What are the contraindications and patient education requirements for the birth control patch?

Contraindications and Patient Education for Birth Control Patch

The birth control patch is contraindicated in women with uncontrolled hypertension (BP ≥160/100 mmHg), history of venous thromboembolism (VTE), stroke, cardiovascular disease, age ≥35 years who smoke ≥15 cigarettes daily, ≤21 days postpartum, known thrombogenic mutations, and multiple risk factors for atherosclerosis. 1

Absolute Contraindications

• Cardiovascular/Thrombotic Risk Factors:

  • History of VTE or current VTE 1
  • Known thrombogenic mutations 1
  • Current or history of ischemic heart disease 1
  • Current or history of stroke 1
  • Complicated valvular heart disease 1
  • Severe hypertension (BP ≥160/100 mmHg) 1
  • Multiple risk factors for atherosclerotic disease 1

• Postpartum Status:

  • ≤21 days postpartum (regardless of breastfeeding status) 1
  • 21-42 days postpartum with other VTE risk factors 1

• Other Medical Conditions:

  • Active liver disease or tumors 1, 2
  • Migraine with aura (any age) 1, 2
  • Breast cancer or other estrogen/progestin-sensitive cancer 2
  • Major surgery with prolonged immobilization 1

• Age/Lifestyle Factors:

  • Age ≥35 years and smoking ≥15 cigarettes daily 1

Relative Contraindications

• Cardiovascular Risk Factors:

  • Moderately controlled hypertension (BP 140-159/90-99 mmHg) 1
  • Age ≥35 years and smoking <15 cigarettes daily 1
  • Superficial venous thrombosis 1

• Postpartum/Breastfeeding:

  • Breastfeeding 21-29 days postpartum 1
  • Breastfeeding 30-42 days postpartum with VTE risk factors 1

• Other Medical Conditions:

  • History of cholestasis related to previous combined hormonal contraceptive use 1
  • Diabetes with vascular complications 1
  • Obesity (BMI >30 kg/m²) - increases risk but not a contraindication 1, 2

Patient Education Requirements

Effectiveness and Proper Use

1. Application Instructions:

   • Apply one patch weekly for three consecutive weeks, followed by one patch-free week 3
   • Apply to clean, dry skin on buttocks, abdomen, upper outer arm, or upper torso (excluding breasts) 3
   • Check patch daily to ensure it remains fully adhered 3

2. Effectiveness:

   • 99% effective with perfect use; approximately 91-94% effective with typical use 2, 3
   • Backup contraception (condoms) needed for first 7 days if not starting on first day of period 1

Side Effects and Warning Signs

1. Common Side Effects:

   • Breakthrough bleeding or spotting, especially in first few months 3
   • Nausea, headache, breast tenderness 3
   • Application site reactions (1.9% discontinuation rate) 3
   • Emotional changes 3

2. Warning Signs (ACHES) - Require Immediate Medical Attention:

   • A: Abdominal pain (severe)
   • C: Chest pain, shortness of breath
   • H: Headache (severe, sudden)
   • E: Eye problems (vision loss, blurring)
   • S: Severe leg pain or swelling 1

Risk Information

1. VTE Risk:

   • Patch users have similar VTE risk compared to users of combined oral contraceptives 4, 5
   • VTE risk with hormonal contraceptives (3-9 per 10,000 woman-years) is lower than during pregnancy (5-20 per 10,000 woman-years) or postpartum (40-65 per 10,000 woman-years) 1

2. Cardiovascular Risk:

   • Small increased risk of myocardial infarction and stroke, particularly in women >35 who smoke or have hypertension 1
   • No increased risk of ischemic stroke or myocardial infarction compared to oral contraceptives 4

3. Cancer Risk:

   • Small increases in breast and cervical cancer risks
   • Decreases in endometrial, ovarian, and colorectal cancer risks 1

Practical Considerations

1. Missed or Detached Patch:

   • If detached <24 hours: Reapply same patch or replace with new patch
   • If detached >24 hours or timing unknown: Apply new patch and use backup method for 7 days 1

2. Drug Interactions:

   • Certain anticonvulsants, rifampin, and some HIV medications may decrease effectiveness 1
   • Antibiotics do not reduce effectiveness 1

3. Benefits Beyond Contraception:

   • Regulated menses and decreased dysmenorrhea 6
   • Improvement in premenstrual symptoms 6

Special Considerations

Compliance Advantages

• Weekly application improves compliance compared to daily oral contraceptives (90% perfect compliance) 3, 7
• Only 1.9% of patches detach completely 3

Return to Fertility

• Prompt return to fertility after discontinuation 2
• No impact on long-term fertility 2

Follow-up Recommendations

• Blood pressure check at initiation and periodically during use 1
• Follow-up visit 1-3 months after initiation to address side effects or compliance issues 1

Postpartum Considerations

• Avoid use until at least 21 days postpartum due to increased VTE risk 1
• For women 21-42 days postpartum with additional VTE risk factors, patch is not recommended 1

The birth control patch provides effective contraception with the convenience of weekly application, but proper patient selection and education are essential to minimize risks and maximize benefits.