If this is your first time using Evra or you are restarting:

• Apply the first patch on days 1-5 of your next period and you will have full contraceptive cover immediately.
• If you have not been sexually active since your last period, you can start it at any time of your cycle. You will need to use additional contraception if you have sex within the first 7 days of using the patch.

The patch should be changed every week at around the same time, for 3 weeks. Then you have a 7 day hormone-free break.

If you are changing from another form of contraception, please send us a message with your Evra request and we can give you individual advice on how to do this.

Tailored Patch-Use

Traditionally, Evra patches are used for 3 weeks in a row and then you have a 7 day break when you will most likely have a withdrawal bleed. This cycle is repeated.

There is no medical reason to leave the Evra patch off for a full 7 days before applying a new one.

It is now recommended that contraceptive patches can be used in cycles as follows to provide more reliable contraceptive cover and better bleeding control if preferred:

Alternative methods of taking combined contraception:

• Apply a new patch every week for 3 weeks and have a patch free interval of 4 days only.
• Apply a new patch every week for 9 weeks and then have a patch free interval of 4 days.
• Continuous use of the patch (applying a new patch every week for at least 3 weeks) until there is spotting for 2 days, then take a 4-day break and apply a new patch. Continue this pattern of use until spotting occurs again.

If you follow a set pattern of use and have a planned break, you will usually bleed during this time. Make sure you apply the next patch after the recommended patch-free break, regardless of your bleeding pattern.

These are examples of ‘off-licence’ patch prescribing. This means they are being used in a different way to that detailed on the product licence by the drug company. These methods of patch-use are supported by the Faculty of Sexual and Reproductive Health. They are considered to be safe.

We can offer you further advice on this, just send us a message via your account when you have completed the request questionnaire.

Evra should be applied to clean, dry, hairless, skin on the buttock, abdomen, upper outer arm or upper torso, in a place where it will not be rubbed by tight clothing.

Evra should not be placed on the breasts or on skin that is red, irritated or cut.

To help minimise the risk of skin irritation each new patch should be applied to a different area of skin (this can be within the same general location).

Before applying a new patch, avoid using any products on your skin. This will help to ensure your patch sticks properly to your skin.

The transdermal patch should be pressed down firmly until the edges stick well.

The patch should not be cut or altered in any way. This can cause contraceptive failure.

You should change your patch on the same day each week and don’t forget to remove the old patch! Check your patch every day to ensure it has not fallen off.
Carefully follow the instructions that come with your medication on how to use the Evra patch.

Evra is very well-tolerated and most women do not experience side effects. In those that do, nausea, headaches and breast tenderness are the most common and usually settle quickly. Spotting between periods is also common and should settle within the first 3 cycles.

Skin irritation and itch can occur where the patch has been applied.

Occasionally skin changes such as acne, decreased libido (sex drive), altered mood and fatigue are reported.

If you develop any of these symptoms and they are persisting, or you are concerned, please speak with your doctor. There are many alternative pill options to consider.

Combined contraception containing oestrogen like the Evra patch can cause increases in blood pressure. It is not medically safe to use this type of contraception if you have high blood pressure. A blood pressure check should be performed every 6-12 months to monitor for this as you are unlikely to have any symptoms.

For full details of the potential side effects of these medications, please ensure that you read the patient information leaflet that comes with your medication before you start to use it.

Yes, using combined contraception, such as the Evra patch, increases your risk of developing potentially harmful blood clots, compared to non-users. However, the overall risk of developing a blood clot is very small and is significantly lower than if you were pregnant or during the postpartum period. But blood clots are potentially very serious and in very rare cases can be fatal.

You should see a doctor immediately if you develop any of the following symptoms when using the Evra patch:

• Pain or swelling in the legs.
• Severe chest pain.
• Breathlessness or coughing up blood.
• Bad fainting attack or collapse.
• Unusual headaches or difficulty with speech or sight.
• Numbness or weakness of a limb.

The potential risk of developing a blood clot when using combined contraception varies between different contraceptive products. Current evidence suggests that the Evra patch may have up to twice the risk compared to some other combined contraceptive products.

• If a blood clot develops in the leg, it can cause deep vein thrombosis (DVT).
• If it travels to the lung, it can cause a pulmonary embolism (PE).
• If it travels to the heart, it can cause a heart attack.
• If it travels to the brain, it can cause a stroke.

The risk of developing a blood clot is greatest in the months immediately after starting combined contraception (evra patch, Nuvaring or any of the combined pills), or when restarting after a break of at least one month. This risk reduces over the first year of use and then remains stable. It is for this reason that frequent starting and stopping of combined contraceptive methods should be avoided.

Other things that can increase your risk of developing a blood clot when using Evra include:

• Being overweight.
• Smoking.
• Increasing age (from 35 years and older).
• Having a family member with a blood clot ages <45 years.
• Postpartum (6-12 weeks post-delivery).
• Reduced mobility (even temporarily).

The more of these risk factors that apply to you, the greater your risk.

Seek additional advice if you are:

• Having a procedure or surgery (of any type).
• Planning a long haul flight.
• Planning a holiday to an area of high altitude.
• Immobilised for a prolonged period of time.

Further information about blood clot risk is detailed in the leaflet that comes with your medication. Please read this before you start this pill.

Here you can find further information about blood clot risk and the Evra patch (page 3). Please read this information before you use this medication so you can make an informed choice.

Some people will experience breakthrough bleeding when they do not have a monthly break.

• Apply a new patch (don’t try to reapply the old patch, or hold it place with a plaster or bandage).
• Change it on your normal change day.

You will have full contraceptive cover if you have used your patch correctly for the previous 7 days (and the 7 days before your patch-free week, if you’re in week 1)

If the patch has been off for 48 hours or more, or you’re not sure how long:

• Apply a new patch.
• Change it on your normal change day, if you’re in week 1 or 2 of your patch cycle.
• If you’re in week 3, you need to start a new patch cycle; you make this day 1 of your new cycle and do not take your usual patch-free week. (You will now have a new weekly patch change day).
• Whatever week you’re in, you will need to use additional contraception until you’ve had a patch on for 7 days in a row.

Emergency Contraception

You may need emergency contraception if you had sex:

• During the patch-free break
• In week 1 and the patch fell off during week 1.
• During week 2 or 3 when a patch had not been on properly for the previous 7 days.

If any of these situations apply to you, please speak with a doctor, nurse or pharmacist for advice.

And don’t forget to check your patch every day to ensure it is still in place!

For more detailed information about what to do if your patch falls off or is not replaced on time, please read the information leaflet that comes with your packet of patches.

If the patch change is late by less than 48 hours:

• Apply a new patch as soon as possible and remove the old patch.
• Change it on your normal change day.

You will have full contraceptive cover if you have used your patch correctly for the previous 7 days (and the 7 days before your patch-free week, if you’re in week 1).

If the patch change is late by more than 48 hours:

• Apply a new patch.
• Change it on your normal change day, if you’re in week 1 or 2 of your patch cycle.
• If you are in week 3, make this day 1 of your new cycle and do not take your usual patch-free week. (You will now have a new weekly patch change day).
• Use additional contraception until you’ve had a patch on for 7 days in a row.
• Contact a healthcare professional for advice as emergency contraception or a follow up pregnancy test may be required.

If you forget to take the patch off at the end of week:

• Take it off as soon as you remember.
• Start your patch-free break.
• Apply your new patch on your usual start day (your patch-free break will be shorter than usual).
• No additional contraception is required but your bleeding pattern may be altered.

No, if you have vomiting or diarrhoea, the Evra patch still provides you with effective contraception and no additional protection is required.

Ensure you remain well hydrated if you have vomiting or diarrhoea to ensure your risk of developing a potential blood clot remains low.

Some medications (prescribed and over-the-counter), herbal remedies and supplements can interact with Evra. This can cause contraceptive failure and increase the possibility of potential side effects.
Please seek advice from a healthcare professional (e.g. doctor, pharmacist or nurse):

• Before starting any new medications, herbal remedies or supplements if you are using Evra.
• If you are taking regular medication and are planning to start using Evra (or any contraceptive).

Examples of some medications that can interact with Evra include EllaOne (emergency contraceptive pill), St John’s wort, antiviral medications used to treat HIV/ AIDs, certain epilepsy medications, griseofulvin antifungal, rifampicin antibiotic (please note, other antibiotics do not affect the Evra patch).