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The birth control patch: side effects, effectiveness, and cost

The birth control patch: side effects, effectiveness, and cost

8 min read

If you’re researching hormonal birth control, you may have already explored or experimented with oral contraceptives (aka the pill), implants, or injectables. Allow us to introduce another option: the birth control patch.

Also known as the transdermal contraceptive patch, this form of birth control is a small, bandage-like adhesive that prevents pregnancy by delivering hormones through your skin and into your bloodstream. While the patch might not be *quite* as easily accessible as condoms or as popular as the pill, it's an effective and convenient way to keep your chances of pregnancy at bay.

In this article, we’ll share some information to help you consider whether or not the birth control patch is right for you. Here are your biggest takeaways before we jump in:

  • How does the birth control patch work? Like most contraceptive pills, the birth control patch works by blocking ovulation, thickening cervical mucus (which makes it harder for sperm to reach an egg if it is ovulated), and preventing the thickening of the lining of the uterus (aka endometrium).
  • What are the benefits of using the patch? The birth control patch is 99% effective at preventing pregnancy with "perfect" use and 91%-93% effective with real-world use.
  • What are potential risks, side effects, and barriers? The patch does not prevent sexually transmitted infections (STIs), and can lead to similar side effects as oral contraceptives.
  • Can the patch impact fertility? No, but you might not see the return of your usual menstrual cycles until four cycles after stopping the patch.
  • Is there anyone who the birth control patch might not be right for? The patch isn't safe for people who are over 35 years old and smoke cigarettes due to an increased risk of cardiovascular side effects (like blood clots). It's also not recommended for people with a history of certain health conditions (like hypertension or migraines with auras). Finally, effectiveness and side effects are impacted by body-fat percentage, so people with a higher body-fat percentage may not be the best candidates for the patch. Talk to your healthcare provider about whether or not the patch is right for you.

"The patch is a good option for patients who are looking for similar secondary effects to the birth control pill, but have a harder time managing taking a pill every day," explains OB-GYN and Modern Fertility medical advisor Dr. Eva Luo, MD, MBA. "Some patients can develop a reaction to the adhesive in the patch, so watch out for any skin irritation."

What is the birth control patch and how does it work?

There are currently two prescription birth control patches sold in the US: Xulane and Twirla. Xulane was approved by the FDA in 2014 as a generic alternative to Ortho Evra (now retired) and Twirla was approved as a new drug in 2020. The two brands are pretty similar minus a few notable differences:

Xulane:

Twirla:

Worn on your butt, belly, or back, the birth control patch enables your body to absorb the hormones estrogen (ethinyl estradiol) and progestin (levonorgestrel or norelgestromin, synthetic forms of progesterone) through your skin. Just like combined oral contraceptives and the vaginal ring, the patch’s hormones are designed to stop the ovaries from releasing eggs (ovulation) in order to prevent pregnancy.

That’s not all the birth control patch has to offer. The hormones in the patch also thicken cervical mucus to block sperm from reaching an egg and can alter the uterine lining in order to prevent implantation.

What are the benefits of the birth control patch?

The patch is considered to be a highly effective method of birth control when used perfectly. According to three large clinical trials of more than 3,000 women over one year, just 1 out of 100 people became pregnant while using Xulane in one year.

That said, perfect use isn’t always the same as actual use. Forgetting to pick up your monthly refill or swap your weekly patch isn’t unheard of, so the typical success rate is closer to between 91% and 93% — meaning approximately 7-9 out of 100 patch users get pregnant each year. (This is the same rate of effectiveness as the pill and the ring.)

Beyond clinical efficacy, there are other benefits to choosing the patch. Compared to swallowing a pill each day, the patch is a fairly simple choice:

  • The patch can be removed at any time, allowing for more flexibility and freedom with your fertility future
  • The patch remains on your skin at all times so need to interrupt sex (or the mood) by reaching for a barrier method like a diaphragm or sponge
  • The steady dose of hormones in the patch can help with menstrual cramps (win!)
  • A more regular and predictable period (assuming you skip the patch on week 4, but we’ll talk about that more later)

What are the side effects and risks of the birth control patch?

The patch is pretty dang good at preventing pregnancy, but it doesn't protect against sexually transmitted infections (STIs). Depending on your situation, you may want to consider also using a condom to best protect yourself from pregnancy and STIs.

The patch tends to be well-tolerated, but these are some of the more common side effects reported.

Side effects for Xulane may include:

  • Breast tenderness (chest tenderness), discomfort, swelling, or pain
  • Nausea or vomiting
  • Headache
  • Abdominal pain
  • Mood and anxiety disorders
  • Vaginal bleeding and menstrual disorders

Side effects for Twirla may include:

  • Skin reactions at the patch site
  • Nausea
  • Headache
  • Menstrual cramps
  • Weight gain

Although rare, Xulane and Twirla can both cause serious side effects including blood clots, stroke, and heart attack (here and here). The risk of blood clots or venous thromboembolism (VTE) is highest when you first start using the patch, or when you restart the patch or another hormonal birth control after a month or more break.

Seek immediate medical advice if you experience any of these symptoms on Xulane or Twirla:

  • Sudden shortness of breath or trouble breathing
  • Trouble speaking
  • Sudden blindness
  • Severe chest pain or pressure
  • Sudden, severe headache that differs from usual headaches
  • Weakness or numbness in arm or leg
  • Leg pain that won’t go away
  • Yellowing of the skin or eyes

Can the birth control patch impact fertility?

Like all other hormonal contraceptives, the patch won't have a negative impact on your fertility — or your ability to conceive, get pregnant, and have kids.

A study of nearly 18,000 women in North America and Denmark found the following:

  • The patch didn’t have a long-term effect on the probability of becoming pregnant within one menstrual cycle (known as fecundability).
  • On average, it took patch users four cycles before they reached their normal fertility (versus 5-8 cycles for injectable contraceptives, three cycles for oral and ring contraceptives, and two cycles for hormonal and copper intrauterine devices and implant contraceptives).

How much does the birth control patch cost and will insurance cover it?

The contraceptive comes with a monthly supply, meaning three patches per month. A monthly pack can run between $0 and $150, potentially costing you $1,800 over the course of a year. Luckily, the patch is completely covered (read: free!) by most health insurance plans and some government programs.

Who might want to pass on the patch?

As always, it’s important to consult your healthcare provider before starting a new birth control (plus, you need a prescription for the patch anyway).

The patch isn’t a safe choice if you’re over the age of 35 years and smoke cigarettes. Smoking is known to increase your risk of serious cardiovascular side effects, such as heart attack, blood clots or stroke, and the estrogen in the patch further increases this risk.

​Another important consideration is body-fat percentage, as estimated via the (flawed) body-mass index (BMI) measurement tool:

  • Women with a BMI of 30 or more who use the patch may be at a higher risk for developing blood clots compared to women with a BMI lower than 30.
  • Phase III clinical trial results for Twirla also found that Twirla was slightly less effective for women with higher BMIs: the one year pregnancy rate was 4.3% for women with BMI <30 and 8.6% for women with BMI ≥30.

Your provider might also advise against the patch if any of the following apply to you:

  • A history of blood clots
  • A history of heart attack, stroke, or certain heart valve or rhythm problems that can cause blood clots
  • A history of hypertension
  • High blood pressure that medicine can’t control
  • Diabetes with kidney, eye, nerve, or blood vessel damage
  • Severe migraines with aura, numbness, weakness, or changes in vision
  • Liver disease or liver tumors
  • Unexplained vaginal bleeding
  • Breast cancer or any cancer that's sensitive to the patch's hormones
  • Are pregnant or think you might be pregnant
  • Are breastfeeding/chestfeeding

How do you get the birth control patch?

If everything you’ve read so far has you thinking that the patch might be the protection for you, your next step is to make an appointment with a healthcare provider to request a prescription and your pack of patches.

Because of the risk factors previously mentioned, your provider will likely review your medical history, check your blood pressure, and cross reference any medications you’re taking (non-prescriptions and herbal products included).

Sounds simple. Is it really though?

Yes, the patch truly is a straightforward option! Here's how it works:

  1. The birth control patch should be applied to clean, dry skin once per week (every seven days) for three weeks, followed by a patch-free week.
  2. The patch begins to work as soon as you apply it to your skin, but you should use a second form of birth control for the first seven days.
  3. Each patch lasts for one week, and you’ll change the patch weekly for three weeks.

If you prefer to skip or delay your period while using Xulane, you have the option to bypass the off-week and instead continue with a new patch on the fourth week.

Skipping a period while on the patch is "absolutely safe" — and "similar to taking birth control pills continuously and skipping the last week/placebo pills," says Dr. Luo. "The 'period' that one sees on the patch is not a real period, but a reaction to the withdrawal of hormones." That bleeding is often referred to as "withdrawal bleeding."

How do you apply the patch? And what if it falls off?

  1. Place the first patch smoothly on clean, dry skin and press firmly for about 10 seconds.
  2. The patch is designed to stick, but you can reapply the patch if it falls off for any reason within 24 hours. If the patch still won't stick, apply a new patch right away.
  3. If the patch is off for longer than one day, apply a new patch and begin the three-week cycle again. At this point you may be at risk for pregnancy, so consider a back-up contraception for the next week (and emergency contraception if you have unprotected sex during that time).

Other than that, here are a few best practices to optimize the patch’s effectiveness:

  • Choose your location wisely. Your butt, stomach, and upper body are all fair game, but it’s best to avoid placing the patch anywhere it might rub against tight clothing (i.e., your breasts/chest and bra strap or your waistband and underwear). Upper outer arm is a common placement.
  • Pick a “patch change day.” Although you only need to remember to change your patch three or four times per month, applying a new patch on the same day of the week (i.e., every Monday) helps to avoid accidental gaps in coverage.
  • Don’t forget to rotate. Apply the new patch on a new patch of skin each week to avoid dry skin or irritating the original spot.
  • Leave the patch as is. Although it may be tempting to trim or move the patch based on outfit or outing, don’t move the patch once applied.

The patch is made to withstand a little wear and tear so don't worry about showering, swimming, or even extreme heat like a sauna or hot tub. That said, the Twirla patch might not stick as well if you often spend extended periods of time (30 minutes or more) in the water.

The bottom line

The contraceptive patch is considered to be a safe and convenient form of hormonal birth control for most people. Although it’s not one of the more common types of birth control in the United States, the patch shows similar effectiveness to birth control pills without the potential hassle of swallowing a pill each day.

(For more clinically sound information around all things birth control, reproductive health, and women's healthcare, bookmark the Modern Fertility blog!)

This article was medically reviewed by Dr. Eva Marie Luo, MD, MBA, OB-GYN at Beth Israel Deaconess Medical Center and Clinical Lead for Value at the Center for Healthcare Delivery Science at Beth Israel Deaconess Medical Center.

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Alexandria Bachert

Alex is a freelance health and science writer, public health professional, and new mama based in New Jersey. She enjoys food tours, making lists, and strolls with her mini bernedoodle.

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