Evra

Evra is a hormonal contraceptive patch that is applied to the skin weekly. It contains the progestin norelgestromin and the estrogen ethinylestradiol, which are continuously released through the skin into the bloodstream.

The patch offers an alternative to taking a pill every day – you only need to remember it once a week. It is waterproof and stays on during showering, bathing, and exercise.

The Pearl Index is about 0.9 overall and about 0.7 with correct use.

Evra works through the same mechanisms as the combined pill:

Prevention of ovulation: The hormones suppress the release of FSH and LH, so that no ovulation takes place.

Cervical mucus: The mucus in the cervix becomes thicker and less penetrable to sperm.

Uterine lining: The endometrium builds up less.

Special feature of transdermal use: The hormones are absorbed evenly through the skin over 24 hours. The hormone level is more constant than with the pill, where it rises briefly after intake and then falls again.

Evra is suitable for women who:

• Want hormonal contraception
• Have problems with taking a pill every day
• Prefer a visible reminder of their contraception

Possibly less suitable in cases of:

• Body weight over 90 kg (reduced effectiveness possible)
• Skin sensitivity or allergies
• A very athletic lifestyle with heavy sweating

Active ingredient content per patch:

• Norelgestromin: 6 mg (daily release: approx. 203 µg)
• Ethinylestradiol: 0.6 mg (daily release: approx. 34 µg)

Patch size:

• 4.5 cm x 4.5 cm (about 20 cm²)

Pack sizes:

• 3 patches (1 month)
• 9 patches (3 months)

Application cycle: 3 weeks with a patch (change weekly), then 1 week off.

Applying the patch: 1. Apply to clean, dry, hairless skin 2. Suitable sites: buttocks, abdomen, outer upper arm, upper back 3. Do NOT apply the patch to the breasts 4. Choose a different site each week 5. Press firmly for 10 seconds

Weekly change:

• Weeks 1-3: Change the patch every 7th day, on the same day of the week
• Week 4: Patch-free break, bleeding occurs
• After exactly 7 days: Apply a new patch

If the patch comes off:

• Less than 24 hours: Reattach it or use a new patch, no additional protection needed
• More than 24 hours: New patch, use additional contraception for 7 days

During sports/swimming: The patch is waterproof. If it comes off anyway, apply a new one.

Evra must not be used in cases of:

• Thromboembolic disorders (current or previous)
• High risk of thrombosis
• Severe cardiovascular diseases
• Migraine with aura
• Severe liver diseases
• Hormone-dependent tumors
• Unexplained vaginal bleeding
• Pregnancy

Reduced effectiveness in cases of:

• Body weight over 90 kg – alternative contraception recommended

Special caution:

• Smoking over the age of 35
• High blood pressure
• Overweight
• Familial predisposition to thrombosis

Very common (>10%):

• Headache
• Nausea
• Breast tenderness

Common (1-10%):

• Skin reactions at the application site
• Mood swings
• Migraine
• Vomiting, diarrhea
• Weight gain
• Dysmenorrhea

Uncommon:

• Fluid retention
• Increased blood pressure
• Galactorrhea

Rare but serious:

• Thromboembolism. Evra may carry up to twice the risk of venous thromboembolism compared with combined hormonal contraceptives containing levonorgestrel, norgestimate or norethisterone. The risk is highest in the very first year of use.

Local reactions: Redness, itching, or irritation at the application site can occur. The application site should be changed regularly.

Effect reduced by:

• Antiepileptic drugs
• Rifampicin
• HIV medications
• St. John's wort

Not affected by:

• Vomiting or diarrhea (unlike the pill)
• Sunscreen or body lotion (do not apply directly to the patch)