Birth Control Bingo: the Contraceptive Patch

The birth control⁠ (birth control: Any number of methods people use to intentionally prevent unwanted pregnancy, including the condom, the cervical barrier, the implant, the patch, the pill, the rhythm method, the ring, the shot, the IUD, spermicide and withdrawal.) patch was first approved for use in the United States in 2002. It's an adhesive square that, when placed on the body, transdermally (through the skin) administers a combination of hormones⁠ (hormones: Chemicals – via our endocrine system – that send messages across our bodies and brains. They both naturally exist and can also be made in a lab.) , including estrogen⁠ (estrogen: A steroid hormone found in the bodies of all people, produced in the ovaries and the adrenal glands.It is involved in puberty, menstruation, pregnancy, mood, bone health, and other things across the body and lifespan .) , to prevent pregnancy⁠ (pregnancy: The state of carrying a developing embryo or fetus within the uterus. Medically, someone is considered to be pregnant when an egg has been fertilized by sperm, cells divide, and the fertilized egg is implanted within the lining of the uterus.) . Those hormones suppress ovulation⁠ (ovulation: The process in the human menstrual/fertility cycle where a mature ovarian follicle ruptures and releases ova.) (keep your body from releasing an egg each month), thicken cervical mucus to interfere with sperm⁠ (sperm: Reproductive cells of people with penises which can fertilize an ovum and create pregnancy.) mobility, and also thin the lining of the uterus⁠ (uterus: An internal, muscular reproductive organ in the pelvis. During pregnancy, this is where a fetus will develop. The lining of a person’s uterus is also the thing that sheds every menstrual cycle in what we call a period.) , making it less hospitable for a fertilized egg to implant in. It works in all three of those ways to basically provide backup in case one of its mechanisms doesn't work at a given time.

The first commercially available transdermal patch was approved by the U.S. Food and Drug Administration in December 1979: it administered scopolamine, for motion sickness.

The Contraceptive Patch is:

• 99% effective in one year of perfect use⁠ (perfect use: When a birth control method is used correctly and reliably, the whole time, every time, in accordance with the manufacturer's directions. Many birth control methods will state an effectiveness for "perfect use" vs. "typical use.") ; less than one out⁠ (out: Short for ‘out of the closet’. When someone’s LGBTQ+ identity is known to other people.) of every 100 people will become pregnant
• 92% effective in one year of typical use⁠ (typical use: When a birth control method is not used perfectly, every single time, the entire time. Many birth control methods will state their effectiveness rates with either "typical use" or "perfect use".) : 8 out of every 100 people will become pregnant

Additional Sources for Effectiveness Ratings and Use:

• 91% typical use/99+% perfect use: Contraceptive Technology, 20th Revised Edition; Hatcher, Trussell, Stewart, Nelson, Cates, Guest, Kowal: Ardent Media, 2011.
• 92% typical use/over 99+% perfect use: Planned Parenthood

The What, the Why, the Where, the When, and the How-to: You use a patch by opening a new patch and putting it, like a band-aid, on a clean⁠ (clean: In a sexual context, usually a word used to suggest a person doesn’t currently have anysexually transmitted infections. That term, however, stigmatizes people with illness. Less stigmatizing choices are "negative," "clear" or "STI-free.") part of your body where it's most likely to stay (you want to choose places that don't rub up against the edges of clothing a lot, for instance), and where you feel most comfortable having it. One place it should NOT be put is on your breasts: that could create breast⁠ (breast: Glandular tissue, fat, connective tissue and skin on the chest.) health problems. And if you use body lotions, be sure to put the patch⁠ (the patch: A hormonal form of birth control that is a stick-on patch put on the skin (anywhere except on the breasts) once a week.) on before you put on any lotion: lotions or oils can keep it from sticking and staying on properly.

Every week -- every seven days -- around the same time, you're going to take off your old patch, and put on a new one in at least a slightly different spot. You'll do that for three weeks in a row, then have one week where you don't have a patch on, but you will still be protected against pregnancy for that week. After that off-week, you go back to putting a patch on once a week for three weeks.

Certain people should not use the patch, such as smokers, those over 35, and people who are breastfeeding, diabetic or have a history of high blood pressure, any cardiovascular disorders or high cholesterol. This is true for all methods with estrogen, but is even more so for the patch as it contains substantially more estrogen than other methods: around 60% more than low-estrogen combination pills. People who are over 198 pounds should also be aware that the patch may not be as effective for them. Be sure to discuss your health history and any current health issues with your healthcare provider⁠ (healthcare provider: A qualified person to provide sound physical and/or mental healthcare, such as a doctor, nurse, clinician, counselor, medical assistant, midwife or other healthcare professional.) so that they can be sure the pill⁠ (the pill: A common term for birth control pills/oral contraceptives. A hormonal medication used to prevent unwanted pregnancy.) is safe and likely to be effective for you.

Too, people who are looking for a hormonal method to suppress periods should probably not use the patch to do that: it has not been studied yet for continuous use, and with the higher dose of estrogens, could pose serious health problems used continuously. If you are looking to suppress periods, first talk to your doctor (particularly if you are in your teens, as doing so may pose extra health risks for you; teens have not been studied for suppression), then if your doc gives you the green light to suppress, consider other hormonal methods such as the pill, the implant⁠ (the implant: Usually, a hormonal contraceptive implant, a long-term from of birth control which is inserted beneath the fat layer of the arm.) or the Mirena IUD⁠ (IUD: Intra-uterine device. A long-term birth control method inserted into the uterus by a healthcare provider. Also called an IUS (Intrauterine system) or IUC (Intrauterine contraceptive).) to safely do so with.

Some typical effects -- pro and con -- of the patch include lighter periods (though technically, people on hormonal methods have withdrawal⁠ (withdrawal: A method of birth control which involves the person with the penis "pulling out" of a vagina well before ejaculation and ejaculating away from a partner's genitals.) bleeds, not actual periods), less cramping, decreased PMS⁠ (PMS: Short for "premenstrual syndrome". A varying set of symptoms that many people who menstruate experience just prior to their period. ) symptoms, skin changes, a more regular schedule of monthly bleeding, bloating, nausea, more frequent or more severe headaches, breast tenderness, mood changes or increased depression or anxiety, a decrease in sexual⁠ (sexual: About or relating in some way to sex or sexuality.) desire⁠ (desire: A feeling of wanting something. In the context of sex or sexuality, desire can be a feeling of a physical and psychological want for any kind of sex or way of being sexual.) , vaginal dryness, weight gain, skin irritation and/or more frequent yeast infections. Rare but more serious side effects can include allergic reactions, blood clots, embolism or stroke, heart attack, gallbladder disease, thrombosis or eye problems.

To get the patch, you'll need to visit your sexual healthcare provider (who may also be your regular doctor) to obtain a prescription to fill at your pharmacy. Patches tend to cost a bit more than birth control pills, usually around $35 - $50 a month.

For detailed instructions on how to use the patch, you can refer to the insert that comes with it, or see the information from the manufacturer here.

Also be aware that certain medications and substances may interfere with the effectiveness⁠ (effectiveness: How well something works.) of the patch, or the patch may interfere with the effectiveness of other medications. If you are using or have, in your current patch cycle (that being the four-week period⁠ (period: The fluid – or flow – which contains blood, from the shedding of the uterine lining usually at the end of each menstrual cycle. Sometimes periods may be less fluid and more globby; this is the state that is often mistaken for blood clotting.) of three patch weeks and the off-week), used, any of the following it's best to use a backup method of birth control (like a condom⁠ (condom: A thin sheath or tube of latex or another material, worn over the penis during sex to prevent or reduce the risk of pregnancy and/or sexually transmitted infections.) ) until your next new cycle:

• Barbituates
• Tetracycline
• Cloribrate
• Neomycin
• Rifampin
• Chloramphenicol
• Penicillin
• Sulfonamide
• Ampicillin
• Nitrofuratonin
• Griseofulvin
• Benzodiazepines
• Metronidazole
• Fluconazole
• Anti-Migraine medications
• Seizure/Epilepsy medications

What will/might you need to discuss or negotiate with a partner⁠ (partner: In a sexual context, a person with whom someone is having some kind of sex. The term "partner" can be used for all kinds of relationships, not just serious ones. "Partner" can also mean the person someone is with in a romantic or familial partnership.) ?

• If you or they are or are not okay with ejaculation⁠ (ejaculation: In a sexual context, a discharge of genital fluid, usually (but not always) as a result of sexual stimulation and/or orgasm.) inside the vagina⁠ (vagina: The internal passage leading from the opening of the vulva to the cervix of the uterus.)
• Possible semen⁠ (semen: Fluid which comes from the urethra of the penis during ejaculation, and which usually contains sperm.) allergies or sensitivities (it is currently estimated as many as around 10% of people may have them), if not being combined with condom use
• STI⁠ (STI: Sexually transmitted infections: illness, infection and/or disease which is often or can be transmitted through sexual or other intimate contact, like HIV, Chlamydia or Herpes. Some people call STIs STDs.) status and history, especially if not being combined with condom use

Some questions and answers about the patch:

• How does estrogen dose effect protection against pregnancy?
• How do I actually get birth control?
• He isn't okay with condoms, so I'm starting the patch. Is that safe enough?

Or, click on the tag for patch for a larger list.

When Good Birth Control Does Bad Things: The birth control patch may fail if it is not replaced every week as required or if the seven-day off period is extended longer than seven days, if it is not used with a backup method within the first seven days to one month, if taken in conjunction with other drugs or substances which may interfere with it, or if the patch slips off and is not replaced within 24 hours. If and when a patch slips off, you can try and put it back on, but if it isn't sticking, you'll need a new patch. Don't try and MacGyver it by using tape or glue to stick an old patch on.

Other methods which can be used as a backup method with the Contraceptive Patch: 

• Cervical Barriers (Diaphragms, Lea's Shield and Cervical Caps)
• Condoms
• Emergency Contraception ( Plan B⁠ (Plan B: A brand of emergency contraception pill.) or the Morning-After-Pill)
• Spermicides
• the Sponge
• Withdrawal

Other methods you might like if you like the Contraceptive Patch:

• Condoms
• the Contraceptive Implant (Implanon)
• Depo-Provera (The Shot)
• Intrauterine Devices (IUD, IUC or IUS)
• the Vaginal Ring (Nuvaring)

Why would the patch be a good option for me? If any of the following are true:

• You want a method which is highly effective when used properly
• You want some of the possible benefits the patch may offer, like the reduction of some kinds of acne, shorter, lighter periods, decreased PMS symptoms and help in preventing certain reproductive cancers
• You are looking for a method which you are completely in charge of yourself, where you don't have to rely on a partner to help with birth control
• You do not have sensitive skin
• You were a perfect pill user but still had a failure, and suspect you might need a method with more estrogen in it
• You have an erratic schedule, or are looking for a hormonal method but cannot or do not want to remember to take pills daily
• You don't want a method you have to think about at the time you're going to have sex

This is part of Scarleteen's Birth Control Bingo. Need to start over or anew? Click here.

Don't forget: Statistically, sexually active⁠ (sexually active: Someone who has had or is currently having some kind of genital sex with a partner or partners.) young adults⁠ (adults: People whose age in years exceeds the legal age of majority, people considered to be adults by law, or people who a culture or individual considers to have reached an adult stage of life.) are as, if not more, likely to acquire a sexually transmitted infection⁠ (infection: When harmful microbes, or germs, or harmful levels of microbes/germs, enter the body and multiply, causing illness. The common cold, flu viruses, sexually transmitted infections, chickenpox, impetigo, rabies and diphtheria are some kinds of infections.) (STI) as you are to become pregnant. Although 15-24-year-olds represent only one-quarter of the sexually active population, they account for nearly half of all new STIs each year, and of the 18.9 million new cases of STIs each year, 9.1 million (48%) occur among 15-24-year-olds (AGI). Often people have some funny ideas about who is most likely to get an STI, but the fact of the matter is that younger people -- of any sexual orientation⁠ (sexual orientation: A term -- like homosexual, heterosexual, bisexual, queer, straight, lesbian, gay, asexual -- used to describe a person's usual or current pattern of emotional, romantic and/or sexual attraction to other people as it relates to or is about gender.) , any economic class, any kind of relationship⁠ (relationship: An ongoing interaction or association with another person, place or thing.) -- have been the highest risk group for some time now.

Condoms are the only method of birth control which also provide protection against STIs. It's pretty typical for younger people to ditch condoms if they have another method of birth control, so just remember that STIs are still a risk if you're using another method. You can read all about safer sex⁠ (safer sex: Practices which aim to reduce the risk of sexually transmitted infections, such as use of latex/nonlatex barriers, regular testing for infections and limiting the number of sexual partners.) here -- Safe, Sound & Sexy: A Safer Sex How-To -- but the rule of thumb most medical experts and prevention organizations suggest, which we also encourage at Scarleteen is six months of safer sex, six months of sexual monogamy, and then TWO full STI screenings for each partner -- once at the start of that six months, once at the end -- before ditching latex barriers.

Illustrations copyright 2014, Isabella Rotman