Overview

The birth control patch is a type of contraception that contains the hormones estrogen and progestin. You wear the patch to avoid becoming pregnant.

Once a week for three weeks, you place a small patch on your skin, so that you wear a patch for a total of 21 days. During the fourth week, you don't wear a patch — which allows menstrual bleeding to occur.

The birth control patch works similarly to combination birth control pills. The birth control patch prevents pregnancy by releasing hormones into your bloodstream that keep your ovaries from releasing an egg (ovulation). The birth control patch also thickens cervical mucus to keep sperm from reaching an egg.

You'll need a prescription from your health care provider to use the birth control patch. The patch doesn't protect against sexually transmitted infections (STIs).

Why it's done

The birth control patch is used to prevent pregnancy. The birth control patch has some advantages over other types of birth control:

  • It eliminates the need to interrupt sex for contraception.
  • You don't need your partner's cooperation to use it.
  • It doesn't require daily attention or having to remember to take a pill every day.
  • It provides a steady dose of hormones.
  • It's easier to use if you have trouble swallowing pills.
  • It can be removed at any time, allowing for a quick return to fertility.

The birth control patch isn't appropriate for everyone, however. Your health care provider may advise against the patch if you:

  • Are age 35 or older and smoke
  • Have chest pain or a history of heart attack, stroke or severe high blood pressure
  • Have a history of blood clots
  • Have a history of breast, uterine or liver cancer
  • Weigh more than 198 pounds (90 kilograms)
  • Have liver disease or migraines with aura
  • Have diabetes-related complications of the kidneys, eyes, nerves or blood vessels
  • Have unexplained vaginal bleeding
  • Developed yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or when previously taking hormonal contraceptives
  • Are about to have major surgery and will be unable to move around as usual
  • Are taking any medications or herbal supplements
  • Are sensitive to any part of the birth control patch

In addition, tell your health care provider if you:

  • Are breastfeeding or recently gave birth, had a miscarriage or had an abortion
  • Have concerns about a new breast lump or change in your breast self-exam
  • Take epilepsy medications
  • Have diabetes or gallbladder, liver, heart or kidney disease
  • Have high cholesterol or triglycerides
  • Have irregular periods
  • Have depression
  • Have skin conditions, such as psoriasis or eczema

Risks

With perfect use, pregnancy happens in less than 1 out of 100 women during the first year of using of the birth control patch. Pregnancy rates are estimated to be 7 to 9 out of 100 women during a year of typical use. Typical use situations might include forgetting to change the patch on time or discovering that the patch came loose from your skin for a prolonged time.

The birth control patch doesn't protect against sexually transmitted infections (STIs).

Side effects of the birth control patch may include:

  • An increased risk of blood-clotting problems, heart attack, stroke, liver cancer, gallbladder disease and high blood pressure
  • Breakthrough bleeding or spotting
  • Skin irritation
  • Breast tenderness or pain
  • Menstrual pain
  • Headaches
  • Nausea or vomiting
  • Abdominal pain
  • Mood swings
  • Weight gain
  • Dizziness
  • Acne
  • Diarrhea
  • Muscle spasms
  • Vaginal infections and discharge
  • Fatigue
  • Fluid retention

Some research shows that the birth control patch may increase estrogen levels in the body compared with combination birth control pills that are taken by mouth. This may mean there's a slightly higher risk of estrogen-related adverse events, such as blood clots, in patch users than in people who take combination birth control pills.

How you prepare

You'll need to request a prescription for the birth control patch from your health care provider. Your health care provider will review your medical history and check your blood pressure. Talk to your health care provider about any medications you're taking, including nonprescription and herbal products.

What you can expect

To use the birth control patch:

  • Talk to your health care provider about a start date. If you're using the birth control patch for the first time, wait until the day your period starts. Then, if you use the first-day start, you'll apply your first patch on the first day of that period. No backup method of contraception is needed. If you use the Sunday start, you'll apply your first patch on the first Sunday after your period starts. Use a backup method of contraception for the first week.
  • Choose where to apply the patch. You can place the patch on your buttock, upper outer arm, lower abdomen or upper body. Don't put it on your breasts or in a place where it will be rubbed, such as under a bra strap. Apply to skin that's clean and dry. Avoid areas of the skin that are red, irritated or cut. Don't apply lotions, creams, powders or makeup to the skin area where the patch will be. If skin irritation develops, remove the patch and apply a new patch to a different area.
  • Apply the patch. Carefully open the foil pouch. Use your fingernail to lift one corner of the contraceptive patch. Peel the patch and the plastic liner away from the pouch, then peel away half of the protective clear lining. Be careful not to cut, alter or damage the patch. Apply the sticky surface of the patch to your skin and remove the rest of the liner. Press down firmly on top of the skin patch with the palm of your hand for about 10 seconds. Smooth it out, making sure that the edges stick well. Leave the patch on for seven days. Don't remove it to bathe, shower, swim or exercise.
  • Change your patch. Apply a new contraceptive patch to your body each week — on the same day of the week — for three weeks in a row. Apply each new patch to a different area of skin to avoid irritation. After you remove a patch, fold it in half with the sticky sides together and throw it in the trash. Don't flush it down the toilet. Remove any adhesive that remains on your skin with baby oil or lotion.
  • Check the patch regularly to make sure it's still in place. If the patch becomes partially or completely detached and can't be reapplied, replace it with a new patch immediately. Don't reapply a patch if it's no longer sticky, it becomes stuck to itself or another surface, or it has other material stuck to it. Don't use other adhesives or wraps to hold the patch in place. If your patch becomes partially or completely detached for more than 24 hours, apply a new patch and use a backup method of contraception for one week.
  • Skip the patch on the week 4. Don't apply a new patch during the fourth week, when you'll have your period. After the fourth week ends, use a new patch and apply it on the same day of the week that you applied the patch in the prior weeks.
  • If you're late applying a new patch, use backup contraception. If you're late applying the birth control patch in your first week or more than two days late in your second or third week, apply a new patch immediately and use a backup method of contraception for one week.

Consult your health care provider as soon as possible if you have:

  • Sharp chest pain, sudden shortness of breath or coughing that brings up blood, which can be signs of a blood clot
  • Persistent pain in your calf or other signs of a blood clot in your leg
  • Sudden partial or complete blindness or other signs of a blood clot in your eye
  • Crushing chest pain or other signs of a heart attack
  • Sudden severe headache, problems with vision or speech, numbness in an arm or leg, or other signs of stroke
  • Yellowing of the skin or whites of the eyes, possibly accompanied by fever, fatigue, loss of appetite, dark urine or light-colored bowel movements
  • Severe trouble sleeping, fatigue or feeling sad
  • Severe abdominal pain or tenderness
  • A breast lump that persists through 1 to 2 menstrual cycles or increases in size
  • Two missed periods or other signs of pregnancy
Aug. 06, 2021
  1. Birth control methods. Office on Women's Health. https://www.womenshealth.gov/a-z-topics/birth-control-methods. Accessed April 15, 2021.
  2. Xulane (prescribing information). Mylan Pharmaceuticals; 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f7848550-086a-43d8-8ae5-047f4b9e4382. Accessed April 14, 2021.
  3. Burkman RT. Contraception: Transdermal contraceptive patches. https://www.uptodate.com/contents/search. Accessed April 13, 2021.
  4. Hatcher RA, et al., eds. Contraceptive patch and vaginal contraceptive ring. In: Contraceptive Technology. 21st ed. Ayer Company Publishers; 2018.
  5. Twirla (prescribing information). Agile Therapeutics; 2020. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcaf8db0-1750-425d-b008-255b5e7a9cc6. Accessed April 14, 2021.

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