Family Planning of Clallam County
Client Information for Informed Consent
THE PATCH — ORTHO EVRA
Before using the patch, you need to know the possible advantages, disadvantages, risks, and warning signs to watch for. We have listed them here for you. Be sure to read the manufacturer’s information, too. We are happy to answer your questions.
Other methods of birth control are available. We will offer you information about their use, effectiveness, advantages, disadvantages, risks, and warning signs. You should read these materials, as well. Let us know if you have any questions about them.
You may notice some differences between the information the manufacturer provides and the information we provide. Please consult your clinician if you have questions about any difference you observe.
The patch is a combined hormone method of birth control. It is a thin, beige, plastic patch that sticks to the skin. You put it on once a week for three weeks in a row. You then have a patch-free week. The sticky surface of the patch contains two hormones. They are constantly released into the bloodstream. They are similar to the estrogen and progesterone made by a woman’s body. They keep the ovaries from releasing eggs. They also thicken the cervical mucus to keep sperm out of the uterus.
The patch is very effective if used correctly. Of every 100 women who use the patch, about eight will become pregnant the first year with typical use. Fewer than one out of 100 will become pregnant with perfect use.
The patch may be less effective for women who weigh more than 198 lbs (90kg), but it may still be a good option for them. It may also be less effective if it is taken with certain drugs, especially some that are used to control seizures or to treat certain mental illnesses or HIV/AIDS. Be sure to talk with your clinician if you take any other medicine — including herbs and over-the-counter medicine. Tell other clinicians you see that you use the patch.
The patch offers no protection against sexually transmitted infections (STIs). Condoms are the best way for sexually active people to reduce the risk of STIs. Always use a condom if you or your partner has other sex partners.
Advantages of the Patch
•no medicine to take every day
•ability to become pregnant should return quickly
•nothing to do before sex to make it work
Because the patch works like the pill, it probably offers the same benefits:
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more regular periods
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some protection against cancers of the ovaries and uterus
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fewer menstrual cramps
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less blood loss
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decreased risk of PID (pelvic inflammatory disease)
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less iron deficiency anemia
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decreased risk of ectopic pregnancy
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some protection against non-cancerous breast tumors and ovarian cysts
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less acne
Disadvantages of the Patch
• Some women may forget to apply and remove it on schedule.
Possible side-effects that usually clear up after two or three months include
• breast discomfort • nausea
• headache • abdominal pain
• skin irritation at the patch site • menstrual cramps
Risks of Using the Patch
More estrogen is absorbed from the patch than from some other hormonal methods. The risks of heart attack, stroke or blood clots in the lungs are rare for the patch, the pill, and the ring. It is uncertain whether patch users have an increased risk of blood clots in the legs.
Users have a slightly greater risk than non-users of developing certain serious problems that may cause death in rare cases, including
• blood clots in the legs that can travel
• heart attack or stroke
• liver tumors
What are your annual chances of developing a blood clot?
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Four out of 100,000 if you don’t use any hormonal birth control and are not pregnant.
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Ten to 30 out of 100,000 if you are taking the pill —may also be true for the patch.
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If you become pregnant, the chance is about 60 out of 100,000 per year.
The more risk factors a woman has for heart disease, the greater the chance of developing certain serious health problems while using the patch. Risk factors include
• being older than 35
• high blood pressure
• tobacco use
• high levels of cholesterol
• diabetes
Tell your clinician if you have any of these risk factors or conditions and about any other past or current medical problems or concerns you may have. Your clinician will help you to decide if the patch is right for you. Special tests or follow-up may be needed.
The patch cannot be used by women who
• are 35 or older and use tobacco
• have certain inherited blood clotting disorders
• have controlled high blood pressure
• have had serious liver disease and use tobacco
• have had cancer of the breast or liver
• have uncontrolled high blood pressure
• have diabetes with vascular disease
• have had heart attack, angina, or stroke
• have had migraine with aura
• have had serious heart valve problems
• will be on prolonged bed rest - after major surgery for example
• have had blood clots in the veins or arteries
• are, or think they are, pregnant
Warning Signs — Call the health center right away if you have
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sharp or crushing chest pain or coughing blood
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shortness of breath
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unusual swelling or pain in the legs or arms
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severe pain in the stomach or abdomen
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sudden severe headaches
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yellowing of the skin or eyes
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changes in the frequency, severity, or associated symptoms of your headache
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severe depression
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unusually heavy bleeding from the vagina
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aura — gradual onset, yet short-term, visual bright, flashing zigzag lines.
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no period after having a period every month
We strongly recommend regular physical examinations for routine healthcare and for screening for sexually transmitted infections and cancer.
Instructions for Use
THE PATCH
When to Use the Patch
Your clinician will advise you when to start using the patch — usually, during the first five days of your next period. The patch is worn for one week. Put on a new patch each week for three weeks (seven days each, for a total of 21 days). Change the patch on the same day of every week —“patch change day.” Do not put on a patch for the fourth week. That is when your menstrual period should start. Put on a new patch on the “patch change day” after the end of the fourth week.
How to Put On the Patch
Each patch is sealed in a pouch to protect it until you are ready to wear it. Tear it open along the top edge and the side edge. Peel the foil open and flat. Take the patch and plastic layer off the foil. Peel one half of the clear layer of plastic away from the patch. Be careful not to touch the sticky part. Apply the sticky half of the patch to clean, dry skin on your buttocks, abdomen, upper outer arm, or upper torso. Never put the patch on your breasts. Remove the other half of the plastic, and press the whole patch to your skin. Hold in place with your palm for 10 seconds.
The patch is meant to stay in place while swimming, taking saunas, using whirlpools, or sweating. But rarely, the patch can loosen or come off the skin. Check your patch every day to make sure it is sticking properly.
If the patch gets loose or falls off and you know it’s been less than 24 hours
• Reapply the patch. If it won’t stick, put on a new patch right away.
• Your “patch change day” will stay the same.
• No back-up contraception is needed.
If the patch gets loose or falls off and you don’t know how long it’s been
or do know that it’s been more than 24 hours
• You could become pregnant.
• Start a new four-week cycle by putting on a new patch.
• This is your new “patch change day”
• Use back-up contraception for the first week of this new cycle
Don’t try to put a patch back on if
• It isn’t sticky any more.
• It gets stuck to itself or something else.
• It’s gotten loose or fallen off – unless it’s been less than 24 hours.
WARNING
Never use tape or anything else to keep the patch in place. If it doesn’t stick to your skin by itself, it won’t be effective. If a patch won’t stick any more, put on a new patch right away.
If you forget to change your patch at the start of a patch cycle — “patch change day” of the first week
• You could become pregnant.
• Put on the first patch of your new cycle as soon as you remember.
• This becomes your new “patch change day.”
• Use back-up contraception for the first week of this new cycle.
If you forget to change your patch in the middle of a patch cycle — second
or third week
• for one or two days
• Put on a new patch as soon as your remember.
• Put on your next patch on your normal “patch change day.”
• No back-up contraception is needed.
• for more than two days
• You could become pregnant.
• Put on a new patch as soon as your remember.
• This starts a new four-week cycle.
• You have a new “patch change day.”
• Use back-up contraception for the first week of this new cycle.
If you forget to change your patch at the end of a patch cycle — the fourth week
• Take the patch off as soon as your remember.
• Start your next cycle on your normal “patch change day.”
• No back-up contraception is needed.
When to Expect Your Period
Most women who use the patch bleed sometime in the patch-free week— fourth week. You still may be bleeding—usually spotting—when it’s time to put on a new patch. Put on the patch, even if you are still bleeding, in order to stay protected against pregnancy.
Storing and Discarding the Patch
Keep the patch at room temperature. Don’t store it in the refrigerator or freezer. Keep patches sealed in their pouches. Put them on as soon as you remove them from the pouch.
Used patches still contain some active hormones. Be sure to fold each used patch in half to stick it to itself. Put it in a plastic bag, seal it, and throw it a way. This reduces the chance of estrogen seeping into the soil and water supply. It also protects children who might otherwise play with a used patch. Do not flush patches down the toilet.
Emergency Contraception — Mistakes happen. That’s why it’s important to remember that emergency contraception pills can reduce the risk of unintended pregnancy. They work best when started as soon as possible within 120 hours of unprotected intercourse. Contact your clinician for more information.
2/09 FPCC 4.01