Combined hormonal contraceptive (transdermal patch) Pregnancy: Not indicated during pregnancy — if pregnancy occurs during use, EVRA should be stopped immediately. Epidemiological studies indicate no increased risk of birth defects in children born to women who used combined oral contraceptives before pregnancy, and most recent studies do not indicate a teratogenic effect with inadvertent use in early pregnancy; data on pregnancies exposed to EVRA are too limited to draw conclusions. Animal studies have shown undesirable effects during pregnancy and lactation. Consider the increased risk of VTE in the postpartum period when re-starting. Breast-feeding may be influenced by CHCs (reduced quantity and altered composition of milk), so use is not recommended until the mother has completely weaned her child. Fertility: women may experience a delay in conception following discontinuation.

Ethinylestradiol with norelgestromin

Brand names: Evra

A combined hormonal contraceptive delivering ethinylestradiol with norelgestromin via a transdermal contraceptive patch.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One transdermal patch (EVRA 203 micrograms/24 hours + 33.9 micrograms/24 hours) applied and worn for one full week (7 days)

Route: Transdermal — apply to clean, dry, hairless, intact healthy skin on the buttock, abdomen, upper outer arm or upper torso, where it will not be rubbed by tight clothing. Do not place on the breasts or on skin that is red, irritated or cut. Apply each consecutive patch to a different place on the skin (may be within the same anatomic site). Press down firmly until the edges stick well; do not apply make-up, creams, lotions, powders or other topical products to the site. Check adhesion visually each day. The patch must not be cut, damaged or altered in any way

Frequency: One patch weekly — each used patch is removed and immediately replaced with a new one on the same day of the week (Change Day) on Day 8 and Day 15 of the cycle; the fourth week is patch-free, starting on Day 22. A new contraceptive cycle begins the day after the patch-free week, and the next patch should be applied even if there has been no withdrawal bleeding or bleeding has not yet stopped

Max: Only one transdermal patch is to be worn at a time. Under no circumstances should there be more than a 7-day patch-free interval between dosing cycles

IF THE PATCH-FREE INTERVAL EXCEEDS 7 DAYS the user may not be protected against pregnancy — a non-hormonal contraceptive must then be used concurrently for 7 days; the risk of ovulation increases with each day beyond the recommended contraceptive-free period, and pregnancy should be considered if intercourse occurred during such an extended interval. STARTING — no hormonal contraceptive in the preceding cycle: begin on the first day of menses; the day the first patch is applied (Day 1/Start Day) determines the subsequent Change Days (cycle Days 8, 15, 22 and Day 1 of the next cycle). If Cycle 1 therapy starts after the first day of the menstrual cycle, use a non-hormonal contraceptive concurrently for the first 7 consecutive days of the first treatment cycle only. SWITCHING — from a combined oral contraceptive: begin on the first day of withdrawal bleeding; if there is no withdrawal bleeding within 5 days of the last active tablet, rule out pregnancy before starting. If therapy starts after the first day of withdrawal bleeding, use a non-hormonal contraceptive concurrently for 7 days. If more than 7 days elapse after the last active tablet, the woman may have ovulated and should consult a physician before starting EVRA. From a progestogen-only method: may switch any day (implant on the day of removal; injectable when the next injection would be due) but a back-up barrier method must be used during the first 7 days. AFTER PREGNANCY — after an abortion or miscarriage before 20 weeks gestation, EVRA may be started immediately with no additional method needed (note ovulation may occur within 10 days); at or after 20 weeks gestation, start either on Day 21 post-abortion or on the first day of the first spontaneous menstruation, whichever comes first. Following delivery, women who choose not to breast-feed should start no sooner than 4 weeks after childbirth, using a barrier method for the first 7 days if starting later (exclude pregnancy first if intercourse has already occurred). DETACHED PATCH — if the patch remains even partly detached for less than one day (up to 24 hours) it should be re-applied to the same place or replaced with a new patch (the SPC extract is truncated at this point — clinician to confirm the advice for detachment of one day or more from the SPC). SPECIAL POPULATIONS — Body weight equal to or greater than 90 kg: contraceptive efficacy may be decreased. Hepatic impairment: EVRA has not been studied and is contraindicated in women with hepatic impairment. Post-menopausal women: not indicated, and not intended for use as hormone replacement therapy. PAEDIATRIC — safety and efficacy have not been established in adolescents under 18 years of age; there is no relevant use in children and pre-menarchal adolescents.

Dose adjustments

Renal

EVRA has not been studied in women with renal impairment. No dose adjustment is necessary, but as there is a suggestion in the literature that the unbound fraction of ethinyl estradiol is higher, EVRA should be used with supervision in this population.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Presence or risk of venous thromboembolism — current VTE (on anticoagulants) or history of DVT/PE; known hereditary or acquired predisposition (APC-resistance including Factor V Leiden, antithrombin-III deficiency, protein C deficiency, protein S deficiency); major surgery with prolonged immobilisation; high risk of VTE due to multiple risk factors
Presence or risk of arterial thromboembolism — current or previous ATE (e.g. myocardial infarction) or prodromal condition (e.g. angina pectoris); cerebrovascular disease (current or previous stroke, or TIA); known hereditary or acquired predisposition (hyperhomocysteinaemia, antiphospholipid antibodies); history of migraine with focal neurological symptoms; high risk of ATE due to multiple risk factors or one serious risk factor such as diabetes mellitus with vascular symptoms, severe hypertension or severe dyslipoproteinaemia
Hypersensitivity to the active substances or to any of the excipients
Known or suspected carcinoma of the breast
Carcinoma of the endometrium or other known or suspected oestrogen-dependent neoplasia
Abnormal liver function related to acute or chronic hepatocellular disease
Hepatic adenomas or carcinomas
Undiagnosed abnormal genital bleeding
Concomitant use with medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir, glecaprevir/pibrentasvir, or sofosbuvir/velpatasvir/voxilaprevir

Side effects

Headache (very common, approximately 21.0% in clinical trials); migraine (common); dizziness (common)
Nausea (very common, approximately 16.6%); abdominal pain (common); vomiting, diarrhoea (rare)
Breast tenderness (very common, approximately 15.9%) — spotting, breast tenderness and nausea may occur at the start of treatment and usually diminish after the first three cycles
Mood, affect and anxiety disorders (common); insomnia, libido decreased (uncommon)
(Vulvo)vaginal fungal infection (common); vaginal candidiasis, application site pustules, pustular rash (rare)
Venous thromboembolism and arterial thromboembolism (rare) — including venous and arterial thrombosis, pulmonary embolism, acute myocardial infarction, cerebrovascular accident and cerebral haemorrhage; hypertension (uncommon), hypertensive crisis (rare)

Interactions

Medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir, glecaprevir/pibrentasvir, or sofosbuvir/velpatasvir/voxilaprevir — concomitant use is contraindicated (stated in SPC §4.3 cross-referring to §4.5; the full §4.5 interaction section was not captured in this bundle — clinician to review it)

Clinical monograph

How it works

The patch delivers both hormones across the skin into the systemic circulation, suppressing ovulation while thickening cervical mucus and altering the endometrium; the transdermal route bypasses first-pass hepatic metabolism.

Prescribing in practice

The patch carries the same systemic VTE and arterial risks as combined oral contraceptives, so apply the full UKMEC screen; absorption may be reduced and failure more likely at higher body weight.
Counsel on what to do if a patch detaches or a change is delayed beyond the permitted window.
Efficacy can still be reduced by enzyme-inducing drugs; rotate application sites to limit skin irritation.

Monitoring

Check blood pressure and reassess cardiovascular and VTE risk at initiation and periodic review.

Counselling the patient

Apply to clean, dry, hairless skin and rotate sites; check daily that the patch is stuck down.
Know how long a patch can be off or overdue before back-up contraception is needed.
Seek urgent help for leg swelling, chest pain, breathlessness or sudden severe headache.

Evidence & guidelines

UKMEC applies the same combined-method eligibility criteria to the transdermal patch as to oral combined contraceptives.

Reference: FSRH CHC guideline; UKMEC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

FAST Exam Protocol — Focused Assessment with Sonography in Trauma · Trauma

Pathways