Guide to the birth control patch

• Period Start: Start your patch within the first 5 days of your period – starting this way protects you from pregnancy immediately! 
• Quick Start: Start your patch on any day of your cycle.  Use a backup method (like condoms) for the first 7 days. After 7 consecutive days, the patch works to prevent pregnancy. 
• Sunday start: Start your patch on the first Sunday after your next period starts – use a backup method (like condoms) for at least 7 days.

*The patch does not protect against STIs and you should always use a condom if you are not 100% sure of your partner’s STI status.

• Day 1: The patch should be placed on clean, dry skin. Xulane should be applied to the lower abdomen, buttocks, back, or upper arm. Twirla should be applied to the lower abdomen, buttocks, or upper torso. Neither patch should be applied to the breast. Wear the patch for 7 days
  
• Day 8 (week 2): Remove your patch and immediately apply a new patch to a different location on your body.
• Day 15 (week 3): Change your patch again on day 15 of your cycle.
• Day 22 (the last day of your third patch), you will remove your patch and have one patch-free week. Most people have their period during this week.
• After 7 patch-free days, you’ll apply the first patch of your new box. Remember that your patch change day will always be the same day of the week – so if you initially started your patch on Sunday, you will always change your patch on Sundays.

For more information visit our How do I start my birth control FAQ. 

The patch is applied to the skin once weekly on the same day of the week each week. Xulane can be worn on the lower abdomen, buttocks, back, and upper arm. Twirla can be worn on the lower abdomen, buttocks, or upper torso. Do not apply either patch to the breast. Be sure to apply it to a clean and dry area of skin that is without lotion. After removing the backing, you should apply the patch firmly, making sure to smooth it out completely, and then hold it in place for 10 seconds.

The birth control patch (Xulane) has a weight limit of 198 pounds. How well they work in people over 198 pounds has not been studied. We do not recommend its use if you weigh over 198 pound unless you use additional backup methods.

The birth control patch, Twirla, may not be as effective for anyone with a BMI over 25. It is not recommended without using a backup method.

In addition, the FDA has placed a black box warning (the strictest warning) against patients using either patch if their BMI is over 30 because of increased risk of blood clot-related complications in this group. The patch results in a level of estrogen in the blood that is 60% higher than a standard pill, which causes the increased risk. We cannot prescribe the patch to patients with a BMI over 30.

The patch is designed to be worn continuously for a week and should not fall off when showering, swimming, or exercising.

If it has been less than 48 hours since the patch fell off, you can stick it back on. If it sticks, you can safely use it for the remainder of that week. If it does not stick, you should replace it with a new patch and then replace that patch on your typical day to switch patches.

If it has been more than 48 hours since the patch fell off, you should start a new cycle with a new patch. This will be the new day that you change the patch weekly. You should use backup protection during the first seven days if using this for pregnancy protection.

To help prevent the patch from falling off, be sure to apply it to a clean and dry area of skin that is without lotion. You should apply the patch firmly, making sure to smooth it out completely, and then hold it in place for 10 seconds.

About 1 in 6 patients will experience skin irritation from wearing the patch. This is not the same as being allergic to the patch. If you find that you have irritation beneath the patch, try applying it to a different area when you replace the patch. You can apply some over-the-counter hydrocortisone to the irritated area. The patch can be applied to the lower abdomen, the back, upper arms, and buttocks. If the irritation persists or the rash is spreading, you should be evaluated for other causes.

The pill, patch, and ring are about 99% effective with perfect use. With typical use, they are about 91% effective. That means if there are 100 people using a method, about 9 will get pregnant yearly. It is important to pick a method that works best for you in terms of remembering to use it. For many people, it is easier to remember to change a ring once monthly rather than take a pill daily.

Although the patch and the ring aren’t FDA-approved for skipping periods, many people do use them this way. If you use the birth control patch just apply a new patch for the 4th week, when you would ordinarily go patch-free. Be aware that because patches contain a slightly higher dose of estrogen than pills, you should be sure to take a one-week break every three months. We do not recommend going any longer than that due to a potential higher risk for blood clots with longer continuous use.