Birth Control Methods
Transdermal Patch
How it works
The patch releases hormones through the skin. Together, estrogen and progestin suppress ovulation. Progestin thickens cervical mucus. The endometrium becomes thinner. Hormone levels stay steadier throughout the day. Vomiting or diarrhea does not affect its effectiveness. After stopping, fertility usually returns in the next cycle. The patch does not protect against STIs; a condom should be added.
Method card: effectiveness, duration, hormones and STI protection
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Types
- Norelgestromin + ethinyl estradiol (Xulane type): Weekly. Worn for 3 weeks, 1-week break.
- Levonorgestrel + ethinyl estradiol (Twirla type): Weekly. Lower dose. Effectiveness may vary with body mass index.
Availability in Turkey may be limited. At SoftCare, which patch is suitable is decided based on availability and patient preference.
Who it is suitable for
- Those who forget to take a pill every day
- Those who experience nausea
- Those who want to regulate their periods
- Those happy to change the patch weekly
Contraindications (the same as for the combined pill):
- Over 35 and smoking more than 15 cigarettes a day
- Migraine with aura
- Uncontrolled high blood pressure
- Past venous thromboembolism
- History of breast cancer
- Severe liver disease
- Suspected pregnancy
The CDC US MEC 2024 criteria are used. In breastfeeding women, it is not recommended in the first 6 months. Effectiveness may be lower in patients with a high body mass index; this is discussed.
Applying the patch
Where to apply it:
- Outer upper arm
- Lower abdomen
- Buttock
- Upper back
Do not apply it to the breasts. Do not apply it to cut or irritated skin. Change the site every week. Do not use the same spot twice in a row. The skin should be clean and dry. Do not use lotion or oil. Press the edges of the patch down firmly. Check every day that it is still stuck on.
Change schedule
- Week 1: Apply the patch.
- Week 2: Apply a new patch on the same day of the week.
- Week 3: Apply a new patch on the same day of the week.
- Week 4: Remove the patch. Take a break. A withdrawal bleed occurs.
- Week 5: A new cycle begins.
The change day should be the same every week. If the break lasts longer than 7 days, a pregnancy test is done and condoms are used for 7 days.
If it falls off or loosens
If it has been off for less than 24 hours:
- If it is still sticky, reapply it in the same place.
- If it is not sticky, apply a new patch.
- Your change day stays the same.
- No backup protection is needed.
If it has been off for 24–48 hours:
- Apply a new patch.
- Use condoms for the next 7 days.
- If you had sex in the last 5 days, emergency contraception is considered.
If it has been off for more than 48 hours:
- Apply a new patch right away.
- This day becomes your new change day.
- Use condoms for the next 7 days.
- If you are in week 3, you can start a new cycle without a break.
At SoftCare, written instructions for what to do if the patch falls off are provided.
Emergency contraception: options by hours since intercourse
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Changes in bleeding
Breakthrough bleeding or spotting may occur in the first 1–3 months. This is part of adjusting. It decreases over time. Periods usually become more regular and lighter. Amenorrhea is rare. If no bleeding occurs, a pregnancy test is done. Heavy or ongoing bleeding needs a check-up.
Side effects
Common:
- Redness or itching at the application site
- Headache
- Breast tenderness
- Nausea
- Breakthrough bleeding
- Mood changes
Skin irritation may lessen by changing the site. If it continues, another method is discussed.
Rare but serious risks:
- Venous thromboembolism (at the level of the combined pill, or possibly slightly higher)
- Arterial thrombosis (in smokers over 35)
- Skin allergy
If you have chest pain, shortness of breath, leg swelling, a sudden headache or vision loss, remove the patch and seek urgent care.
Benefits
- Regulates periods and reduces bleeding
- May ease period pain
- May improve acne
- No daily pill to remember
- Vomiting or diarrhea does not affect its effectiveness
These benefits are seen with regular use.
How it differs from the gold IUD and other methods
At SoftCare, the gold IUD is our first choice. The transdermal patch may be preferred in these situations:
- A patient who forgets the pill and does not want an IUD
- A patient who has stomach side effects
- A patient happy to change it weekly
The gold IUD is hormone-free and carries no risk of forgetting. The hormonal IUD reduces bleeding. The implant is effective for 3 years. The vaginal ring is changed every 3 weeks. The patch is changed weekly. It does not protect against STIs; a condom should be added. The decision is based on risk of forgetting, skin condition and thrombosis risk.
Compare methods
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Follow-up
- Check for bleeding and skin reactions in the first 3 months
- Annual blood pressure measurement
- Pap smear and HPV screening continue as routine
- Stop the patch if you are over 35 and smoke, or develop migraine with aura
- Urgent evaluation if there are signs of thrombosis
At SoftCare, patients starting the patch receive application sites and instructions for when it falls off in writing.
Our approach at SoftCare
At SoftCare Clinic, assessment for the transdermal patch starts with your gynecological history, blood pressure and questions about smoking. The gold IUD is our first recommendation; the patch is discussed with patients who forget the pill or have stomach side effects. You are shown where to apply it. A check-up is planned within the first 3 months. Written instructions are given for when the patch falls off. If there is a thrombosis risk or skin irritation, another method is recommended. If there is an STI risk, condoms and testing are recommended.
Appointments: +90 212 241 30 10 · softcareclinic.com
References
- 1. Centers for Disease Control and Prevention (CDC). U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.
- 2. GoodRx. Xulane Birth Control Patch.
- 3. Drugs.com. Twirla vs Xulane comparison.
- 4. UpToDate. Combined hormonal contraception: Transdermal patch.
- 5. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397–404.
- 6. Find My Method. Doğum Kontrol Yaması Yan Etkileri.
- 7. T.C. Sağlık Bakanlığı. Gebeliği Önleyici Yöntemler.
- Note: Rules for when the patch falls off or for breaks may vary by type of patch. At SoftCare, the gold IUD is our first choice; the transdermal patch is discussed with selected patients. This reference list is for information purposes.
Frequently asked questions
Can I get pregnant if the patch falls off?
If it is off for less than 24 hours, the risk is low. If it is off longer, use condoms for 7 days.
Where do I apply it?
Upper arm, abdomen, buttock or back. Do not apply it to the breasts. Change the site every week.
Will my periods stop?
Rarely. A withdrawal bleed is expected during the break. If no bleeding occurs, a test is done.
Can I use it while breastfeeding?
It is not recommended in the first 6 months; during this period, progestin-only methods are preferred.
Does it cause weight gain?
Direct weight gain is not expected. Bloating may occur in the first months. Effectiveness may be lower with a high body mass index.
Can I still have a Pap smear?
Yes. The patch does not prevent a Pap smear. Routine screening continues.
When should I stop?
Stop when you plan a pregnancy, or if you develop signs of thrombosis, skin irritation, or start smoking over age 35. Fertility returns quickly after stopping.
Why choose the patch instead of the gold IUD?
For patients who do not want an IUD, forget the pill, or have stomach side effects. At SoftCare, the decision is based on patient preference and medical eligibility.
A citation does not mean that SoftCare wrote that text.
Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: