The birth control patch may be more convenient than the pill but there's a greater chance of side effects
- The birth control patch is an effective hormonal birth control method that contains both estrogen and progestin.
- A primary benefit of the birth control patch is that you only have to replace it three times a month.
- The birth control patch releases a higher dose of hormones, leading to a greater risk of side effects including irregular bleeding, nausea, cramps, and headaches.
- This article was medically reviewed by Jamie Lipeles, DO, founder of Marina OB/GYN in Marina Del Rey, California and Olivia P. Myrick, MD, who is a clinical assistant professor with the Department of Obstetrics and Gynecology at NYU Langone.
If you struggle to take your birth control pill on time, you're not alone. Over the course of just one month, 31% of women reported failing to take the pill on schedule and 16% said they had missed at least two pills, according to a CDC study.
Now, there are other birth control options that don't require as much attention. One simple and convenient choice is Xulane, commonly known as the birth control patch.
"The patch is a fantastic birth control option, but just like any type of medication, it really depends on the individual," says Hector Chapa, MD, a Texas A&M College of Medicine OB-GYN.
Here's what you should know if you are considering the hormonal birth control patch.
The patch is a hormonal form of birth control
The patch is a combination hormonal birth control option. It releases the hormones estrogen and progestin onto the skin so they can be absorbed into the bloodstream. Estrogen and progestin are sex hormones that prevent pregnancy by inhibiting the release of follicle-stimulating and luteinizing hormones which trigger ovulation.
Preventing ovulation means that the ovaries don't release an egg. Without an egg there's nothing for sperm to fertilize. Estrogen and progestin also thicken mucus in the cervix, which makes it more difficult for sperm to reach the uterus in the first place.
Just like other hormonal birth control options, the patch requires a prescription. Additionally, the birth control patch does not protect against STIs. Only physical barriers, such as male and female condoms, can provide protection against STIs.
The patch is replaced three times a month
The patch is an adhesive square that looks like a small Band-Aid. One of the biggest benefits of the patch is that you only have to replace it three times a month compared to the pill, which must be taken daily.
You apply a new patch at the same time each week for three weeks in a row; on the fourth week, you don't wear the patch and will have your period.
"This method eliminates some of the human error that is introduced with the pill — since it has to be taken consistently every day to be effective," says Chapa.
When used perfectly, the pill and the patch have the same rate of protection against pregnancy; 99% for perfect use, and 91% for average use. However, compliance rates are higher in women who use the patch compared to women who take the pill.
How to wear the patch
Where you place the patch on your body doesn't affect how it works — you can wear it on your upper arm, back, lower abdomen, or buttocks. However, you should not wear the patch on your breasts or irritated skin.
Also, avoid wearing it on areas that are commonly rubbed against, such as under your bra or at your waistline, to reduce the likelihood of it falling off. To avoid irritating the skin, you should reapply the patch in a different area each time you change it out.
About 20% of users experience mild to moderate skin irritation — a side effect unique to the patch. If your skin becomes irritated remove the patch and apply a new one to a different area. Women considering the patch should inform their healthcare provider if they have skin conditions such as psoriasis or eczema.
To ensure it sticks, apply the patch to clean, dry skin, and avoid applying lotion, creams, or oils to these areas. If applied properly, you can swim, shower, and sweat in the patch with low risk of it falling off.
Because the patch is so small, you may forget it's even there. In order to remember when to replace it, use an app reminder or set an alarm for the same time each week.
If your patch falls off
While it's uncommon for the patch to fall off, it is possible. There is a 6% chance of the patch initially falling off, but after consistent use, you get the hang of wearing it and that likelihood drops to 2%.
If this happens and you are able to reapply the same patch within 24 hours, it will still be effective. However, if the patch loses its adhesiveness, apply a fresh one and contact your healthcare provider for a replacement prescription.
If you fail to replace the patch within 48 hours, you should take the following precautions:
- Use a backup birth control method like a condom the next time you have unprotected sex.
- If you've already had unprotected sex without replacing the patch, then use an emergency contraceptive, such as Plan B, to protect against pregnancy.
- Apply the same patch, or a new one, as soon as possible while continuing to use a back-up method. When your next period arrives the patch will become fully effective, again.
Don't apply more than one patch at a time because it can increase your risk of side effects due to the high dose of hormones.
Common side effects include skin irritation and irregular bleeding
Unlike the pill, which delivers hormones in one hefty dose, the patch slowly releases hormones throughout the day. This means those who use the patch will experience fewer fluctuations and more sustained hormone levels than women who take a combination birth control pill.
Yet, overall hormone levels are higher in patch users because the hormones are absorbed directly into the bloodstream. Meanwhile, the pill has to be metabolized, or broken down first, leading to lower hormone levels.
Higher overall levels of estrogen put women at a greater risk of experiencing the adverse side effects associated with hormonal birth control. Common side effects of the patch can include:
- Cramps
- Nausea
- Headaches
- Breast tenderness
- Changes in libido
- Depression
- Irregular bleeding
- Skin irritation
Spotting or changes in your menstrual cycle may occur, but will likely decrease after continued use as your body adjusts to the hormones.
One rare, but serious side effect of the patch is blood clotting, which can lead to deep vein thrombosis or pulmonary embolism, two potentially deadly medical conditions.
Women who smoke are at a higher risk of experiencing cardiovascular complications, such as strokes or heart attacks, while using hormonal birth control, like the patch. This risk increases with age and smoking frequency.
When considering the patch
Due to the side effects, women who use the patch should have a healthy BMI, no history of high blood pressure or blood clots, be non-smokers, and under age 35.
The American College of Obstetrics and Gynecology (ACOG) advises women who are obese not to use the patch because extra fatty tissue can keep hormones from being properly absorbed, Chapa says.
Skin type and lifestyle should also be taken into account if you are considering the patch. Although it is uncommon for the patch to detach it may be more of a concern for people with oily skin or those who work out regularly. Therefore, women who use the patch should regularly check to make sure it is still applied.
Talk to a healthcare provider who can help you decide if the patch is the best birth control option for you.