Pharm

Contraceptive Patch

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Contraceptive Patch, Transdermal Contraception, Ortho Evra, Xulane, Twirla

  • Mechanism
  1. Transdermal patches release Hormones at constant rate
  • Preparations
  1. Ortho Evra
    1. Ethinyl Estradiol 20 mcg/day
    2. Norelgestromin 150 mcg/day
  2. Xulane
    1. Ethinyl Estradiol 35 mcg/day
    2. Norelgestromin 150 mcg/day
  3. Twirla
    1. Ethinyl Estradiol 30 mcg/day
    2. Levonorgestrel 120 mcg/day
  • Technique
  • 4 week cycles
  1. Patch applied to unbroken skin, and replaced each week for 3 weeks
    1. Upper arm
    2. Buttock
    3. Lower Abdomen
    4. Upper trunk (not on Breasts)
  2. Patch removed for 1 week for withdrawal bleeding
  3. New patch started and replaced each week for 3 weeks
  • Efficacy
  1. Ortho Evra
    1. Failure rate: 0.88 pregnancies per 100 woman years
    2. Lower efficacy if weight >198 pounds (90 kg)
  2. Twirla
    1. Lower efficacy rate if BMI >30
  • Adverse effects
  1. Overall patch has similar adverse effects to OCP
  2. Transdermal specific adverse effects
    1. Contact Dermatitis reaction to patch
    2. Detachment rate: 2.8% of patches partially detach (Ortho Evra)
  3. Increased adverse effects in first two months
    1. Breakthrough bleeding in 40% on Twirla at one year (8% with Xulane)
    2. Breast discomfort (Mastalgia)
  4. Thromboembolism risk may be as high as twice the risk of Oral Contraceptives
    1. Likely related to the higher Estrogen concentrations in the patch compared with Oral Contraceptives
    2. Cole (2007) Obstet Gynecol 109(2 Pt 1):339-46 [PubMed]
  • Benefits
  1. Higher compliance rate than with Oral Contraceptives
  • References
  1. (2020) Presc Lett 27(12): 70
  2. Herndon (2004) Am Fam Physician 69(4):853-60 [PubMed]