Evra

Evra is a contraceptive patch, used for the prevention of pregnancy.

Can I get Evra online?

The Online Clinic can prescribe Evra online following a consultation. Complete the consultation form online and submit to one of our experienced GPs for assessment.

What is Evra?

Evra is a contraceptive transdermal (skin) patch. It is one of the combined hormonal contraceptives, comprising two sorts of hormones; one hormone is an oestrogen (ethinyl estradiol) and the other a progestogen (norelgestromin).

EVRA acts by supressing the hormones called luteinising hormone and follicle stimulating hormone produced in the pituitary (master) gland. These hormones stimulate your ovaries to produce oestrogen and progesterone. By supressing these hormones, Evra stops egg release from the ovary (ovulation). It also alters the mucus in the cervix (neck of the womb) and changes the endometrium (womb lining) so that the womb is less receptive to egg implantation.

How to use Evra

Before starting Evra, ensure that you are not pregnant. Full instructions about how you should use Evra will be given to you by your doctor. You are at risk of becoming pregnant if you do not use a patch for more than 7 consecutive days or have accidental deviations from the treatment schedule. Use alternative non-hormonal protection for one week.

The day that you start Evra will depend on your circumstances, such as when first using a hormone contraceptive, changing from an alternative contraceptive, and after miscarriage, abortion, and birth. Your doctor will advise you what to do.

Evra is used in 4-week cycles, starting Week 1, Day 1. The patch is made to work for 7 days, and should be changed on the same weekday every week. You can put the patch at the top of your back or outer arm, or on your abdomen or a buttock, in an area where tight clothes will not rub it. The skin must be clean and dry, and without hair. Patches are not for use on a breast, on damaged or irritated skin, or on skin after body products (e.g., creams, cosmetics) have been used on or near the application site.

After opening the foil packet (tear along its edge), remove the patch taking care not to remove its protective covering. Peel back this covering half way, avoiding contact with the patch surface. Place the patch on the chosen skin site, and remove the covering. Press the patch firmly onto the skin for 10 seconds using your palm, ensuring the edges are well stuck. On Day 8 (Week 2), remove the patch and replace it immediately with a new patch. It is recommended to use a different skin site to prevent skin irritation. This is repeated on Day 15 (Week 3). On Day 22 (Week 4), the patch is removed; no patch is worn from Day 22 to Day 28. During this week you should have a period. There is no need for additional contraception as long as you start Evra again on Day 29 (this is Day 1 of a new 4-week cycle). On Day 1 of the new cycle, place a new patch on your skin regardless of the timing of your period. Repeat this method.

You should discuss with your doctor any alterations that you wish to make to your treatment schedule. Changing the day that your patch is renewed should be done during Week 4. Using a patch in Week 4 will delay your period. There must be no more than six consecutive weeks of patch use; Week 7 must be a patch-free week

If you notice that a patch has begun to become unstuck or fallen off, either put it back (if it is sticky and not stuck to anything) or use a new patch as soon as possible. If you have been without a patch for over 24 hours or do not know the length of time, then begin another 4-week cycle. Forgetting to change a patch means that you must replace the patch immediately. Depending on when you remember may mean a change in patch replacement day or the start of a 4-week cycle, so ask your doctor. One patch only should be used at any one time. Remove extra patches and get medical advice. If you decide to stop Evra then you may temporarily experience changes to your pattern of menstruation.

Who can use Evra?

Evra is for women who do not wish to become pregnant; it is not for use by children or adolescents under the age of 18 years who have not started menstruating. Evra will not prevent infection with sexually transmitted diseases (e.g., chlamydia, gonorrhoea, genital warts, and HIV).

Evra must not be used during pregnancy or breastfeeding. Remove the patch immediately if you are or think you could be pregnant, or planning pregnancy or to breastfeed. You cannot use Evra if you have allergies to ethinyl estradiol, norelgestromin, or another ingredient in the patch. Treatment (ombitasvir/paritaprevir/ritonavir + dasabuvir) for hepatitis C must be completed before Evra can be used.

Before starting Evra, discuss all of your medical conditions with your doctor. Your doctor will also want to know of any condition that develops or worsens while using Evra; it may be important regardless of how relevant you think it may be. Specifically, a doctor will want to know if you have or have had a blood clot in a blood vessel or a blood clotting disorder, or are waiting surgery or are immobile for long time periods. Being overweight, older age (+35 years), smoking, and a family history of blood clots, heart attacks or stroke increase your risk of blood clots. Mention any past heart attacks, angina, stroke/mini stroke, very high blood pressure, diabetes, high blood cholesterol or homocysteine levels, liver disease, migraine (with aura), abnormal vaginal bleeding, or if you have recently had a baby. Also, very important is to mention cancer, particularly of the breast, womb, cervix, or vagina, or liver.

All your medicines (conventional and herbal; current, recent, and future) must be discussed with your doctor before starting Evra. They can interfere with Evra’s mechanism of action, leaving you at risk of pregnancy. These include anti-virals for HIV and hepatitis C (non-nucleoside reverse transcriptase inhibitors, and protease inhibitors), other anti-infectives (rifampicin, griseofulvin), anti-epileptics, bosentan (high blood pressure), and St. John’s Wort (depression).

Evra side effects

It is useful to know that when first using the Evra patch you may experience vaginal bleeding or vaginal spotting. Contact your doctor should this carry on for longer than three 4-week cycles. Not having a period during Week 4 does not automatically mean a pregnancy, but speak with your doctor if you miss two periods consecutively.

Headache, nausea, and tender breasts are very common in women using Evra. Commonly, women have mood changes, breast enlargement/lumps, menstrual problems (e.g., changes in pattern, cramps, vaginal discharge), weight gain, digestive disorders, dizziness, migraine, and skin rashes and itchiness (particularly at the application site). Some women report difficulty sleeping, loss of libido, premenstrual syndrome, increases in blood pressure or cholesterol/triglycerides, hair loss, increased appetite, and sun sensitivity. Rarely, there are reports of blood clots, heart attack, or stroke; cancer or benign tumours of the breast, cervix or liver; uterine fibroids; fluid retention; gall bladder problems; brown-coloured spots on the face; and changes in blood sugar and blood insulin levels.

Evra can affect blood/urine test results; when having such tests, mention your Evra patch to the person taking the samples.