Birth Control Patch Regimen
For a healthy reproductive-age woman without contraindications, apply one transdermal contraceptive patch weekly for three consecutive weeks (21 days total), followed by one patch-free week, creating a 28-day cycle. 1, 2
Standard Application Protocol
Weekly Dosing Schedule
- Apply one patch per week for 3 consecutive weeks, changing the patch on the same day each week (e.g., every Monday). 1, 2
- Follow with a 7-day patch-free interval during which withdrawal bleeding typically occurs. 1, 2
- The patch delivers norelgestromin 150 mcg and ethinyl estradiol 20-35 mcg daily through the skin. 2, 3
Application Site Selection
- Apply to clean, dry skin on the abdomen, upper torso (excluding breasts), upper outer arm, or buttocks. 4
- Rotate application sites with each new patch to minimize skin irritation. 5
- Apply immediately upon removal from the protective pouch. 2
Key Counseling Points
Expected Efficacy and Compliance
- Typical failure rate is 0.7%, comparable to combined oral contraceptives, with method failure at 0.4%. 5
- Perfect compliance achieved in 90% of cycles due to weekly rather than daily dosing requirements. 5, 6
- Only 1.9% of patches detach completely during normal use. 5
Bleeding Pattern Expectations
- Counsel about potential breakthrough bleeding, particularly during the first 3-6 months of use, which is common but generally not harmful and decreases with continued use. 1
- Unscheduled bleeding does not indicate contraceptive failure unless accompanied by missed or delayed patch applications. 1
Management of Delayed Application or Detachment
If Patch Delayed or Detached <48 Hours
- Apply a new patch immediately (or reapply if detached <24 hours). 1
- Keep the same patch change day—no adjustment needed. 1
- No backup contraception required. 1
- Emergency contraception generally not needed unless the issue occurred in the first week or last week of the previous cycle. 1
If Patch Delayed or Detached ≥48 Hours
- Apply a new patch as soon as possible and maintain the same patch change day. 1
- Use backup contraception (condoms) or abstain from intercourse for 7 consecutive days until the patch has been worn continuously for this duration. 1
- If the delay occurred during week 3: Skip the hormone-free week entirely by starting a new patch immediately after completing week 3, or use backup contraception for 7 days if unable to start immediately. 1
- Consider emergency contraception if the delay occurred during week 1 and unprotected intercourse occurred in the previous 5 days. 1
Critical Safety Considerations
Thromboembolism Risk
- The patch carries approximately twice the VTE risk of combined oral contraceptives (odds ratios 1.2-2.2), though absolute risk remains low. 7, 3
- This patient has no history of blood clots, smoking, or hypertension, making her an appropriate candidate. 7
- Higher total estrogen exposure occurs with the patch compared to oral contraceptives due to continuous transdermal delivery, despite more stable serum levels without peaks and troughs. 3, 8
Common Adverse Effects
- Application site reactions occur in 1.9% of users and represent a unique side effect of this delivery method. 5
- Other adverse effects (nausea, breast tenderness, headache, emotional lability) are similar to oral contraceptives and typically mild-to-moderate. 5, 8
- Most side effects are not treatment-limiting; only 1.9% discontinue due to application site reactions. 5
Important Pitfalls to Avoid
Do Not Confuse Timing Windows
- If uncertain when detachment occurred, assume ≥48 hours and follow the more conservative protocol requiring backup contraception. 1
- The 48-hour threshold is critical—management differs significantly above versus below this timepoint. 1
Storage and Handling
- Do not store patches unpouched; keep at room temperature 20-25°C (68-77°F). 2
- Keep out of reach of children—packaging is not child-resistant. 2