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The Patch

The patch is a method of hormonal birth control in the form of a thin, adhesive patch that is attached to the skin every week for 3 weeks followed by a week of no patch. There are 2 brands of patches: Xulane and the new Twirla. The patch does NOT protect against sexually transmitted diseases (STDs).

How does it work?

Hormones released from the patch are absorbed through the skin. Estrogen in the patch prevents egg release or ovulation. Progestin thickens cervical mucus and thins the uterine lining. Together, these actions make pregnancy very unlikely.

How well does it work?

The patch is 99% effective in preventing pregnancy with perfect use and 91% effective with typical use. When does it start working? When the patch starts to work depends on where you are in your cycle. If you apply the patch within the first 5 days of your period, it will get to work right away. Otherwise, you will need to use backup birth control, like condoms, for at least 7 days.

How do I use it?

  1. Apply a patch to the skin of the upper arm, stomach, buttock, or upper back where there is little to no hair. Avoid the breasts, genitals, and broken/irritated skin. The skin under the patch should be clean and dry, with no lotions or creams. Leave it on for one week.
  2. After the one week passes, remove the patch. Fold it in half and throw it in the trash. Apply a new patch to a new location immediately.
  3. Repeat this process until you have worn a new patch every week for 3 weeks. Remove the third patch and do not apply a new patch for the fourth week. You may get your period during this time. After the 7 patch-free days, begin the monthly cycle again by applying a new patch.

Can I leave the patch on while I shower?

Yes. You may leave the patch on while showering, swimming, and exercising. The adhesive is strong, but check the patch regularly to make sure it isn’t peeling and falling off.

What if the patch falls off?

Put the patch back on right away. If the patch will not stick or if the patch has been off for more than 24 hours, apply a new patch to a new site and use backup birth control, like condoms, for the next 7 days. The day that you placed the new patch is your new patch change day. If this happened during the third patch week, skip the patch-free week and apply a new patch on your patch change day.

What if I forget to change it on time?

Each patch delivers enough hormones to prevent pregnancy for up to 9 days. If you left it on for longer than that, remove it and apply a new patch to a new location right away. Use backup birth control for the next 7 days. Consider using emergency contraception, like Plan B One-Step, if you had sex while the patch was out of hormones.

What are some side effects might I experience?

Though rare, there are serious side effects that can occur when using the patch. These include blood clots and strokes. If you experience sudden and/or severe pain in your stomach, chest, head, or legs with or without dizziness, nausea, vomiting, difficulty breathing, or changes in vision or mental status, call your health care provider right away and/or get to an emergency room. You may experience nausea, headache, breast tenderness, or changes in bleeding patterns. These symptoms usually resolve within 3 months of patch use. Some people experience skin irritation.

What if I want to get pregnant soon?

You can get pregnant as soon as you stop using the patch.

Is it right for me?

The patch is an effective, convenient, pill-free option that is safe for many people. Some health conditions (history of blood clots, high blood pressure, strokes, heart attack, migraine, smoking, and age over 35) make it unsafe to use the patch, so other methods (without estrogen) can be used instead (see the other fact sheets here). The patch can lead to more hormone in the body that other forms of birth control; this is important to keep in mind for those who are sensitive to estrogen or at a high risk of blood clots. The patch may also not be the best option if you have a skin condition, like eczema, or if you are overweight.

What are the differences between Twirla and Xulane?

Xulane has been available since 2014, and Twirla was introduced in 2020. Twirla has less estrogen than Xulane, making it relatively safer to use in terms of blood clot risk; however, it is twice the size of the Xulane patch, and this can be a drawback for those who want a more hidden form of birth control.

Updated August 2020