Birth Control Pills (Oral Contraceptives) vs. Patch (Ortho Evra)

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Birth Control Pills vs. Patch: What's the difference?

What are Birth Control Pills? What is the Patch?

Birth control pills (oral contraceptives) are a method of birth control used to prevent pregnancy. Birth control pills are hormonal preparations that may contain combinations of the hormones estrogen and progestin or progestin alone. Combinations of estrogen and progestin prevent pregnancy by inhibiting the release of the hormones luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland in the brain. LH and FSH play key roles in the development of the egg and preparation of the lining of the uterus for implantation of the embryo. Progestin also makes the uterine mucus that surrounds the egg more difficult for sperm to penetrate and, therefore, for fertilization to take place. In some women, progestin inhibits ovulation (release of the egg).

Norelgestromin/ethinyl estradiol transdermal patch is a combination of 2 hormones (an estrogen and a progestin) and is used to prevent pregnancy. It works mainly by preventing the release of an egg (ovulation) during your menstrual cycle. It also can work by making vaginal fluid thicker to help prevent sperm from reaching an egg (fertilization) and by changing the lining of the uterus (womb) to prevent attachment of a fertilized egg. If a fertilized egg does not attach to the uterus, it passes out of the body. The total amount of estrogen received when using the patch is higher than the amount from most birth control pills, which may increase the risk for blood clots or other side effects from the birth control patch compared to the pill. If you weigh more than 198 pounds (90 kilograms), this patch may not work as well for you.

What are the side effects of birth control pills and the patch?

Birth control pills

The most common side effects of the birth control pills include nausea, headache, breast tenderness, weight gain, irregular bleeding, and mood changes. These side effects often subside after a few months' use. Scanty menstrual periods or breakthrough bleeding may occur but are often temporary, and neither side effect is serious. Women with a history of migraines may notice an increase in migraine frequency. On the other hand, women whose migraines are triggered by fluctuations in their own hormone levels may notice improvement in migraines with oral contraceptive use because of the more uniform hormone levels during oral contraceptive use.

Uncommonly, oral contraceptives may contribute to increased blood pressure, blood clots, heart attack, and stroke. Women who smoke, especially those over 35, and women with certain medical conditions, such as a history of blood clots or breast or endometrial cancer, may be advised against taking oral contraceptives, as these conditions can increase the adverse risks of oral contraceptives.

Ortho Evra

WARNING

Ortho Evra is intended to prevent pregnancy. It does not protect against HIV (AIDS) or other sexually transmitted diseases such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis.

The most common side effects of Ortho Evra include:

• nausea and vomiting,
• breast symptoms,
headache,
menstrual cramps, and
abdominal pain.

In addition, change in appetite, nervousness, depression, dizziness, loss of scalp hair, rash, and vaginal infections may occur.

Skin Irritation

Skin irritation, redness or rash may occur at the site of application. If this occurs, the patch may be removed and a new patch may be applied to a new location until the next Change Day. Single replacement patches are available from pharmacies.

Vaginal Bleeding

Irregular vaginal bleeding or spotting may occur while you are using Ortho Evra. Irregular bleeding may vary from slight staining between menstrual periods to breakthrough bleeding which is a flow much like a regular period. Irregular bleeding may occur during the first few months of contraceptive patch use but may also occur after you have been using the contraceptive patch for some time. Such bleeding may be temporary and usually does not indicate any serious problems. It is important to continue using your contraceptive patches on schedule. If the bleeding occurs in more than a few cycles or lasts for more than a few days, talk to your health care professional.

Problems Wearing Contact Lenses

If you wear contact lenses and notice a change in vision or an inability to wear your lenses, contact your health care professional.

Fluid Retention or Raised Blood Pressure

Hormonal contraceptives, including the contraceptive patch, may cause edema (fluid retention) with swelling of the fingers or ankles and may raise your blood pressure. If you experience fluid retention, contact your health care professional.

Melasma

A spotty darkening of the skin is possible, particularly of the face. This may persist after use of hormonal contraceptives is discontinued.

What is the dosage for birth control pills vs. the patch?

Birth control pills

Many of the birth control pills come in easy-to-use dispensers in which the day of the week or a consecutive number (1, 2, 3, etc.) is written on the dispenser with a corresponding tablet for each day or number.

For example, some Ortho-Novum dispensers are labeled "Sunday" next to the first tablet. Thus, the first tablet is to be taken on the first Sunday after menstruation begins (the first Sunday following the first day of a woman's period). If her period begins on Sunday, the first tablet should be taken on that day.

For birth control pills that use consecutive numbers, the first tablet (#1) is taken on the first day of the menstrual period (the first day of bleeding). Tablet #2 is taken on the second day and so on.

Still other packages instruct women to begin on day five of the cycle. For such products, women count from day one of their menstrual cycle (day one is the first day of bleeding). On the fifth day, the first tablet is taken. Tablets then are taken daily.

Most birth control pills are packaged as 21-day or 28-day units. For 21-day packages, tablets are taken daily for 21 days. This is followed by a seven-day period during which no birth control pills are taken. Then the cycle repeats.

For the 28-day units, tablets containing medication are taken for 21 consecutive days, followed by a seven-day period during which placebo tablets (containing no medication) are taken.

Newer formulations with 24 days of hormone pills and only four days of placebo pills are now available, as are continuous or extended-cycle oral contraceptive regimens, in which only active hormone pills are taken. Extended-cycle preparations include seven-day intervals of placebo pills to be taken approximately every three months.

Women just starting to take birth control pills should use additional contraception for the first seven days of use because pregnancy may occur during this period.

If women forget to take tablets, pregnancy may result. If a single tablet is forgotten, it should be taken as soon as it is realized that it is forgotten. If more than one tablet is forgotten, the instructions that come with the packaging should be consulted, or a physician or pharmacist should be called.

Ortho Evra

Ortho Evra keeps you from becoming pregnant by transferring hormones to your body through your skin. The patch must stick securely to your skin in order for it to work properly. This method uses a 28 day (four week) cycle. You should apply a new patch each week for three weeks (21 total days).

You should not apply a patch during the fourth week. Your menstrual period should start during this patch-free week. Every new patch should be applied on the same day of the week. This day will be your ‘Patch Change Day.’

For example, if you apply your first patch on a Monday, all of your patches should be applied on a Monday.

You should wear only one patch at a time. On the day after week four ends, you should begin a new four week cycle by applying a new patch.

What drugs interact with birth control pills and the patch?

Birth control pills

Estrogens can inhibit the metabolism (elimination) of cyclosporine, resulting in increased cyclosporine blood levels. Such increased blood levels can result in kidney and/or liver damage. If this combination cannot be avoided, cyclosporine concentrations can be monitored, and the dose of cyclosporine can be adjusted to assure that its blood levels do not become elevated.

Estrogens appear to increase the risk of liver disease in patients receiving dantrolene (Dantrium) through an unknown mechanism. Women over 35 years of age and those with a history of liver disease are especially at risk.

Estrogens increase the liver's ability to manufacture clotting factors. Because of this, patients receiving warfarin (Coumadin) need to be monitored for loss of anticoagulant (blood thinning) effect if an estrogen is begun.

A number of medications, including some antibiotics and antiseizure medications, can decrease the blood levels of oral contraceptive hormones, but an actual decrease in the effectiveness of the oral contraceptive has not been convincingly proven. Nonetheless, because of this theoretical possibility, some physicians recommend backup contraceptive methods during antibiotic use. Examples of medications that increase the elimination of estrogens include

carbamazepine (Tegretol),
• phenobarbital,
phenytoin (Dilantin),
primidone (Mysoline),
• rifampin (Rifadin),
rifabutin (Mycobutin), and
ritonavir (Norvir).

Birth control pills with higher concentrations of estrogen or alternative forms of contraception may be necessary in women using those medications.

Ortho Evra

Certain drugs may interact with hormonal contraceptives, including Ortho Evra, to make them less effective in preventing pregnancy or cause an increase in breakthrough bleeding. Such drugs include rifampin, drugs used for epilepsy such as barbiturates (for example, phenobarbital), anticonvulsants such as topiramate (TOPAMAX), carbamazepine (Tegretol is one brand of this drug), phenytoin (Dilantin is one brand of this drug), phenylbutazone (Butazolidin is one brand), certain drugs used in the treatment of HIV or AIDS, and possibly certain antibiotics. Tetracycline has been shown not to interact with Ortho Evra. Pregnancies and breakthrough bleeding have been reported by users of combined hormonal contraceptives who also used some form of St. John’s Wort. As with all prescription products, you should notify your health care professional of any other medications you are taking. You may need to use a barrier contraceptive when you take drugs that can make Ortho Evra less effective.

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Are birth control pills and the patch safe to use while pregnant or breastfeeding?

Birth control pills

Use of birth control pills during lactation has been associated with decreased milk production, decreased infant weight gain, and decreased nitrogen and protein content of milk. The amount of estrogen consumed by an infant whose mother takes a standard dose of birth control pills is considered to be the same as from a lactating woman who is not taking birth control pills, and side effects have not been reported. Using a progestin-only product is most often recommended during lactation if birth control pills are to be used during this period. The American College of Obstetrics and Gynecology (ACOG) recommends delaying taking combined estrogen-progestin contraceptives until at least six weeks postpartum, while the World Health Organization (WHO) recommends delaying the initiation of combined contraceptives until six months.

Ortho Evra

There is no conclusive evidence that hormonal contraceptive use causes birth defects when taken accidentally during early pregnancy. Previously, a few studies had reported that oral contraceptives might be associated with birth defects, but these findings have not been seen in more recent studies. Nevertheless, hormonal contraceptives, including Ortho Evra, should not be used during pregnancy.

If you are breast-feeding, consult your health care professional before starting Ortho Evra. Hormonal contraceptives are passed on to the child in the milk. A few adverse effects on the child have been reported, including yellowing of the skin (jaundice) and breast enlargement. In addition, combination hormonal contraceptives 52 may decrease the amount and quality of your milk. If possible, do not use combination hormonal contraceptives such as Ortho Evra.

Summary

Birth control pills (oral contraceptives) and norelgestromin/ethinyl estradiol transdermal patches (Ortho Evra) are methods of birth control used to prevent pregnancy. Side effects of birth control pills and the patch that are similar include nausea, headache, breast tenderness/enlargement, missed/irregular bleeding, and breakthrough bleeding (spotting).

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Medically Reviewed on 5/21/2019
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Source content for Ortho Evra sections courtesy of the U.S. Food and Drug Administration
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