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Contraception - Management
How should the combined contraceptive patch be started?
When the combined contraceptive patch is best started depends on the woman's situation:
- New users who have not been using hormonal contraception and have not recently delivered or had an abortion:
- Advise the woman to start using the patch at the beginning of menstruation, ideally on the first day — this is the only licensed use:
- The patch can also be started up to and including day 5 of the cycle, without additional contraceptive protection being required.
- If it is not possible or practical to start the combined contraceptive patch by day 5 of the menstrual cycle:
- Starting immediately after oral emergency contraception:
- Levonorgestrel emergency contraception used — advise additional contraception (condoms or avoidance of sex) for the first 7 days of use.
- Ulipristal acetate emergency contraception used — advise additional contraception (condoms or avoidance of sex) for the first 14 days of use.
- Advise the woman to take a pregnancy test no sooner than 3 weeks after the last episode of unprotected sex.
- After abortion or miscarriage:
- No additional contraceptive method is needed if the patch started within 7 days of an abortion or miscarriage before 24 weeks of gestation:
- In the case of miscarriage at or after 24 weeks gestation, manage as for postpartum women who are not breastfeeding.
- An additional contraceptive method (e.g. condoms) is required for 7 days if the patch is started more than 7 days after abortion.
- Postpartum women who are not breastfeeding (including any pregnancy over 24 weeks gestation):
- No additional contraceptive method is needed if the patch started on day 21 after delivery as recommended.
- An additional contraceptive method (e.g. condoms) is required for 7 days if the patch is started more than 21 days after delivery.
- Advise the woman that these recommendations may differ from that stated in the package insert:
- The only licensed time for starting the patch is the first day of the menstrual cycle. Initiation at any other time is an unlicensed use.
Basis for recommendation
- These recommendations are based on guidelines published by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2004c; FFPRHC, 2005a], which were adapted from guidelines developed for the World Health Organization by an expert working group [WHO, 2004b].
- Recommendations about unlicensed uses of the combined contraceptive patch are inconsistent with recommendations in the British National Formulary [BNF 53, 2007]. These recommendations can be found in FFPRHC guidelines on the use of contraception outside the terms of the product licence [FFPRHC, 2005a].
- The recommendations on how long additional contraception should be used if combined hormonal contraception is started immediately after oral emergency contraception is based on the Quick starting contraception guidance issued by the Faculty of Sexual and Reproductive Healthcare (FSRH) [FSRH, 2010e].
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