To assess a woman's eligibility for a combined contraceptive patch:

• In young women and women with special needs, assess their competence to decide, and support them in making their own decisions about contraception.
• Exclude pregnancy.
• Assess the woman's risk for sexually transmitted infection and, when appropriate, advise testing, promote safer sex, and/or refer for counselling.
• Check the woman's blood pressure.
• Check the Combined hormonal methods to ensure that the assessment is complete and that the woman is eligible for a patch.
• Women should not use a combined contraceptive patch (UKMEC 4) in the following situations:
• Breastfeeding and less than 6 weeks postpartum.
• Age 35 or more years and smoking 15 cigarettes or more a day.
• Multiple risk factors for arterial cardiovascular disease (e.g. older age, smoking, diabetes, and hypertension) — UKMEC 3 if less severe.
• Hypertension not adequately controlled (systolic blood pressure equal to, or greater than 160 mmHg, OR diastolic blood pressure equal to, or greater than 95 mmHg).
• Vascular disease, including angina or other ischaemic heart disease, intermittent claudication, hypertensive retinopathy, transient ischaemic attacks, other cerebrovascular disease.
• History of, or current venous thromboembolism on anticoagulants.
• High risk of venous thromboembolism (e.g. major surgery with prolonged immobilization, known thrombogenic mutation, Raynaud's disease with lupus anticoagulant).
• Valvular or congenital heart disease if complicated by pulmonary hypertension, atrial fibrillation, or subacute bacterial endocarditis.
• Migraine with aura (any age).
• Breast cancer (current).
• Diabetes with nephropathy, neuropathy, retinopathy, or other vascular disease — UKMEC 3 if less severe.
• Cirrhosis of the liver, decompensated (e.g. ascites, jaundice, encephalopathy, or gastrointestinal haemorrhage).
• Liver tumours — benign (hepatocellular adenoma) or malignant (hepatoma).
• Women should use a combined contraceptive patch only after consultation with an expert (UKMEC 3) in the following situations:
• Breastfeeding and between 6 weeks and 6 months postpartum.
• Postpartum less than 21 days and not breastfeeding.
• Age 35 or more years, and smoking less than 15 cigarettes a day, or stopped smoking less than 1 year ago.
• BMI more than 35 kg/m².
• Multiple risk factors for arterial cardiovascular disease (e.g. older age, smoking, diabetes, and hypertension) — UKMEC 4 if more severe.
• Hypertension adequately controlled (systolic blood pressure less than 159 mmHg, AND diastolic blood pressure less than 94 mmHg).
• Family history of venous thromboembolism in a first-degree relative less than 45 years of age.
• Moderately increased risk of venous thromboembolism (e.g. immobility unrelated to surgery, wheelchair use, debilitating illness).
• Known dyslipidaemia with increased risk of cardiovascular disease.
• Migraine without aura at any age, while using the combined contraceptive patch.
• Past history (5 years or more) of migraine with aura, at any age.
• Undiagnosed breast mass, carriers of known gene mutations associated with breast cancer (e.g. BRCA1), past history of breast cancer with no recurrence for 5 years or more.
• Diabetes with nephropathy, neuropathy, retinopathy, or other vascular disease — UKMEC 4 if more severe.
• Gall bladder disease, current or medically treated.
• History of cholestasis, if related to past COC use.
• Use of liver enzyme–inducing drugs (see Selected concurrent medications).

• Contraception for young women and women with learning disabilities:
• Contraception should be seen in terms of the needs of the individual rather than in terms of relieving the anxieties of carers or relatives.
• When a woman with a learning disability is unable to understand and take responsibility for decisions about contraception, carers and other involved parties should meet to address issues around the woman's contraceptive need and to establish a care plan.
• See Considerations for girls under 16.
• The following examinations and laboratory tests are not required to assess eligibility for a combined contraceptive patch:
• Breast, pelvic, or genital examination.
• Cervical cytology screening.
• Routine laboratory tests including haemoglobin measurements.
• Thrombophilia screening.

• These recommendations for assessing a woman before starting a combined contraceptive patch are based on guidelines issued by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC):
• New product review: norelgestromin/ethinyl oestradiol transdermal contraceptive system (Evra) [FFPRHC, 2004c]
• First Prescription of Combined Oral Contraception [FFPRHC, 2007b]:
• Because the risks for users of the combined contraceptive patch are similar to those for users of combined oral contraceptives (COCs), guidelines and evidence on the use of COCs largely applies to the patch (the exceptions are obvious and mainly relate to the differences in absorption routes).
• UK medical eligibility criteria for contraceptive use (UKMEC) [FSRH, 2009b].
• The examinations and investigations that are specifically not recommended do not contribute substantially to the safety of women using combined hormonal contraceptives [British Society for Haematology, 2001; FFPRHC, 2007b].
• Obesity as a contraindication to use of the contraceptive patch:
• The manufacturer of the contraceptive patch warns that contraceptive efficacy may be decreased in women who weigh 90 kg or more, but does not discuss BMI.