Contraceptive patch – rant or rave?

Patches seem to be all the rage right now. 

Pain? Lidocaine patch. 

Tired? Green tea caffeine patch. 

Blemish? Salicylic acid patch.

Hungover? Vitamin B patch.

Now birth control patches (which I call the contraceptive patch) are a different story. They aren’t new and they certainly aren’t all the rage either. In fact, the Guttmacher Institute estimates that only 0.3% of all people of reproductive age use the patch as their form of contraception. Why so low?

Here are the deets on the contraceptive patch!

Photo by Matt Howard

I usually clump combined oral contraceptives (COCs), the vaginal ring, and the contraceptive patch all together when discussing options with patients. They all contain a combination of the synthetic versions of estrogen and progesterone so they work in the same way: the estrogen suppress ovulation, the progesterone thickens cervical mucus and stops / tries to stop sperm from reach the uterus. They can be effective at lessening menstrual flow and minimizing period cramps. 

The biggest difference between the pills / patch / ring? The way they deliver the hormones! 

  • PILLS: The pills are taken orally daily. There are hundreds of combinations of birth control pills – here’s my article for more details!
  • RING: There are 2 vaginal rings on the market – NuvaRing and Annovera. They are placed inside the vagina and hormones are absorbed from there into the blood stream. We also have an article about vaginal rings if you’re interested!
  • PATCH: one patch is applied to the skin and changed weekly. 

Patch specifics: 

There are 2 patches available in the US today: Twirla and Xulane.

One has been discontinued: Ortho Evra

Ortho Evra was first FDA approved birth control patch, approved in 2001. It was quite innovative at the time. But with most other FDA approved drugs, it only had a limited exclusivity timeline. That means that after a certain number of years, generics are allowed on the market. That number is typically 5 years, and brands strive to market, gain popularity, get loyalty, and make a bunch of money in those years. Once generics are on the market, the brand name is often substituted out for a generic because generics are cheaper. So that’s what happened in this situation – when Xulane came on the market as the generic version, Ortho Evra tanked and was discontinued. 

Here’s the scoop on the 2 options: 

XULANE

  • Contains 150mcg / day of norelgestromin and 35 mcg /day of ethinyl estradiol 
  • Norelgestromin is the progestin (that’s what we call a synthetic progesterone). Its metabolite is a commonly used progestin called levonorgestrel. Levonorgestrel is used in some of my favored birth control pills, the hormonal IUDs, and Plan B. It’s a well studied and popular progestin. 
  • The amount of ethinyl estradiol (35mcg / day) is the same as the highest dose birth control pill available on the market in the US. But the amount of ethinyl estradiol that becomes active in the body is higher from the patch than the pills. That means this patch is highest amount of estrogen available in birth control form. Higher estrogen can increase in the risk of blood clots and other serious complications in birth control users. Not so good. 
  • Not effective for people with a BMI over 30 and weight >200lbs, which limits its use. 

TWIRLA:

  • Contains 120mcg / day of levonorgestrel and 30 mcg /day of ethinyl estradiol 
  • See above for the levonorgestrel info (similar to Xulane)
  • The amount of ethinyl estradiol (30mcg / day) is lower than Xulane. In the studies, it also doesn’t appear to have the same dramatic increase in levels compared to birth control pills. So as far as the dose, this one is preferable over Xulane. 
  • Not as effective for people with a BMI over 25 and should absolutely not be used if BMI >30.  This limits its use quite a bit, even more than Xulane. 

My bottom line: 

If you’re interested in the contraceptive patch and have a BMI <25, Twirla is your girl. 

Some additional tips and reminders!

  • Change the patch once a week, on the same day each week. Set an alert. 
  • After 3 patches / weeks, no patch is worn on the 4th week. That’s the same as the “placebo” week with birth control pills. A withdrawal bleed could / should happen.
  • The patch can be placed anywhere on the body except the breasts and vulva. Most people place it in an inconspicuous place like the hip or upper leg. 
  • Place the patch somewhere that clothes won’t rub. That can be annoying but also can rub it off. 
  • It’s more likely to come off if exposed to water often, like swimming or hot tubs. But in the studies, this only happened to 5% of users 
  • If it comes off, put on a new patch when you notice! If it’s off and you didn’t realize it, take Plan B if you’ve had unprotected sex. You’ll also need a back off form of contraception for a week once you put a new one back on. 
  • The patch can get a bit grimy around the edges, just like an old band aid. Know that it’s normal, but also applying it to clean, freshly washed skin without moisturizer or oils can decrease it. 

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