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Contraception - Management
Starting a combined contraceptive patch
What is the combined contraceptive patch?
- The combined contraceptive patch is a patch that is stuck to the skin to continuously deliver hormones, providing contraceptive cover.
- One combined contraceptive patch is available in the UK: Evra®.
- It releases 33.9 micrograms of ethinylestradiol (an oestrogen) and 203 micrograms of norelgestromin (a progestogen) per 24 hours for 7 days.
In depth
How should I assess a woman before providing her with a combined contraceptive patch?
How should the combined contraceptive patch be started?
- New users with no previous hormonal contraception and no recent childbirth or abortion:
- Apply the patch on day 1–5 of the menstrual cycle for immediate contraceptive cover.
- If applied outside days 1–5 of the menstrual cycle, exclude pregnancy and use additional contraceptive cover for 7 days.
- 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 after miscarriage within 24 weeks of gestation:
- Apply the patch within 7 days of abortion or miscarriage for immediate contraceptive cover.
- If applied outside day 7 after abortion or miscarriage, use additional contraceptive cover for 7 days.
- Postpartum women who are not breastfeeding (including any pregnancy over 24 weeks gestation):
- Apply the patch on day 21 postpartum for immediate contraceptive cover.
- If applied after day 21 postpartum, use additional contraceptive cover for 7 days.
- Advise the woman that recommendations in the packet may differ from these recommendations, and that only application on day 1 is a licensed indication.
In depth
How should the combined contraceptive patch be applied?
- The contraceptive patch should be applied weekly for 3 consecutive weeks. No patch is applied during the fourth week. A new cycle is started the following week. To avoid skin irritation use a different site when changing a patch.
In depth
What follow-up arrangement should I consider for a woman using the combined contraceptive patch?
- Review the woman no longer than 3 months after she starts to use the contraceptive patch, to ensure correct use and that there are no problems.
- Depending on the woman's wishes and anticipated use of the patch, arrange for up to 1 year's supply following this, before requiring a new prescription. Women with specific medical conditions may need more frequent follow-up.
- Advise the woman that she should return at any time if she has any problems.
In depth
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