What you should know about the birth control patch, Xulane

Are you looking for an effective method of birth control that you don’t have to think about every day? If an IUD or birth control shot feel like too much commitment but popping a daily pill or using a monthly vaginal ring seems like a hassle, the weekly birth control patch could be more your speed.

According to the CDC, approximately 11% of women have ever used the birth control patch, and while it’s not as well-known as condoms or birth control pills, it’s an effective option for anyone looking to prevent pregnancy. Read on to learn the pros and cons of this form of contraceptive. 

What is the birth control patch?

The birth control patch, which is also called the “transdermal contraceptive patch” or simply “the patch,” is a generic form of hormonal birth control available under the name Xulane. It’s a thin, beige bandage about 1.5 inches wide that you apply like a Band-Aid to the skin on your stomach, upper arm, buttocks, or back. You put on a new patch once a week, on the same day every week. It was formerly known as Ortho Evra, but that was removed from the market when the generic Xulane was released in 2014. 

How does the birth control patch work?

The birth control patch prevents pregnancy by steadily releasing a combination of the hormones estrogen and progestin (in the form of ethinyl estradiol and norelgestromin) into your body transdermally, i.e. through your skin. The birth control patch has a similar hormonal makeup to many low-dose birth control pills.

Like other forms of hormonal contraception, the patch prevents pregnancy in three different ways. First, it stops ovulation, the time of the month when your ovaries release a mature egg in anticipation of fertilization. Then, the hormones in the patch thicken your cervical mucus, making it much more difficult for sperm to fertilize any wayward eggs. Last, it thins the uterine lining, so it’s much more difficult for a fertilized egg to implant. 

How fast the patch begins to work after it is applied depends on where you are in your menstrual cycle. Typically, after the first contraceptive patch is applied, you must wait seven days before it can be fully protective against pregnancy. In the meantime, use a backup method, such as a condom. The patch is 99% effective if it’s used exactly as indicated; in reality, it’s around 91% effective.

How do I use the birth control patch?

You’ll first need to talk with your healthcare provider about the pros and cons of the birth control patch, as well as any health risks. The patch is only available by prescription. 

After receiving a prescription, you’ll apply the first patch during the first 24 hours of your period. It will become effective immediately with no need for backup contraceptive methods (however, protection against sexually transmitted infections, or STIs, is still needed). Another option is to apply the first patch on the first Sunday after your period has started, which will require using a backup method for the next seven days. The first day you apply the transdermal patch will become your patch change day, so mark it on your calendar!

Talk to your doctor about your options if you are switching from a different birth control method to the patch, or are beginning the patch after an event such as childbirth or miscarriage.

Application

Your healthcare provider should give you step-by-step information on how to apply the patch correctly so it’s effective. The sticky side of the patch must be placed on certain areas of your body in order to deliver the hormones to your system properly. It can be placed on your upper outer arm, abdomen, buttocks, or back in a location where it will not be easily rubbed or irritated by straps or clothing, such as on your breasts. Be sure to apply your patch to clean, dry skin—any sort of makeup, lotion, or oil can cause the patch to loosen, fall off, or otherwise interfere with the patch’s function. 

When you first apply your patch, apply pressure for 10 seconds to make sure it fully adheres, and smooth out any wrinkles. Then, keep it on continuously for seven days, without taking it off to bathe or exercise. When replacing the patch each week, you must place the new patch in a different location from the old patch. You can get off any residual stickiness with lotion or oil.

Removal

Check your patch every day to make sure it’s firmly affixed to your skin. If you notice it’s come off or isn’t on perfectly and it has been less than one day, try to reapply it. If the patch does not stick completely, replace it immediately with a new patch. No backup contraception is warranted. If it’s been off for longer than a full day or you’re not sure how long it’s been off, reapply a new patch ASAP and use a backup birth control method for at least a week. You’ll also need to start a new four-week cycle with a new day of the week designated to change your patch.

If you forget to change your patch but are only one or two days late in changing it, reapply a new patch immediately. Maintain your previous “patch change day.” However, if you are later than two days in applying a new patch, you’ll have to use a secondary form of contraception for a week and start a new 4-week cycle. Remember that the day on which you apply the new patch is considered the first day of your new patch application cycle.

You can either change your patch each week for three weeks and take the fourth week off, which will mean you’ll menstruate as usual. You can also opt to use the patch every week and skip your period altogether. It’s up to you.

Xulane side effects

The potential side effects of the patch are similar to that of other hormonal contraceptives such as the birth control pill and NuvaRing. 

• Acne or other skin problems, such as skin blotches
• Bloating
• Breast tenderness or discomfort 
• Breakthrough bleeding
• Decrease in libido
• Dizziness
• Fatigue
• Headache
• High blood sugar, especially in women with diabetes
• High cholesterol and/or triglycerides levels 
• Mood changes like increased anxiety or depression
• Menstrual cramps or pain 
• Nausea, vomiting, or diarrhea
• Skin irritation at the patch application site
• Stomach pain
• Weight gain
• Vaginal infections or change in discharge

What are the disadvantages of the birth control patch?

There are a number of factors to keep in mind when it comes to choosing the patch. Talk to your healthcare provider about any previous or current conditions you have, including breast cancer, diabetes, migraine, if you think you might be pregnant, and what drugs and supplements you’re currently taking. Because of the way the patch works, you’ll actually be exposed to 60% more estrogen than if you were taking an oral contraceptive with the same level of estrogen. If you’re sensitive to estrogen or currently have or have had a medical history of estrogen-related conditions, including breast cancer, this would be something to take into serious consideration. Smokers over 35 are advised against using the patch. Additionally, there are a few other downsides to Xulane:

• The patch doesn’t protect against STIs, so you’ll need to use condoms if that’s a concern.
• Drug interactions (anti-seizure medication, HIV medications, treatments for chronic hepatitis C, and St. John’s Wort) may make the patch less effective.
• It’s less effective if you’re unable to change the patch on time or if it gets loose regularly.
• It’s less effective if you weigh over 198 pounds.
• Skin irritation and rashes may occur at the patch site.
• There are more serious risks, such as blood clots, heart attack, high blood pressure, gallbladder disease, liver cancer, and stroke
• Timing restrictions require the patch be changed on the same day every week.

What are the advantages of the birth control patch?

There are many upsides to using Xulane, namely that it’s convenient to use and easily reversible (simply by removing the patch). It’s not as invasive as long-acting as the shot or IUD, and it’s side effects are comparable to other forms of hormonal birth control.

How to get the Xulane birth control patch

After discussing the pros and cons of the patch with your healthcare provider, he or she will write you a prescription. Xulane is covered by most insurance plans, but it can cost up to $150 for a pack of three without insurance—unless you’re using discount programs like SingleCare. 

Here’s a full breakdown of what getting birth control without insurance will cost, including the visit to your healthcare provider. You can also visit a health center like Planned Parenthood that will work with you depending on your income.