Evra® Patch (Ethinylestradiol / Norelgestromin)

What is this medication for?

Evra^® is a combined hormonal contraceptive medication that contains two types of sex hormones, an estrogen called ethinylestradiol and a progestogen called norelgestromin. This medication can help to prevent ovulation and regulates other naturally occurring hormones in the body. When used correctly, this prevents pregnancy and promotes regular menstrual bleeding.

How should I take or use this medication?

• Do not stop using your medication without checking with your healthcare professional.
• If you are switching from other forms of contraception, please seek advice from your healthcare professional.
• For the first pack of Evra^®, you may apply the first patch on the first day of your menses (if this is your first time using hormonal contraceptives or you are restarting this medication after a break).
• If you are also using it for contraceptive purposes, a barrier method of contraception (e.g. condoms) is recommended for the first 7 days of using this medication.
• You should apply a new patch ONCE A WEEK for 3 weeks and stop for 1 week (7-day patch-free interval), during which you will experience withdrawal bleeding (menses).
• Wear the patch for exactly seven days for 3 weeks and change the patch on the same day every week (“Patch Change Day”).
• After the 7-day patch-free interval, apply a new patch even if you are still having menstrual bleeding.
• For example:

• How to apply the patch:

Directions for use
Always put your patch on clean, dry and hairless skin. Put it on the buttock, abdomen, upper outer arm or upper back – in places where it will not be rubbed by tight clothing. Do not put on the breast or skin that is red, irritated or cut. Do not use adhesives or wraps to hold the patch in place. Do not use creams, oils, lotions, powder or other skin care products on the application site. The patch may not stick well. Put the new patch on a different area of the skin each time to reduce skin irritation.
Do not use scissors to open the foil pouch. Use your fingers to open the pouch by tearing it along the edge. There is a clear protective covering on the patch. Peel away half of the clear protective covering (refer picture). Try not to touch the sticky surface.  (Some patches might stick to the inside of the sachet. Be careful not to remove the clear covering as you remove the patch)
Put the patch on your skin. Take off the other half of the covering. Press down firmly on the patch with the palm of your hand for 10 seconds. Make sure the edges stick well. Check your patch every day to make sure it is still stuck firmly and has not fallen off.

• Normal activities (e.g. bathing or showering, using a sauna or exercising) should not affect how well the patch works. The patch is designed to stay in place during these activities. However, you should check that the patch has not fallen off after doing these activities.

What should I do if I forget to take or use this medication?

Follow the instructions below closely to ensure you are protected from pregnancy.

If you forget to change your patch at the start of any patch cycle (Week 1/Day 1):

• Put on a new patch as soon as you remember.
• You now have a new Day 1 and a new “Patch Change Day”.
• You will need back-up contraception. Use a barrier method such as a condom for the first week of your new cycle.

If you forget to change your patch in the middle of the patch cycle (Week 2/Day 8 or Week 3/Day 15):

• For one or two days (up to 48 hours):
  • Put on a new patch immediately.
  • The next patch should be applied on the usual “Patch Change Day”.
  • No back-up contraception is needed.
• For more than two days (48 hours or more):
  • Start a new cycle immediately by putting on a new patch.
  • You now have a new Day 1 and a new “Patch Change Day”.
  • You will need back-up contraception. Use a barrier method such as a condom for the first week of your new cycle.

If you forget to take off your patch at the end of the patch cycle (Week 4/Day 22):

• Take it off as soon as you remember.
• Start your next cycle on your usual “Patch Change Day”, the day after Day 28.
• No back-up contraception is needed.

**If you miss your period (especially if you have not been using the patch correctly), check with your doctor to find out if you are pregnant before starting the next cycle of contraceptives.

What precautions should I take when taking or using this medication?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.
• You are pregnant, planning to become pregnant, or breastfeeding.
• You are taking any other medications, including supplements, traditional medications and herbal remedies.
• You have a history of or current medical conditions such as liver problems, stroke, heart diseases, blood clots (such as deep vein thrombosis or pulmonary embolism), high blood pressure, migraine headaches, epilepsy (fits), diabetes or cancer.
• You are a smoker. You may be advised to stop smoking when using Evra^®.
• You are overweight. This makes the patch less effective, and being overweight also increases your risk of blood clots.
• You are going for surgery or will be on bed rest.
• You are going for a MRI scan. You may need to remove the patch during the scan.

What are some common side effects of this medication? ​

• Spotting or bleeding may occur between your periods during the first few months of wearing the patch. However, if this continues after the third month, check with your doctor.
  • Using the patch incorrectly can also cause spotting or light bleeding
• Application site reactions such as dryness, redness and itching where the patch is applied.
  • Put the patch on a different area of the skin each time to reduce irritation
• Nausea, vomiting, bloating and stomach cramps
• Breast tenderness
• Headache or migraine
  • You may take painkillers such as Paracetamol to manage headaches
• Unable to tolerate contact lenses
• Weight changes, mood swings
• Acne

Inform your doctor if the side effects above become severe and bother you.

What are some rare but serious side-effects that I need to seek medical advice immediately? 

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

You can also find out about drug allergies by watching these videos:
They are available in English, 中文, Melayu and தமிழ்: Drug Allergies

Using a combined hormonal contraceptive medication increases a woman’s risk of developing blood clots compared with a woman not taking any combined hormonal contraceptive medication. The risk of developing a blood clot in a vein is highest during the first year. Other risk factors of developing blood clots include smoking and obesity. However, blood clot formation is rare and the doctor would have evaluated and weighed its benefits over risks before making the recommendation.

Report to your doctor if you are experiencing any of the following symptoms:

• Any unusual sudden cough
• Severe pain in the chest which may reach the left arm
• Change in your speech, including slurring of words
• Change in your senses of hearing, smell or taste
• Breathlessness or difficulty in breathing
• Unusual, severe or long lasting headache or worsening of migraine
• Dizziness or fainting
• Severe pain in your abdomen
• Severe pain in legs or swelling in either of your legs
• Weakness or numbness in any part of your body

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

What food or medication should I avoid when I take or use this medication?

Some medications including antibiotics and antifungals may affect how the medication works or be affected by the medication. Please inform your other healthcare professionals about this medication which you are taking if you are seeing them for other medical conditions.

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.

How do I throw away this medication safely? ​

Used patches may still contain some active hormones. Fold the used patch into half such that the adhesive sides stick together.

Pack this medication into a black trash bag and seal it tightly before throwing it into the rubbish chute or bin.