, 10.1016/S0015-0282(01)03275-7. Accessed 12 Mar. 2020.

Stewart, Felicia H., et al. “Extended Use of Transdermal Norelgestromin/Ethinyl Estradiol: A Randomized Trial.” Obstetrics & Gynecology, vol. 105, no. 6, June 2005, pp. 1389–1396,, 10.1097/01.aog.0000160430.61799.f6. Accessed 12 Mar. 2020.

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