Evra Patches

Evra is a transdermal contraceptive patch containing norelgestromin 6 mg and ethinylestradiol 600 micrograms, releasing approximately 203 micrograms of norelgestromin and 33.9 micrograms of ethinylestradiol per 24 hours.

It is a combined hormonal contraceptive applied once weekly for three weeks, followed by a patch-free week. Evra is a prescription-only medicine (POM) in the UK.

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Evra is a transdermal contraceptive patch that delivers a combination of two hormones, norelgestromin (a progestogen) and ethinylestradiol (an oestrogen), through the skin to prevent pregnancy.

Each patch is worn for one week, with a new patch applied each week for three consecutive weeks, followed by a patch-free week during which a withdrawal bleed occurs.

Manufactured by Janssen (a Johnson and Johnson company), Evra is a prescription-only medicine (POM) in the United Kingdom.

It is the only combined hormonal contraceptive patch currently available in the UK.

Contraception is a fundamental aspect of reproductive healthcare. In England alone, approximately 3.3 million women use a method of contraception, according to NHS data.

While the combined oral contraceptive pill has been the most widely used hormonal method for decades, the contraceptive patch offers an alternative that eliminates the need for daily pill-taking, potentially improving adherence and reducing the risk of unintended pregnancy due to missed doses.

This page provides a comprehensive clinical guide to Evra for patients in the United Kingdom, covering how it works, how to use it, effectiveness, side effects, important safety information including blood clot risk, drug interactions, and how to obtain a prescription through the NHS or a sexual health service.

Important safety information about Evra

Before reading further, note the following essential safety points. Evra is a prescription-only medicine and must be used under clinical supervision.

  • Evra must not be used by women with a history of blood clots (DVT, PE), stroke, heart attack, or migraine with aura.
  • Women aged 35 and over who smoke must not use Evra.
  • All combined hormonal contraceptives carry a small increased risk of venous thromboembolism. Know the symptoms: painful swollen leg, sudden breathlessness, chest pain.
  • Evra does not protect against sexually transmitted infections. Use condoms for STI prevention.
  • The efficacy of Evra may be reduced in women weighing 90 kg or more.

How Evra works: mechanism of action

Evra delivers two hormones transdermally. Norelgestromin is the primary active metabolite of norgestimate, a third-generation progestogen. Ethinylestradiol is a synthetic oestrogen used in most combined hormonal contraceptives. Together, these hormones prevent pregnancy through three mechanisms.

The primary mechanism is suppression of ovulation. The continuous delivery of progestogen and oestrogen inhibits the hypothalamic-pituitary-ovarian axis, preventing the mid-cycle surge of LH and FSH that triggers ovulation. Without ovulation, no egg is released for fertilisation.

The secondary mechanism is thickening of the cervical mucus. Progestogen causes the cervical mucus to become thick and viscous, creating a barrier that impedes sperm transport through the cervical canal.

The tertiary mechanism is alteration of the endometrium. The hormonal environment induced by the patch makes the endometrial lining thinner and less receptive to implantation, providing an additional layer of contraceptive protection.

The transdermal delivery system provides steady-state hormone levels, avoiding the daily peaks and troughs associated with oral contraceptive pills.

Each Evra patch releases approximately 203 micrograms of norelgestromin and 33.9 micrograms of ethinylestradiol per 24 hours.

Serum levels reach steady state within approximately 48 hours of the first patch application.

Effectiveness of Evra

With perfect use (applying and changing the patch correctly every week), Evra is more than 99% effective at preventing pregnancy (fewer than 1 pregnancy per 100 women per year).

With typical use, which accounts for real-world errors such as late patch changes or patches falling off, the effectiveness is approximately 91% (about 9 pregnancies per 100 women per year).

This typical-use effectiveness is comparable to that of the combined oral contraceptive pill.

Efficacy may be reduced in women weighing 90 kg (approximately 14 stone) or more.

In clinical trials, a higher proportion of pregnancies occurred in women in the highest weight category.

If you weigh 90 kg or more, discuss alternative contraceptive options with your prescriber.

How to use Evra: step-by-step guide

The 4-week cycle

Week 1 (days 1 to 7): Apply the first patch. This day becomes your patch change day.

Week 2 (days 8 to 14): Remove the old patch and apply a new one on your patch change day.

Week 3 (days 15 to 21): Remove the old patch and apply a new one on your patch change day. Week 4 (days 22 to 28): Patch-free week.

Remove the patch and do not apply a new one. A withdrawal bleed will usually occur during this week.

After the 7-day break, apply a new patch to begin the next cycle, regardless of whether the bleed has finished.

Applying the patch

Choose a clean, dry, non-hairy area of skin. Suitable sites include the buttock, abdomen, upper outer arm, and upper torso (excluding the breasts).

Do not apply to broken, irritated, or sunburned skin. Do not apply lotions, creams, oils, or powders to the area.

Remove the patch from its foil pouch, peel off the protective liner, and press the adhesive side firmly against the skin for at least 10 seconds, running your finger around the edges to ensure a secure seal.

When to start Evra

If starting on day 1 of your menstrual period, contraceptive protection is immediate.

If starting on any other day, use additional barrier contraception (condoms) for the first 7 days.

If switching from a combined oral contraceptive pill, apply the first patch on the day after the last active pill or on the day after the pill-free or placebo-pill interval.

If switching from a progestogen-only method, apply the first patch on the day the next injection is due (for injectable), on the day of implant removal (for implant), or on any day (for POP), using barrier contraception for the first 7 days.

What to do if the patch falls off

If the patch has been detached for fewer than 24 hours, reapply the same patch (if still sticky) or apply a new one. Continue with the usual schedule. No additional contraception is needed.

If the patch has been detached for 24 hours or more, or if you are unsure how long it has been off, start a new 4-week cycle with a fresh patch.

This becomes your new patch change day. Use barrier contraception for the first 7 days. Consider emergency contraception if unprotected intercourse occurred during the detached period.

Late patch change

If you forget to change the patch but are fewer than 48 hours late, apply the new patch immediately. No backup contraception is needed.

If the delay is 48 hours or more, start a new cycle with a fresh patch, use barrier contraception for 7 days, and consider emergency contraception if appropriate.

Side effects of Evra

Common side effects

The most frequently reported side effects include application site reactions (redness, irritation, itching), headache, nausea, breast tenderness, mood changes (including low mood and irritability), abdominal pain, and menstrual pain.

These are similar to side effects seen with combined oral contraceptive pills and commonly improve after the first 2 to 3 cycles of use.

Uncommon side effects

These include dizziness, migraine, vomiting, diarrhoea, acne, skin rash, fluid retention, weight gain, vaginal discharge, decreased libido, fatigue, and muscle cramps. Changes in bleeding pattern (lighter or absent withdrawal bleeds, or breakthrough bleeding) may occur.

Rare but serious side effects

Venous thromboembolism (deep vein thrombosis, pulmonary embolism) is the most important rare risk.

The absolute risk is low in healthy young women (approximately 5 to 12 per 10,000 users per year) but higher than in non-users (approximately 2 per 10,000 per year).

Arterial events (stroke, myocardial infarction) are very rare but more likely in women with additional risk factors. Other rare effects include hypertension, gallbladder disease, hepatic adenoma, and chloasma.

When to seek urgent medical advice

Seek immediate help (call 999 or attend A&E) if you experience sudden painful swelling of one leg, sudden breathlessness or sharp chest pain, sudden severe headache unlike your usual headaches, visual disturbance, weakness or numbness on one side of the body, or difficulty speaking.

These may be signs of a blood clot or stroke. Contact your GP or NHS 111 for persistent headaches, mood changes, or other symptoms that concern you.

Report suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Blood clot risk (venous thromboembolism)

All combined hormonal contraceptives slightly increase the risk of VTE.

The risk is highest during the first year of use and after restarting following a break of 4 weeks or more.

Risk factors include obesity (BMI above 30), prolonged immobility (long-haul flights, surgery, bed rest), smoking, family history of VTE at a young age, increasing age, and known thrombophilia.

Women should be assessed for these risk factors before prescribing. Evra should be stopped at least 4 weeks before elective surgery requiring prolonged immobilisation.

Arterial thromboembolism

The risk of arterial events (stroke, myocardial infarction) is very low in young healthy women but increases with smoking, hypertension, diabetes, hyperlipidaemia, obesity, migraine (especially with aura), and age.

Evra must not be used in women who smoke and are aged 35 or over.

If migraine with aura occurs for the first time during Evra use, the patch must be removed and alternative contraception considered.

Weight considerations

Clinical data suggest that the efficacy of Evra may be reduced in women weighing 90 kg or more.

If your weight is at or above this threshold, discuss alternative contraception with your prescriber.

Methods such as the levonorgestrel intrauterine system (hormonal coil), copper intrauterine device, or progestogen-only implant are not affected by body weight.

Sexually transmitted infections

Evra provides no protection against sexually transmitted infections including HIV, chlamydia, gonorrhoea, syphilis, and HPV. Use condoms (male or female) alongside Evra for STI prevention if you or your partner may be at risk.

Drug interactions

Enzyme-inducing medicines significantly reduce the contraceptive effectiveness of Evra.

These include rifampicin, rifabutin, carbamazepine, phenytoin, phenobarbital, primidone, topiramate (at doses above 200 mg), oxcarbazepine, eslicarbazepine, St John's wort, and certain antiretroviral drugs.

Women taking short courses of these medicines should use additional barrier contraception during treatment and for 28 days after stopping.

Women on long-term enzyme inducers should consider a non-hormonal method or a progestogen-only method not affected by enzyme induction (such as the copper coil or hormonal coil).

Broad-spectrum antibiotics that do not induce liver enzymes (such as amoxicillin, doxycycline, azithromycin) do not reduce the effectiveness of Evra. Additional contraception is not routinely required with these antibiotics, unless severe vomiting or diarrhoea occurs concurrently.

Pregnancy and breastfeeding

Evra must not be used during pregnancy. If pregnancy is suspected, remove the patch immediately and consult your GP.

Evra is not recommended during breastfeeding, as oestrogen may reduce milk production and small amounts of hormones may pass into breast milk. Progestogen-only methods are preferred during breastfeeding.

Getting Evra in the UK

Evra is a prescription-only medicine available free of charge on the NHS.

You can obtain it from your GP, a sexual health or family planning clinic, or an authorised online prescriber.

Contraception is free for all women in the UK, regardless of age, and is exempt from prescription charges even in England.

Your prescriber will assess your medical history, blood pressure, BMI, and risk factors before prescribing.

Choosing the right contraceptive for you

The contraceptive patch is one of many options available on the NHS.

It may suit women who find it difficult to remember a daily pill, who want a method they only need to think about once a week, or who prefer transdermal delivery.

It may be less suitable for women weighing 90 kg or more, women who are sensitive to adhesive, or women who prefer a method with no oestrogen.

Other combined methods include the combined pill and the vaginal ring (NuvaRing). Progestogen-only methods include the mini-pill, the hormonal coil (Mirena), the implant (Nexplanon), and the injection (Depo-Provera).

Non-hormonal options include the copper coil and barrier methods.

Your GP, practice nurse, or sexual health clinic can help you choose the method that best fits your lifestyle and medical history.

When to seek medical advice

Contact your GP, pharmacist, or sexual health clinic if you have questions about using Evra, if you experience persistent side effects, or if you wish to change your contraceptive method.

Seek emergency care (call 999 or attend A&E) if you develop symptoms of a blood clot (painful swollen leg, sudden chest pain, breathlessness, sudden severe headache, visual disturbance, or one-sided weakness).

Report suspected adverse reactions to the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Sources

Medical information

Evra delivers a combination of a progestogen (norelgestromin, the primary active metabolite of norgestimate) and an oestrogen (ethinylestradiol) through the skin. These hormones prevent pregnancy through three complementary mechanisms: suppression of ovulation by inhibiting the mid-cycle surge of luteinising hormone (LH) and follicle-stimulating hormone (FSH); thickening of the cervical mucus, which impedes sperm penetration; and alteration of the endometrium, making it less receptive to implantation. Transdermal delivery provides steady-state hormone levels without the peaks and troughs associated with daily oral contraceptive pills. When used correctly, Evra has a typical-use failure rate of approximately 1%, comparable to the combined oral contraceptive pill. Evra is a prescription-only medicine in the UK, classified as POM.

Dosage guidance

Evra is used in a 4-week cycle: apply one patch per week for 3 consecutive weeks (days 1 to 7, 8 to 14, and 15 to 21), followed by a 7-day patch-free interval during which a withdrawal bleed occurs. Apply the new cycle's first patch on the same day of the week as previous applications (the "patch change day"). Apply each patch to clean, dry, non-hairy skin on the buttock, abdomen, upper arm, or upper torso. Avoid the breasts. Press the patch firmly in place for at least 10 seconds, ensuring the edges stick well. Do not apply to skin that is red, irritated, or cut. Do not use lotions, oils, powders, or other topical products on or near the patch site. Change the patch on the same day each week. If starting for the first time or after a hormone-free interval, apply the first patch on the first day of the menstrual period for immediate protection. If starting on any other day of the cycle, use additional barrier contraception (condoms) for the first 7 days. If a patch change is late by less than 48 hours (up to 2 days), apply the new patch immediately. No additional contraception is needed. If the patch has been off or the change is more than 48 hours late, apply a new patch immediately to start a new cycle, use additional barrier contraception for 7 days, and consider emergency contraception if unprotected intercourse has occurred. If a patch falls off for less than 24 hours, reapply it or apply a new patch immediately. No backup contraception is needed. If the patch has been detached for more than 24 hours, start a new cycle with a new patch, use barrier contraception for 7 days, and consider emergency contraception if appropriate. Evra is intended for women of reproductive age. It is not recommended for adolescents under 18 who have not reached menarche. No dose adjustment is required for body weight up to 90 kg, but efficacy may be reduced in women weighing 90 kg or more.

Side effects and warnings

Common side effects of Evra include application site reactions (redness, irritation, itching at the patch site), headache, nausea, breast tenderness or pain, mood changes (including depressed mood), abdominal pain, and dysmenorrhoea (painful periods). These effects are similar to those experienced with combined oral contraceptive pills and often settle after the first 2 to 3 cycles. Uncommon side effects include dizziness, migraine, vomiting, diarrhoea, acne, skin rash, fluid retention, weight gain, vaginal discharge, decreased libido, fatigue, and muscle cramps. Rare but serious side effects include venous thromboembolism (deep vein thrombosis, pulmonary embolism) and arterial thromboembolic events (myocardial infarction, stroke). The risk of VTE with Evra is estimated to be similar to that of combined oral contraceptives containing levonorgestrel, though some earlier studies suggested a slightly higher risk. The absolute risk remains low in healthy young women: approximately 5 to 12 per 10,000 users per year compared with 2 per 10,000 non-users. Risk factors that increase VTE risk include smoking, obesity, prolonged immobility, personal or family history of thrombosis, and age over 35. Other rare effects include hypertension, gallbladder disease, hepatic adenoma (extremely rare), and chloasma (pigmentation changes, especially with sun exposure). Seek immediate medical attention (call 999) if you experience sudden severe leg pain or swelling, sudden chest pain or breathlessness, sudden severe headache, visual disturbance, or weakness on one side of the body. Contact your GP or NHS 111 if you develop persistent headaches, mood changes, or any symptom that concerns you. Report suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

Evra is contraindicated in women with a current or past history of venous or arterial thromboembolism (DVT, PE, stroke, MI), known thrombophilic disorders, migraine with aura, breast cancer (current or within the past 5 years), oestrogen-dependent tumours, undiagnosed abnormal vaginal bleeding, severe hepatic disease or liver tumours, and uncontrolled hypertension.

It is also contraindicated in women who smoke and are aged 35 or over, due to the significantly increased risk of cardiovascular events.

All combined hormonal contraceptives carry a small increase in the risk of venous thromboembolism.

The risk is highest in the first year of use and after restarting following a break of 4 weeks or more.

Risk factors include obesity (BMI above 30), immobility (long-haul travel, surgery, bed rest), smoking, family history of VTE at a young age, and known thrombophilia.

Women should be counselled about VTE symptoms (leg swelling, chest pain, breathlessness) and advised to seek immediate medical help if these occur.

The risk of arterial events (stroke, myocardial infarction) is very low in healthy young women but increases with smoking, hypertension, diabetes, obesity, migraine (especially with aura), hyperlipidaemia, and age.

Evra must not be used in women who smoke and are 35 or older. Evra does not protect against sexually transmitted infections (STIs).

Condoms should be used for STI prevention. The efficacy of Evra may be reduced in women weighing 90 kg or more.

Alternative contraception should be considered for these women.

Drug interactions: enzyme-inducing medicines (rifampicin, rifabutin, carbamazepine, phenytoin, phenobarbital, primidone, topiramate at doses above 200 mg, oxcarbazepine, eslicarbazepine, St John's wort, and certain antiretrovirals) reduce the effectiveness of combined hormonal contraceptives.

If using short-course enzyme inducers, additional barrier contraception should be used during treatment and for 28 days after stopping.

Women on long-term enzyme-inducing drugs should consider a non-hormonal method or a progestogen-only method unaffected by enzyme induction.

Antibiotics that do not induce liver enzymes (such as amoxicillin and doxycycline) do not reduce the efficacy of Evra.

Additional contraception is not routinely required with these antibiotics unless severe vomiting or diarrhoea occurs.

Evra should be discontinued at least 4 weeks before elective surgery requiring prolonged immobilisation. Restart after full mobilisation.

It should also be discontinued if sustained hypertension develops, or if migraine with aura occurs for the first time during use.

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