What to Know About Birth Control Patches

A Convenient Delivery Method for Hormonal Contraception

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Birth control patches are used to prevent pregnancy. They are small adhesive stickers that deliver hormonal contraception through the skin. Patches are an alternative to birth control pills.

There are currently two types of birth control patches approved in the United States. Each delivers both an estrogen and a progestin, similar to a combination pill. However, the type of progestin is different in each patch:

  • Xulane contains norelgestromin (progestin) and ethinyl estradiol (estrogen). It is a square patch. Xulane uses the same types of medication as the discontinued patch Ortho Evra. It is considered a generic.
  • Twirla contains levonorgestrel (progestin) and ethinyl estradiol. It is a round patch.

Birth control patches are not recommended for women who weigh more than 198 pounds or who have a body mass index (BMI) higher than 30 kg/m2. The weight limit is because the dosage of medication delivered by the patch can not be adjusted. The BMI limit is because of the risk of blood clots.

Woman wearing a contraception patch on her upper arm
B. Boissonnet / Getty Images

Uses of Birth Control Patches

Birth control patches are a type of hormonal contraception, like the pill or the ring. They deliver a combination of estrogen and progestin through the skin.

Unlike birth control pills, also known as oral contraceptives, you only need to stick on a patch once a week. You will wear each patch for a week at a time and then, after three weeks, take a week off to allow a withdrawal bleed.

Birth control patches work by stopping ovulation. When the body does not produce an egg, there is no way to become pregnant.

When used perfectly, hormonal contraception is highly effective. But many people miss doses or otherwise have problems that make their contraceptives less effective. This may be particularly true for adolescents. No birth control method apart from abstinence is 100% effective in preventing pregnancy.

In general, people are more likely to use a birth control patch correctly than a birth control pill. However, people who use the patch may be more likely to stop using it because of side effects.

Before Using a Birth Control Patch

Birth control patches are available by prescription. Before getting a birth control patch, your doctor will likely check your weight and height to make certain it is appropriate for you to use a patch. Your doctor will also check to see if you smoke and make certain you are not pregnant.

Talk to your doctor about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration of whether the pros of treatment outweigh the cons in your case.

The birth control patch does not protect against sexually transmitted infections. It is important to practice safer sex and use condoms or other barriers, as appropriate.

Precautions and Contraindications

Smokers, particularly those over 35, are advised not to use a birth control patch for contraception. People with a BMI over 30 kg/m2 should use another form of contraception. For these people, there is an increased risk of having a blood clot or deep vein thrombosis.

Birth Control Patch Dosage

Each birth control patch is available in only one dose. This is why they are restricted to women below a certain weight. Above that weight, the patch may be less effective:

  • Xulane contains 35 micrograms (mcg) ethinyl estradiol and 150 mcg norelgestromin. It may be less effective in people over 198 lbs (90 kg).
  • Twirla contains 30 mcg ethinyl estradiol and 120 mcg levonorgestrel. It is less effective in people with a BMI of over 25 kg/m2.

How to Take and Store

Both types of birth control patches are used in the same way. The patch is placed on the back, buttocks, or stomach for a week. After a week, it is removed, and a new patch is placed. The birth control patch should not be placed on the breasts. Xulane can be placed on the upper outer arm.

Patches come in a protective pouch and should be kept in the pouch until use. The patch should be stored at room temperature, not in the fridge or freezer. Used patches should be folded, sticky-side together, before discarding. They should not be flushed down the toilet.

Used patches still have hormones. They should be kept away from children. Ideally, patches should be placed in a sturdy container with a child-proof cap before being discarded.

Side Effects

In general, side effects of birth control patches are similar to those of other forms of hormonal birth control. Specific side effects may vary based on the patch being used. Side effects may be more common in patch users than pill users.

Common Side Effects

Common side effects of the birth control patch include:

  • Nausea
  • Breast pain
  • Headache
  • Skin irritation at the patch site
  • Mood changes
  • Changes in menstrual bleeding
  • Weight gain

These symptoms will usually go away with time. They do not require you to stop using the birth control patch, although they should be reported to your doctor.

Severe Side Effects

Venous thromboembolism (VTE) or deep vein thrombosis is a severe side effect associated with use of birth control patches and other forms of hormonal contraception. The risk of VTE in patch users is higher than in the general population but lower than the risk of VTE during pregnancy or the postpartum period.

Call a healthcare professional immediately if you have any of the following symptoms:

  • Leg pain that will not go away
  • Sudden shortness of breath
  • Sudden changes in eyesight
  • Severe chest pain or pressure
  • Sudden, severe headache that is different from usual headaches
  • Weakness or numbness on one side of the body
  • Difficulty speaking
  • Yellowing of the skin or eyes

Warnings and Interactions

Twirla and Xulane both have boxed warnings stating that their use is contraindicated in women 35 years or older who smoke. Cigarette smoking is associated with an increased risk of cardiovascular events from combined hormonal contraceptives.

Both patches also have boxed warnings stating that use is contraindicated in women with a BMI greater than or equal to 30 kg/m2. Higher BMI is also associated with an increased risk of cardiovascular events from combined hormonal contraceptives.

In general, people should not use the birth control patch if they are at increased risk of having a blood clot or have a history of blood clot or stroke. Birth control patches may also be contraindicated in people with certain other types of chronic illness.

Birth control patches may interact with certain types of medication. Discuss all medications you are on with your provider before starting to use the patch.

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  1. National Institutes of Health DailyMed. Label: Xulane—norelgestromin and ethinyl estradiol patch. Updated February 4, 2021.

  2. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366(21):1998-2007. doi:10.1056/NEJMoa1110855

  3. Lopez LM, Grimes DA, Gallo MF, Stockton LL, Schulz KF. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2013;2013(4):CD003552. doi:10.1002/14651858.CD003552.pub4

  4. MedlinePlus. Estrogen and progestin (transdermal patch contraceptives). Updated February 15, 2021.

  5. National Institutes of Health DailyMed. Label: Twirla—levonorgestrel/ethinyl estradiol patch. Updated September 11, 2020.