Sex & fertility
Is Evra safe?
Q: Does the new Evra birth control patch really work? Does it stay on? More importantly, is it safe?
A. The Evra patch is a highly effective form of hormonal birth control that delivers the same hormones into your system as the Pill. But with the patch, the transdermal delivery system passes those hormones through your skin instead of passing them through your digestive tract.
The patch seems to stick perfectly well. When I wore the patch, in fact, it seemed to stick better the longer I had it on. I have also read a study done at a health club in which women wore the patch while exercising, in hot tubs, and in saunas. Most women had no problem with its adhesiveness. And if the patch does fall off, you can apply a replacement patch. If done promptly, this does not seem to reduce the effectiveness.
The Evra patch carries similar risks and benefits to birth control pills, but there have been some questions raised recently about its safety. Because of the sustained-release nature of transdermal delivery with the patch, you have minimal peaks and troughs in serum blood levels of the active ingredient — synthetic estrogen, and up to 60% more total estrogen exposure as a result. For those women who have symptoms triggered by their baseline hormonal fluctuations, such as hormonal migraines, the steady-state dosing methods like the Evra patch or NuvaRing can be useful. In contrast, oral birth control pills can create major peaks and troughs of hormone levels for the 24-hour period after ingestion. However, some women using the Evra patch do experience an increase in other estrogen-dominance type symptoms, such as fluid retention, breast tenderness or enlargement, and so forth.
Although the symptoms discussed above typically subside after a few months of use, the fact remains that there is a certain inherent risk of adverse events with any hormonal contraceptive method, largely due to the doses. Before starting any form of birth control, it’s a good idea to inform yourself of what risks or side effects may be involved — at minimum thoroughly read the product insert.
Recent studies do show a slightly greater risk of thromboembolic events (e.g., blood clots in particular) from higher exposure to synthetic estrogen using the Evra patch than with low-dose birth control pill use. The overall increased risk in terms of numbers goes up from 1 in 10,000 to 3–5 in 10,000 with the patch.
Nonetheless, many women prefer the ease of wearing a patch over having to remember to take a pill every day. I ask all of my patients to take a multivitamin, calcium supplement, and essential fatty acids every day, and the patch does make for one less pill to swallow.
Like the Pill, the patch is used for three consecutive weeks followed by a week where you go without one and have a hormone withdrawal bleed. A new patch is applied only once a week during those three weeks on, which appeals to many women more than a daily routine.
(Read more on the Evra patch here: www.orthoevra.com)
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Original Publication Date: 11/01/2005
Last Modified: 08/17/2009
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician