EVRA PATCH 9`S

EVRA is a weekly transdermal hormonal contraceptive patch that delivers a combination of norelgestromin (a progestogen) and ethinylestradiol (EE) continuously through the skin. It provides the same hormonal contraceptive mechanism as the combined oral contraceptive pill — suppressing ovulation, thickening cervical mucus, and altering the endometrium — but via a transdermal route.

EVRA is indicated for contraception in women of reproductive age. It offers several practical advantages over daily oral pills: it is applied only once weekly (three weeks on, one week off), reducing the risk of missed doses and improving adherence. It bypasses first-pass hepatic metabolism, providing more stable hormone levels.

A 9-patch pack covers 3 complete 28-day contraceptive cycles (3 weeks of patches + 1 patch-free week per cycle). Efficacy is comparable to combined oral contraceptives when used correctly (Pearl Index approximately 0.9 per 100 woman-years), though it may be less effective in women weighing more than 90 kg.

Apply one new patch every 7 days for 3 consecutive weeks, followed by a 7-day patch-free interval.

28-Day Cycle

•       Week 1 (Day 1): Apply patch 1 — this is your Patch Change Day (PCD).

•       Week 2 (Day 8): Remove patch 1, apply patch 2 on the same day.

•       Week 3 (Day 15): Remove patch 2, apply patch 3 on the same day.

•       Week 4 (Days 22–28): Remove patch 3 — no patch worn. Withdrawal bleed typically occurs.

•       Day 29 (Day 1 of new cycle): Apply patch 1 of new cycle on the same PCD.

Application Sites

•       Apply to clean, dry, hairless skin on the buttocks, abdomen, upper outer arm, or upper torso (not on breasts).

•       Do not apply to irritated, damaged, or cut skin.

•       Rotate application sites with each new patch.

Starting the First Patch

If starting on Day 1 of menstrual period: immediate contraceptive effect. If starting after Day 1 of period: additional barrier contraception needed for 7 days. If switching from pill: start EVRA on the day after the last active pill — no additional contraception needed.

Missed or Detached Patches

•       If patch has been off for less than 24 hours: re-apply or apply new patch. Keep original PCD — no additional contraception needed.

•       If patch off for more than 24 hours: apply new patch immediately; new PCD is today; use additional contraception for 7 days.

Common Side Effects

•       Application site reactions: erythema, pruritus, irritation, rash.

•       Breast tenderness or discomfort.

•       Headache.

•       Nausea.

•       Mood changes, decreased libido.

•       Breakthrough bleeding or spotting.

•       Weight gain or fluid retention.

Serious Risks

•       Venous thromboembolism (DVT, PE) — key risk of all combined hormonal contraceptives. EVRA delivers EE via a non-first-pass route — some data suggest slightly higher EE exposure than equivalent-dose pills, which may affect VTE risk. Counsel accordingly.

•       Arterial thromboembolism — stroke, myocardial infarction. Risk is higher in smokers (especially over 35), hypertension, and migraine with aura.

•       Hypertension.

•       Cervical cancer — with long-term use (multifactorial).

•       Small increased breast cancer risk — similar to oral CHCs.

VTE Risk

All combined hormonal contraceptives increase VTE risk. The risk is highest in the first year of use, in smokers, overweight women, and those with immobility. Pharmacovigilance data suggest that EVRA may carry a slightly higher VTE risk than 20–35 mcg EE pills, potentially related to the higher systemic EE exposure from the transdermal route. This should be discussed during counselling, particularly in women with additional VTE risk factors.

Reduced Efficacy in Women over 90 kg

Clinical data suggest that EVRA patch efficacy may be reduced in women weighing more than 90 kg. This is because the fixed drug delivery may not achieve adequate plasma levels in higher body-weight patients. Alternative contraceptive methods should be considered for women above this weight threshold.

Skin Application Cautions

Avoid applying patches to areas likely to rub against tight clothing (waistband areas). Do not apply moisturiser, powder, or cosmetics to or near the patch site. Do not use adhesive tape or bandages over patches. Inspect adhesion at each change.

Surgery and Immobility

Stop EVRA patch at least 4 weeks before major elective surgery or prolonged immobilisation, as VTE risk is substantially increased peri-operatively. Restart no earlier than 2 weeks after full mobilisation.

•       CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, St John's Wort) — reduce EE and NGMN plasma levels, potentially reducing contraceptive efficacy; use additional/alternative contraception during and for 28 days after use of inducer.

•       HIV antiretrovirals (ritonavir, lopinavir, efavirenz) — complex interactions; some reduce hormonal levels; additional contraception or alternative method recommended.

•       Lamotrigine — oestrogen significantly reduces lamotrigine levels, potentially causing seizures; monitor closely or switch to progestogen-only contraceptive.

•       Warfarin — oestrogen may alter anticoagulant requirements; monitor INR.

•       Broad-spectrum antibiotics — older caution; current evidence does not confirm significant pharmacokinetic interaction with most antibiotics.

•       Store below 25 degrees Celsius. Do not freeze.

•       Store in original sealed sachets until use.

•       Used patches retain hormones — fold sticky sides together and dispose in household waste.

•       Keep out of reach of children.

EVRA patch is a prescription-only medicine (POM) in Kenya, prescribed by general practitioners, family planning clinics, and gynaecologists for contraception.

Annual review of contraceptive needs, risk factors, and blood pressure is recommended.

Counselling Points for New Users

•       Clear explanation of the 3-week-on, 1-week-off cycle.

•       Patch change day must remain consistent — same day each week.

•       What to do if a patch is missed, late, or detached (see Section 2).

•       VTE warning signs: sudden leg pain/swelling (DVT), chest pain/breathlessness (PE), severe headache, visual disturbance (stroke).

•       Reduced efficacy in women over 90 kg.

•       EVRA does not protect against STIs.

Comparing to Combined Pill

EVRA is pharmacologically equivalent to a 20 mcg EE combined pill but with once-weekly dosing improving adherence significantly. Efficacy in typical use is similar. Key differences: weekly vs daily dosing; transdermal vs oral administration; potential for skin reactions; possible higher EE exposure affecting VTE risk; reduced efficacy above 90 kg body weight.

Can I wear the EVRA patch while swimming or exercising?

Yes — the EVRA patch is designed to stay in place during swimming, bathing, showering, exercising, and most physical activities. If the patch becomes loose at the edges, press it down firmly. If it comes off completely during exercise or swimming, check how long it has been off and follow the missed patch instructions. Avoid applying moisturiser or oil to the skin near the patch as this may reduce adhesion.

I weigh more than 90 kg — can I still use EVRA?

EVRA may be less effective in women weighing more than 90 kg, as the fixed hormone dose may not provide adequate blood levels to reliably prevent pregnancy. You should discuss this with your doctor, who may recommend a different contraceptive method — such as a combined oral pill at higher dose, an IUD, or an implant — that does not have this body weight limitation.

What should I do if I forget to remove my patch at the end of week 3?

If you forget to remove the third patch at the end of week 3 and start the patch-free week late, remove the patch as soon as you remember and begin the patch-free week from that point. Apply your new patch 7 days after removing the old one. No additional contraception is needed unless the patch-free week has exceeded 7 days, in which case treat it as a missed patch and use additional contraception for 7 days.