Gynecology Book


Contraceptive Patch

Aka: Contraceptive Patch, Transdermal Contraception, Ortho Evra, Xulane, Twirla
  1. Mechanism
    1. Transdermal patches release Hormones at constant rate
  2. Preparations
    1. Ortho Evra
      1. Ethinyl Estradiol 20 mcg/day
      2. Norelgestromin 150 mcg/day
    2. Xulane
      1. Ethinyl Estradiol 35 mcg/day
      2. Norelgestromin 150 mcg/day
    3. Twirla
      1. Ethinyl Estradiol 30 mcg/day
      2. Levonorgestrel 120 mcg/day
  3. Technique: 4 week cycles
    1. Patch applied to unbroken skin, and replaced each week for 3 weeks
      1. Upper arm
      2. Buttock
      3. Lower Abdomen
      4. Upper trunk (not on Breasts)
    2. Patch removed for 1 week for withdrawal bleeding
    3. New patch started and replaced each week for 3 weeks
  4. Efficacy
    1. Ortho Evra
      1. Failure rate: 0.88 pregnancies per 100 woman years
      2. Lower efficacy if weight >198 pounds (90 kg)
    2. Twirla
      1. Lower efficacy rate if BMI >30
  5. Adverse effects
    1. Overall patch has similar adverse effects to OCP
    2. Transdermal specific adverse effects
      1. Contact Dermatitis reaction to patch
      2. Detachment rate: 2.8% of patches partially detach (Ortho Evra)
    3. Increased adverse effects in first two months
      1. Breakthrough bleeding in 40% on Twirla at one year (8% with Xulane)
      2. Breast discomfort (Mastalgia)
    4. Thromboembolism risk may be as high as twice the risk of Oral Contraceptives
      1. Likely related to the higher Estrogen concentrations in the patch compared with Oral Contraceptives
      2. Cole (2007) Obstet Gynecol 109(2 Pt 1):339-46 [PubMed]
  6. Benefits
    1. Higher compliance rate than with Oral Contraceptives
  7. References
    1. (2020) Presc Lett 27(12): 70
    2. Herndon (2004) Am Fam Physician 69(4):853-60 [PubMed]
Medication Costs
xulane (on 6/7/2017 at Medicaid.Gov Pharmacy Drug pricing)
XULANE PATCH Generic $34.04 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Contraceptive Patch (C2985284)

Definition (NCI) A dermal patch that contains estrogen and progestin hormones for release and absorption through the skin and into the body to prevent pregnancy.
Definition (NCI_NICHD) A medicated adhesive patch that is placed on the skin to deliver estrogen and progestin hormones for release and absorption through the skin and into the body to prevent pregnancy.
Concepts Medical Device (T074)
LNC LA16581-3
English Contraceptive Patch, Contraceptive patch
Derived from the NIH UMLS (Unified Medical Language System)

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