Pediatric and Adolescent Gynecology

Using the patch

How does the patch work?

When you are not using birth control, estrogen and progesterone are released from your ovaries. When the patch is applied to your skin, the estrogen and progesterone move from the adhesive on the patch, through your skin and into your body. Your body then knows that estrogen and progesterone are coming from somewhere else (from the patch), so your ovaries don’t need to release hormones; they “take a little nap.” While they’re “napping,” they don’t release hormones, and don’t cause the release an egg, which is how the patch works for birth control.

Forgetting to replace the patch on time can cause the ovaries to “wake up.” When that happens, the ovaries release hormones and may release an egg, which can cause women to get pregnant.

How to use the patch

  • Apply your first patch as directed.
  • The day you apply the first patch is your • “patch change day.” After applying the first patch, replace the patch once every week for 3 weeks on the patch change day.
  • On the 4th week you will not wear a patch. This is the “patch free week.” You should start bleeding this week. Most people start bleeding on the 2nd or 3rd day of this week.
  • After 7 days off the patch, apply another patch on your “patch change day”. You might or might not still be bleeding; it doesn’t matter either way. You will again be using the patch for 3 weeks and then 1 week off the patch.
  • If you are using the patch as an extended cycle, your doctor or nurse practitioner will tell you when to expect bleeding.

What to do if you forget to change a patch

  • If an edge or corner of the patch becomes loose, try to press it down again.
  • If the patch comes off and you are sure it has been off for less than 24 hours, apply a new patch. Stay on the same schedule with your patches and keep the same patch change day.
  • If the patch comes off and you have no idea when it came off, apply a new patch and start a new cycle. (This becomes patch #1 and this is your new patch change day.)
  • If you forget to replace a patch, your ovaries may “wake up.” Be sure to use condoms during intercourse to prevent pregnancy; start a new patch cycle.
  • If you have questions about what to do, call the triage nurse.

Most people don’t have any side effects with the patch

However, during the first three months you may experience:

  • Bleeding or spotting when the patch is on. This is called breakthrough bleeding and is usually worst during month 1, less during month 2, and by month 3 most people have regular periods during the patch free week. If breakthrough bleeding continues after month 3, you may need a different method.
  • Write down the dates of any bleeding that you have on a calendar. Bring the calendar to each visit with your clinician.
  • Other problems are not common, but you may have nausea, breast tenderness, headaches, or mood changes. If they occur, they are usually mild and don’t last long.
  • If you are having problems that are making you feel miserable, do not stop using the patch, but call the triage nurse.
  • The patch does • not cause weight gain.

Danger signs using the patch

Call the office immediately if you have:

  • Dizziness
  • Vision changes

Consider immediate evaluation if you experience the following

Severe headaches (the worst headache you’ve ever had)

  • Chest pain
  • Pain in the calf of one leg


  • The patch does not protect against sexually transmitted diseases. Use condoms every time you have sex.
  • Never run out of patches. You can always call the triage nurse and ask for a refill.
  • If we gave you samples of the patch and you will run out of patches before your next visit, call the triage nurse and we will call a prescription to your pharmacy. Never use someone else’s patches or share yours with anyone else.
  • If you are having a problem, don’t just stop using the patch. Call the triage nurse.
  • The Ortho Evra Patch is the only birth control patch available at this time. If you are miserable using this method, discuss other methods of birth control with your doctor or nurse practitioner.