Evra plaster side effects. Contraceptive patch Evra - how to glue it correctly and how does it work? Contraindications and side effects

The Evra patch is an easy, reliable method of contraception. The patch itself is a thin and smooth small plate. Protection against pregnancy is provided due to the fact that after the patch is attached by substances that penetrate from it through the skin, ovulation is blocked and the mucus of the cervix changes. A prerequisite for the use of the patch is the presence of a permanent sexual partner, as well as the absence of genital infections in the couple. Consider the disadvantages side effects and contraindications for Evra patch.

Disadvantages of Evra patch

Despite the numerous advantages and advantages of the Evra patch, it also has some disadvantages, the main of which are:

the possibility of peeling it off, and you may not notice it immediately. Approximately 4% of all women using the Evra patch face such an unpleasant situation;
the likelihood of developing an allergic reaction in some women. At the time of adhesion, skin irritation occurs in about 2% of women, which is why they have to stop using this method contraception;
the patch does not affect menstruation, as does taking birth control pills.

The Evra patch as a contraceptive is characterized by a poor interaction with some medications, and therefore, when taking drugs you should consult your doctor before using the patch.

Evra patch side effects

The Evra contraceptive patch contains the same substances as most oral contraceptives (a combination of estrogen and gestagen). The Evra patch has the same side effects as in the case of using other forms of microdosing hormonal contraception... The most unpleasant of them are those that arise from the side of the circulatory system. These include the occurrence of venous insufficiency, accompanied by thrombus formation. In addition, the common side effects of Evra patch include:

the occurrence of hemorrhoids;
increased blood pressure;
the occurrence of an increased heartbeat;
the appearance of edema.

From the peripheral and central nervous system Maybe:

the occurrence of headaches (including migraines);
the appearance of dizziness;
the occurrence of hypersensitivity to loud sounds, bright light, pain;
development of sensitivity disorders in the form of crawling sensations on the body;
the appearance of seizures;
trembling of the limbs and the whole body;
the onset of depression;
the appearance of a feeling of anxiety;
changeable mood;
sleep disturbance;
irritability.

With regard to the gastrointestinal tract, it is possible:

occurrence inflammatory processes periodontal tissues (gingivitis, periodontitis);
increased or decreased appetite;
the appearance of inflammatory processes in the stomach and intestines;
the occurrence of nausea, vomiting, unstable stools (alternating constipation and diarrhea);
bloating;
the appearance of abdominal pain.

An infection can join the upper and lower respiratory tract due to a decrease in immunity, bronchial asthma and shortness of breath may appear.

With regard to the female genital organs, the local immunity of the external genital organs may decrease and an infection (colpitis, thrush) may join, the nature of vaginal discharge and mucus secreted from the cervical canal may change, pain may occur during sexual intercourse. In addition, it is possible:

the occurrence of ovarian dysfunction;
development of ovarian cysts;
decreased libido;
the appearance of discharge from the mammary glands;
enlargement of the mammary glands;
the occurrence of inflammatory processes and benign tumors of the mammary glands.

From the side of the kidneys and urinary tract the development of infectious and inflammatory diseases is possible due to a general decrease in immunity.

V musculoskeletal system possible occurrence:

muscle cramps;
pain;
muscle weakness;
pain in joints and bones.

A side effect from the skin can be:

dry skin;
development different types skin rash;
the appearance of a pustular rash on the face and upper body;
increased sweating;
change in complexion;
the development of allergies to sunlight;
hair loss.

With regard to the sense organs, vision impairment, the development of conjunctivitis are possible. In metabolic processes, a malfunction can occur, as a result of which there is a sharp increase in weight, an increase in the content of "harmful" cholesterol in the blood.

In addition to all of the above, the side effect of the Evra patch can be:

the development of a flu-like syndrome (cough, runny nose, fever);
emergence constant feeling tiredness and weakness;
occurrence in soft tissues suppurative processes;
the appearance of pain in the heart;
swollen lymph nodes;
anemia;
fainting is rare.

Most of the side effects are mild to moderate, which does not limit the use of the patch. In addition, side effects, as a rule, disappear 2-3 months after the start of the application of the patch, when the body has adapted to the substances contained in it.

Contraindications to the use of Evra patch

There are some contraindications to the use of Evra patch, including:

the presence of thrombosis;
period of pregnancy and lactation;
a history of myocardial infarction or stroke;
the presence of a suspected or established diagnosis of a malignant tumor.

In addition, the patch is contraindicated in women who are over 35 years old and who smoke more than 15 cigarettes a day.

EURA is a popular contraceptive method based on the transdermal effect of a patch with a hormonal component on the female body. This method of preventing an unplanned pregnancy is considered one of the most reliable, and, at the same time, the most convenient to use. The patch must be applied once every 7 days, so the "forgetting effect" is completely excluded, as is often the case with oral contraceptives. The patch does not cause discomfort to wear, adheres reliably to the skin and is not affected by water or sunlight.

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Better than pills

I chose the Evra patch because I am very worried about my liver. I have serious problems with this organ due to the transferred hepatitis, and any contraceptives in the form of pills carry the risk of negative effects on the liver. But in the contraceptive patch, the dose of hormones is very low, so about some side effects you don't have to worry. In addition, like pills, it is one of the most reliable and highly effective in preventing pregnancy.
I feel the lack only in the summer, when I often swim during my holidays. Due to repeated contact with a humid environment, the plate still comes off. Therefore, I recommend that you protect it with something additionally, with a waterproof plaster, for example.

2017.05.11 at 22:11 wrote: Evelina

Alternative OK

I use the patch according to the scheme, which is indicated in the instructions. I glue a new patch on the indicated days (8,15,22 days of the cycle). Then on day 29 you need to peel it off and take a break.
This is a hormonal drug that is an excellent alternative to pills. It works effectively. For example, in my case, he copes with the prevention of pregnancy by 100%.
I glue it on clean skin, in the abdomen or buttocks. The gluing points must be changed every time.
The patch is small, does not leave discomfort when wearing. It is not visible under the clothes. Holds tightly, I had cases of peeling off. If this happens, then the instructions indicate the steps that must be taken immediately.

2017.05.03 at 18:35 wrote: innaaboky

One of the contraceptive options

If you compare with classic pills, then the dose of hormones is higher there, and this is not good. In this regard, plasters are safer. One pack is enough for a month, the price of the issue is about a thousand, depending on where to buy, not in every pharmacy you will find this.
There are three patches in the pack, each for a week, the fourth week is a respite. There are also instructions and stickers to remember about the new patch.
I prefer to glue plasters on the lower abdomen. There is no itching or irritation, since the skin there is not bent as much as on the stomach, then the plaster is held firmly. But perfectly, before gluing, wipe the skin with plain vodka to disinfect and cleanse and degrease the surface.
Well, wear for a week, at the end it keeps weaker, the edges usually come off, debris or dirt from the skin is often clogged under them. By the way, you can wash with him, this does not affect the stickiness and performance.
As a means of contraception, it works, although the dose is small for hormones. I've been using it for six months now and everything is fine. So if there are no contraindications and there is no desire to take pills, then after consultation (it is required!), The EVRA plasters are an excellent analogue.

2017.04.23 at 14:09 wrote: quilon

One flaw and many virtues

If I choose between oral contraceptives or the Evra hormonal patch, then I cannot give an unequivocal answer, but I tend to lean more towards the plates, because they have more advantages in comparison with the cook.
And the advantages in relation to pills are as follows:
- less hormonal background;
- hormonal components are not involved in the digestion process, which means that the liver is not involved, which does not bear aggravating consequences;
- much easier to use, since you often forget to take pills if there is no reminder;
These remedies are similar in that both are equally good at regulating the menstrual cycle and relieving pain, as well as providing a reliable contraceptive effect.
The patch has one drawback. If worn in one place, then over time, black marks remain from the adhesive layer on the body, so it is better to alternate the areas of adhesion.

2017.04.11 at 12:07 wrote: Arina_Rodionovna

Simplicity and ease of use

I switched to the plaster on the advice of a gynecologist, since OK was not recommended for use after 35 years of age. Therefore, I chose a transdermal therapy system.
The difference, of course, is huge between taking pills and wearing a patch.
I feel such freedom, because I don't have to take pills every day and worry if I forgot. I no longer feel stress after forgetting like this.
The only similarity is that in the same way you need to take a week break after 21 days of use. Only here the whole point is that you stick a plate (and there are only 3 of them) every seven days.
It is visible only on the beach if the swimsuit is open. And then, if you look closely, because he is of a flesh tint.

2017.04.03 at 08:08 wrote: AnnaVanna

Less estrogen

I switched to plasters after Yarina, which turned out to be dangerous for the liver. A year later, no, no, yes, and ache in this area, plus the young, and I'm 28, it's too early to use drugs in which there are a lot of estrogens. The climax can begin earlier. So I switched to a safer option, without sacrificing efficiency.
The patches are tiny and finally they began to be made to match the skin, they are beige and, when properly glued, literally merge with the skin. The surface of the plaster seems to be impregnated with a water-repellent solution, which is why you can easily relax on the sea, splash around in the bathroom, roll on the beach with the plaster, which is especially important now. I checked it myself, for an hour in the sauna and subsequent swims in the pool, the plaster did not change either color or the degree of adherence to the skin. The plaster has a lot of advantages. The main thing, of course, is that hormones immediately enter the bloodstream, stomach, liver, and do not participate in any way in the processing and transportation of active substances from the patch. This means that there are fewer side effects. The second plus, on each package there is a reminder with the numbering of the patch, that is, in fact, it is impossible to forget which patch you need to glue now, everything is clear, with recommendations and tips for each gluing. Five points!

2017.03.21 at 20:10 wrote: Happy

Protects against pregnancy and normalizes hormones

I like to use Evra patch instead of OK, in my opinion it is very convenient. The patch is easy to stick and adheres well to the skin. Protects against pregnancy by 100% and additionally normalizes hormones. After I started using the patches, my menstrual cycle was completely normal.
Initially, I was a little confused by the scheme of use. You need to glue on certain days of the cycle for the patch to work as expected. Then I got used to it and now I even stopped using the calendar to remind the days of changing the patch.
Although the patch, like the pills, is hormonal, but due to external local exposure, it is still safer.

2017.03.13 at 15:53 wrote: NatalyaGel

Better than pills

Evra began to use the plaster after a reaction to the hormonal contraceptives I was used to (my chest hurt, my legs pulled, sometimes I felt a little dizzy).
The good thing about the patch is that it works topically. I stick it on clean, dry, intact skin. It is important that it does not have hair, scratches, wounds, etc.
Ideal areas for adhesion are the lower abdomen, shoulders, back, and even the buttocks. It is important to change the place with each new application of the patch.
When gluing, you need to make sure that the patch is glued evenly, without folds or wrinkles. I do not know why such a requirement, but the instructions say that. I am not experimenting and strictly follow the recommendations.
The patching schedule is a bit tricky. The first time I got confused. Then I got used to it and now there are no problems. It all depends on the cycle.
I start using the patch on the first day of my cycle. Then I change to a new patch on the 8th, 15th day. On the 22nd day of the cycle, I take off the plaster and take a break. After, on the 29th day, I again repeat the cycle of gluing and replacing the plasters. If there are deviations from this schedule, then the instructions clearly spell out the steps that need to be taken in this or that case. I try to follow this pattern so that there are no glitches. For this, I started a special calendar. There I mark the days of the cycle so as not to get lost.
1 package contains 3 plasters (each individually wrapped) and a reminder sticker that I use so as not to forget the days of changing the patch to a new one.
I have no side effects from the patch. I noticed that after applying the patch, my monthly cycle stabilized. The soreness and discomfort also went away.
Additionally, the skin was cleared of acne and rashes.

2017.03.10 at 10:07 wrote: Myoni

Holds up perfectly

The first contraceptive patch that doesn't fall off when I shower. Now I'm used to it and I'm not limiting myself in anything. I go to the pool, to fitness, actively sweat, then take a shower, then do baths at home and sit in them for hours. And he's holding on! Even the corners practically do not leave. You don't have to glue anything. The only thing, occasionally, under the patch from the edges get hairs, sand or dust particles that are difficult to clean. You can remove cotton wool from a cotton swab and remove the villi with it. In principle, there is nothing wrong with that. But the main thing is that the patch stays on, it is practically invisible and it is effective.
Evra has a complicated scheme of use, but if you do everything exactly a couple of times, then you get used to it and wear it without any problems. The patch starts to stick on the first day critical days... Then they wear it for 7 days, on the 8th and 15th day, the plaster is changed. Then they take a break until menstruation begins and again on a new one. That is, in a week, approximately without a plaster, CDs come. If there is a need to postpone your period (rest, competition or something else), then you can simply not stop wearing the patch, your period will not come. But I didn’t do it myself, I don’t want to interfere in the affairs of nature. This is not useful, I believe.

2017.02.23 at 08:59 wrote: Miss Understanding

Convenient and efficient

It suited me very much! I have been using it for almost a year and only positive impressions from use, how simple, understandable and most importantly effective! It's easy to use, I stick the patch on my back and forget about it for 7 days. But, attention! There are a lot of side effects and contraindications - read the instructions. For myself, I can note a slight deterioration in well-being in the first week of admission, although it may have coincided, I can’t boast of anything else. In the summer at sea, I was all afraid that the plaster would come off, but nothing of the kind, it holds up perfectly. In general, for me it’s better not to come up with it, it’s very convenient!

2017.02.11 at 12:12 wrote: Yanochka

Great! Five!

From the very beginning I did not believe in the strength of the patch. She used contraceptive pills all the time. I have been using it for almost a year now. Everything is going well, except that in the first month the cycle was lost for several days, but then everything became normal. A very positive point is that the course of menstruation has changed a lot, there are no more severe cutting pains and nausea, as before, which means that the drug works well for my entire body.
I keep a calendar, so as not to get lost, I stick a plaster once a week - it's convenient, I won't return to the pills.

2017.01.20 at 15:55 wrote: 777

Ideal solution for liver problems

As a means of protection, Evra had to be used forcibly due to liver problems. The gynecologist offered me a choice of either a patch or tablets plus Carsil to support the liver. For testing, I bought a small package, in which 3 plasters were enough for almost a month (I wore 21 days, 7 breaks). Hormones enter the bloodstream transdermally bypassing the liver and stomach, the gastrointestinal tract and other organs are not affected.

It is incredibly convenient to use a patch, it compares favorably with tablets. Even if, due to forgetfulness, the plaster is not changed on time, then two days of delay are considered acceptable. For 7 months of use, no problems, reliable protection against pregnancy (regular sexual contacts). I was lucky and did not feel any side effects on myself, the first acquaintance with Evra went smoothly. Perhaps this is due to the fact that I was taking Cardiomagnet for blood thinning and folic acid in tablets.
The patch is expensive, its cost is significantly higher than that of most popular tablets. The instructions say that long-term use of the patch is an excellent prevention of female diseases, which will definitely not be superfluous.

2017.01.12 at 15:41 wrote: moulya

The best way against unwanted pregnancy

The plasters are just excellent, they have been working without misfires for a year and a half. During this time, there was everything, and slipped and peeled off. But pah-pah carried it, then I just found my optimal way of gluing. First, I wipe the skin with salicylic, then glue.
I used to stick it on the buttocks, but from there the plaster slipped, then it began to stick to the lower abdomen, optimally. Wrinkle less, fits as tightly as possible, you can always check the patch on the spot or not.
The patch is small, flesh-colored, thin, not visible under the clothes, on the body, if you don't look closely too. The adhesive base is good, after peeling off the patch, a little glue remains on the skin, but again salicylic saves, well, or vodka can be at worst. You can also forget about the plaster, especially with prolonged use, you just turn around at work and that's it. But I solved the issue simply - I put a reminder on my phone, now every Sunday at 10 am my alarm clock rings, and there is the text "patch", the main thing is to go right there and change it. Otherwise, it will be forgotten again later. So far so good. Although the patch is hormonal, it did not affect me in a negative way. Hair, nails, weight - all right.

2017.01.10 at 19:52 wrote: Bojulia

All ingenious is simple

Band-aids are just the perfect solution for me. The box costs about 1200 rubles, this is the cheapest cost, I buy it at the MI, bring it to the pharmacy next to my house, and pick it up from there. Discounts are sometimes made, but rarely.
The package contains 3 plasters plus a huge instruction that is worth reading to do everything right. I naively thought that the plasters were glue and glue to myself, but here is the whole scheme, if you miss the day of sticking, then everything is smark.
Each patch lies in an individual bag, it is easy to remove, you need to remove the sticker, tear the bag and voila, I first wipe the skin with something alcohol-containing, but this is understandable. Then I glue it on. I try not to go into the water for at least three or four hours for the glue to set. Although such precautions may not be needed. The patch holds up perfectly. True, for the first time I pasted it somehow carelessly, one corner came off, but it's not scary, the main thing is to make sure that the plaster is in contact with the skin by more than 3/4, otherwise you need to change it.
And one more thing, if the jamb happened and the patch came off on the fifth day, then you still need to glue a new patch for 2 days, and then change it according to the scheme. So you have to buy an extra pack.

2016.12.10 at 20:15 wrote: Hamster

I lost weight, my breasts increased and my skin cleared

I have been using the patch as contraception for almost a year and I am very happy, Evra has never let me down. In addition to reliable protection against unwanted pregnancy, I was able to lose 4 kg without any effort on my part, simply due to the normalization of hormonal levels. The chest has increased by one size, it is visually noticeable. Menstruation is easier to tolerate, there are no severe painful sensations and uterine spasms. But the PMS tortured me, and tortures me, no changes have occurred. But on the skin during this period, fewer acne crawls out. The skin of the face and scalp has become less greasy, I can not wash my hair every day.
I put on the first patch on the first day of menstruation, and then strictly followed the instructions. In the first month, the head ached periodically, there were unpleasant sensations in the calves, similar to convulsions. Then the body was rebuilt and everything went away. It is rather difficult to remove the plaster, at first I removed it from dry skin. Painful sensations due to the epilation of the lung with the cannon on the stomach were provided. Then I thought of taking off the plaster under the shower, it is less unpleasant and less traumatic for the skin. Remaining sticky marks can be removed without problems.
Euro is quite difficult to find in ordinary pharmacies; you have to order it via the Internet.

2016.10.13 at 20:39 wrote: Albina

Many contraindications

It was not easy enough to start using plasters, I had to go on a diet so that the plasters would be effective for me, I dropped to 75. Since girls whose weight is more than 80 kilos are plasters like a dead poultice.
I am very pleased that now I do not need to take pills, they made me drum even more, and then I even lost weight with the plasters. But her husband says that his arms have become wider, and deflated at the waist. The plasters were glued strictly according to the scheme, after the purchase I had to wait two weeks to start the course of use. Before that, my husband had to suffer for 2 months, since she could no longer drink pills, they used rubber bands. And with plasters beauty! The main thing is to start a calendar, put it on the refrigerator. After all, the most popular place in the apartment, now there are no problems with forgetfulness.

The adaptation period was difficult, it seems to me that in the third week of using the PMS patch, I was terrible, I was frustrated at everyone, but then everything passed abruptly and now I am not worried about my emotional state.
I stick the plasters on the outer side of the thigh, there is the smoothest skin, there are no folds when walking and sitting, I cannot wear the lower abdomen, there is a roller, it has already peeled off twice. Overall, I'm happy!

2016.10.07 at 20:04 wrote: Zelenka

Great thing, but you need to carefully read the instructions

An excellent and convenient remedy for preventing unwanted pregnancy, I have not yet found better for myself. True, the patch is suitable for use only with a permanent reliable partner, since it cannot protect against STDs. The principle of the patch is very simple. Hormones penetrate the blood through the skin, prevent follicles from maturing, and ovulation does not occur. I glue the plaster on different places of the abdomen and back, but not on the chest (this is strictly prohibited). I constantly monitor the tightness, if something is wrong, then I immediately change the patch to a new one. If left as it is, the hormones will not enter the bloodstream in the proper amount, the effect will decrease. If I don't know when the peeling occurred, then I just switch to regular barrier contraception so as not to risk it.
In the first days of using Evra, I did not sleep well at night, but after that the body adapted. For a year of use, there were no problems, the method of contraception has established itself as very reliable. But before using, I read the instructions in detail, since the list of contraindications is quite impressive. There are also a lot of drugs that reduce the activity of hormones and reduce the effectiveness of the patch.

Evra: instructions for use and reviews

Latin name: Evra

ATX code: G03AA13

Active substance: Norelgestromin + Ethinylestradiol (Norelgestromin + Ethinylestradiol)

Producer: LTC Lohmann Therapie-Systems AG (Germany)

Description and photo update: 11.07.2018

Evra is a combined contraceptive.

Release form and composition

Evra's dosage form is a transdermal patch [transdermal therapeutic system (TTS)]: square, with perforation along the tear line, with a matte beige backing on which the inscription "EVRA" is embossed, with rounded corners, a colorless adhesive (glue) layer and a transparent protective film , size with protective film - (51 + 1) mm x (51 + 1) mm (1 pc. in bags of laminated paper and aluminum foil, 3 bags in transparent film bags, 1 or 3 film bags (3 or 9 plasters, respectively) in a cardboard box complete with special stickers on the calendar to mark the terms of use of the patch).

Active substances in the composition of the patch:

norelgestromin (HE) - 6 mg;
ethinylestradiol (EE) - 0.6 mg.

Within 24 hours, one patch releases 0.203 mg HE and 0.0339 mg EE.

The transdermal patch consists of the following layers:

auxiliary components: adhesive mixture of polyisobutylene and polybutylene (221.4 mg), lauryl lactate (12 mg), crospovidone (60 mg);
polyester nonwoven fabric (34 mg);
supporting film (110.7 mg);
protective film (208.95 mg).

Pharmacological properties

Pharmacodynamics

The contraceptive effect of Evra is due to inhibition of the gonadotropic function of the pituitary gland, suppression of follicle development and an obstacle to the ovulation process. Also, the drug increases the viscosity of the cervical secretion and reduces the susceptibility of the endometrium to the blastocyst, thereby enhancing the contraceptive effect.

The Pearl index, reflecting the frequency of pregnancy in 100 women within 1 year of using the selected method of contraception, is 0.9. At the same time, the frequency of pregnancy does not depend on the race and age of the woman, but increases with a body weight of more than 90 kg.

Pharmacokinetics

After the application of TTS, the concentration of active substances in the blood plasma reaches steady-state values after 48 hours and is 0.8 ng / ml HE and 50 pg / ml EE.

With long-term use of this contraceptive, the equilibrium concentration (C ss) and the area under the concentration-time curve (AUC) slightly increase.

During physical exertion and various temperature conditions, there are no significant changes in C ss of ethinylestradiol, C ss and AUC of norelgestromin, and AUC of ethinyl estradiol at physical activity increases slightly.

The target values of the equilibrium concentration of HE and EE are maintained for 10 days of using the patch, that is, the contraceptive effect of Eura is maintained even if the woman changes the patch 2 days later than the 7-day period.

Norelgestromin and its serum metabolite norgestrel are characterized by a high degree of binding to plasma proteins (> 97%). Norelgestromin binds to albumin, norgestrel - mainly to globulins that bind sex hormones. Ethinylestradiol has a high degree of binding to blood plasma albumin.

It is NOT metabolized in the liver to form norgestrel, various conjugated and hydroxylated metabolites. EE is metabolized to various hydroxylated compounds, their sulfate and glucuronide conjugates.

In human liver microsomes, progestogens and estrogens inhibit many enzymes of the cytochrome P 450 system (including CYP3A4 and CYP2C19).

The half-life is NOT on average 28 hours, EE - 17 hours. Their metabolites are excreted through the intestines and by the kidneys.

The C ss and AUC values of Eura's active substances decrease slightly with increasing age, surface area or body weight.

Indications for use

Evra is a drug used for contraception (prevention of unwanted pregnancy).

Contraindications

Absolute:

known or suspected pregnancy;
postpartum period (4 weeks);
breastfeeding period;
migraine with focal neurological symptoms;
diagnosed (including in history) or suspected estrogen-dependent malignant tumors (for example, endometrial cancer);
confirmed or suspected breast cancer;
vaginal bleeding of unexplained etiology;
cholestatic jaundice during a previous pregnancy or jaundice with previous use of hormonal contraceptives;
benign or malignant liver tumors;
acute or chronic liver disease with impaired liver function;
diabetes mellitus with vascular lesions;
conditions preceding thrombosis (including transient ischemic attacks and angina pectoris), including a history of;
thrombosis (arterial and venous) and thromboembolism (including thrombosis, deep vein thrombophlebitis, cerebrovascular disorders, pulmonary embolism, stroke, myocardial infarction) at present or in history;
severe or multiple risk factors for venous or arterial thrombosis, including smoking over the age of 35, uncontrolled arterial hypertension, hereditary dyslipoproteinemia, cerebrovascular or coronary artery disease, complicated valvular heart disease, atrial fibrillation, subacute bacterial endocarditis, obesity [mass index bodies over 30 kg / m 2 - the ratio of body weight (in kilograms) to the square of growth (in meters)], extensive surgical intervention with prolonged immobilization;
hereditary predisposition to venous or arterial thrombosis, including the presence of antibodies to phospholipids (antibodies to cardiolipin, lupus anticoagulant), antithrombin III deficiency, protein S deficiency, activated protein C resistance, hyperhomocysteinemia, and protein C deficiency;
age under 18;
hypersensitivity to the components of the drug.

Relative (for the following diseases / conditions, Evra can be used only after a careful assessment of the expected benefits and possible risks):

herpes during a previous pregnancy;
Crohn's disease;
ulcerative colitis;
hemolytic uremic syndrome;
systemic lupus erythematosus;
family history of cholestatic jaundice (eg, Rotor, Dubin-Johnson syndromes);
chronic idiopathic jaundice;
multiple sclerosis;
diabetes mellitus without vascular complications;
thrombophlebitis of superficial veins and varicose veins;
venous or arterial thromboembolism in close relatives (parents, brothers, sisters) at a relatively young age;
breast cancer in first-line relatives;
severe depression, including a history of
gallstone disease, including a history of;
chorea;
otosclerosis;
hypertriglyceridemia;
uterine fibroids and endometriosis;
chloasma;
controlled arterial hypertension;
porphyria;
acute liver dysfunction during a previous pregnancy or previous use of sex hormones;
severe migraine without focal neurological symptoms.

Instructions for the use of Evra: method and dosage

To achieve the maximum contraceptive effect, Evra must be used in strict accordance with the recommendations described below.

One patch is designed for 7 days of use, after this period it should be immediately replaced with a new one, on the same day of the week - that is, on the 8th and 15th day of the drug use cycle (the so-called replacement days). From the 22nd to the 28th day of the cycle - a break, during which menstrual-like bleeding of withdrawal is noted. After that, a new contraceptive cycle begins, even if the withdrawal bleeding has not ended by this time.

Under no circumstances should a break in wearing the patch be exceeded for more than 7 days, since the risk of a decrease in the effectiveness of the drug and, as a consequence, pregnancy, increases. If the break was exceeded, it is necessary to additionally use barrier contraceptives within 7 days, since with each expired day, the likelihood of ovulation increases.

Mode of application

Transdermal patch Evra must be glued, pressing tightly, on healthy, clean, dry, intact skin of the outer surface of the upper shoulder, abdomen, buttocks, upper body with minimal hair growth - in areas where it will not come into contact with tight-fitting clothing. To avoid possible irritation, it is recommended to stick each new patch on a different area of the skin, including within the same anatomical region. It is categorically impossible to apply TTS on the area of the mammary glands. To avoid reducing the adhesive properties of the patch, do not apply powder, cream, lotion or any other local remedy to the skin where it will be glued.

Every day, a woman should inspect the patch to be sure of the strength of its attachment.

The used plasters still contain a significant amount of the active substances of the drug, so they should be disposed of correctly: from the outside of the bag, separate a special adhesive film, place the TTS, turning its sticky side to the painted area on the bag and lightly pressing it to seal it, and then throw it into the trash bucket. Do not throw it down the drain or toilet.

Starting a transdermal patch

If in the previous menstrual cycle the woman did not use a hormonal contraceptive, it is necessary to stick the Euro on the first day of menstruation. Exactly after 7 and 14 days - on days 8 and 15 of the cycle, respectively - the patch is replaced with a new one. On the 22nd day of the TTS cycle, it is necessary to remove and take a break until the 28th day of the cycle. Day 29 - the first day of a new contraceptive cycle, etc.

In cases where a woman does not start using the patch on the first day of the cycle, an additional barrier method of contraception should be used over the next 7 days.

When switching to Evra from a combined oral contraceptive (COC), it is necessary to stick the patch on the first day of menstrual bleeding that occurs after stopping the COC. If this recommendation is followed, the pronounced effect of the drug remains, otherwise, within 7 days, it is necessary to additionally use a barrier method of contraception. However, with a break of more than 7 days, ovulation is possible, therefore, before using a transdermal patch, a woman should consult a doctor. Sexual contact during this time can lead to pregnancy. If withdrawal bleeding does not begin within 5 days after taking the last active oral contraceptive pill, pregnancy should also be excluded before starting to use Eura.

When switching to Evra from drugs containing only progestogen, you can start using the patch on the day the implant is removed or the day when the next injection is to be made, however, during the first 7 days, you should additionally use a barrier method of contraception.

After giving birth, non-breastfeeding women can start using the transdermal patch 4 weeks after delivery. If later, within 7 days it is necessary to use an additional barrier method. Women who had sexual intercourse during this period should first exclude pregnancy or wait for the first menstruation.

After an abortion or miscarriage before the 20th week of pregnancy, you can start using Evra immediately, then additional contraception is not required.

After an abortion or miscarriage at the 20th week of pregnancy or later, you can start using the drug on day 21 or on the first day of the first menstruation (whichever comes first).

Missed doses

In cases where the patch is partially or completely peeled off, an insufficient amount of active contraceptive substances enters the bloodstream.

If less than 24 hours have passed after peeling off the TTS (even partial), it is necessary to re-stick the plaster in the same place or immediately replace it with a new one and continue to adhere to the usual mode of application of Evra. Additional contraceptive protection is not required.

If after peeling off the TTS (even partial) more than 24 hours have passed, or the woman does not know exactly when the patch came off, it is necessary to immediately start a new cycle, i.e. stick a new patch and then consider this day as the first day of the contraceptive cycle. In the first 7 days, it is recommended to additionally use a barrier method of contraception.

Do not try to re-glue a patch that has lost its adhesive properties. In this case, you must use a new one. Do not use sticky tapes or bandages to hold the TTS in place.

Missed days of changing the patch

After a 7-day break from using the patch, you need to glue a new one. In cases where a woman forgets to do this, the recommendations described below should be followed.

If this happened at the beginning of the contraceptive cycle (first week / first day), it is necessary to stick the patch as soon as the woman remembers this, and consider this day the first day of the contraceptive cycle, respectively, the replacement day will also shift. For 7 days, you additionally need to use a barrier method of contraception. In the case of sexual intercourse during this extended period, conception is possible.

If this happened in the middle of the cycle (second week / eighth day or third week / fifteenth day), while:

no more than 48 hours have passed since the day of replacement (the day when it was necessary to replace the TTS), it is necessary to immediately glue a new plaster, and the next one - on the usual day of replacement. For women who used the previous TTS correctly within 7 days preceding the first missed day of attaching a new patch, additional contraception is not required;
more than 48 hours have passed since the day of replacement, you must immediately glue a new patch, consider this day the first day of the new contraceptive cycle and count the new days of replacement from it. For 7 days, you should additionally use a barrier method of contraception.

In cases where a woman forgot to remove the patch on the 22nd day of the cycle, it should be removed as soon as possible, the next cycle should be started on the usual replacement day (29th day of the cycle). Additional methods of contraception are not required.

Change day of replacement

To move your period by one cycle, you must apply a new patch on day 22 of the cycle, thereby skipping the standard 7-day cancellation period. However, it should be borne in mind that in this case, the appearance of spotting discharge or intermenstrual bleeding is possible. After 6 weeks of consecutive use of Evra, it is imperative to take a break in the use of the drug, and then resume its regular use.

Women who wish to postpone the replacement day should complete the current contraceptive cycle, i.e. remove the third patch, and, choosing a new replacement day, stick the first patch of the next contraceptive cycle. It is important to take into account that the period of interruption in the use of Evra should not exceed 7 days. You should also be aware that the shorter this period, the higher the likelihood of the absence of the next menstrual bleeding, and during the next contraceptive cycle, the occurrence of scant or abundant acyclic bleeding is possible.

Side effects

According to data from clinical trials, the most common adverse reactions of Evra are: discomfort in the mammary glands, local reactions, headache, nausea.

The frequency of side effects is classified as follows: very often - ≥ 1/10, often - from ≥ 1/100 to< 1/10, нечасто – от ≥ 1/1000 до < 1/100, редко – от ≥1 /10 000 до < 1/1000, очень редко – < 1/10 000, включая отдельные сообщения.

Possible side effects:

local reactions: often - reactions on the skin at the site of application of the patch, such as peeling, dryness, burning, swelling, bruising, crusting, induration, inflammation, atrophy, discharge, infection, formation of nodules and pustules, scarring, loss of sensitivity, unpleasant odor , erosion, ulcer, excoriation, eczema, abscess, bleeding, paresthesia, photosensitivity, tumor growth; infrequently - irritation;
general disorders: often - malaise, fatigue; infrequently - peripheral edema, hypersensitivity reactions;
on the part of the cardiovascular system: infrequently - arterial hypertension; rarely - thrombophlebitis of the veins of the extremities, venous thrombosis; very rarely - arterial thrombosis and thromboembolism, myocardial infarction, hypertensive crisis;
from the gastrointestinal tract: very often - nausea; often - bloating, abdominal pain, diarrhea, vomiting; very rarely - colitis;
on the part of metabolism and nutrition: often - an increase in body weight; very rarely - increased appetite, hyperglycemia, insulin resistance;
from the musculoskeletal system: often - muscle cramps;
from the central and peripheral nervous system: very often - headache; often - migraine, dizziness; very rarely - subarachnoid hemorrhage, migraine with focal neurological symptoms, dysgeusia, cerebrovascular accidents (including transient cerebrovascular accidents, occlusions and stenosis of cerebral vessels, ischemic and hemorrhagic strokes);
on the part of the psyche: often - aggressiveness, tearfulness, affect, anxiety, emotional instability, depression; infrequently - insomnia, change in libido; very rarely - frustration, anger;
from the hepatobiliary system: infrequently - cholecystitis, cholelithiasis; very rarely - liver damage, cholestasis, cholestatic jaundice;
infections and invasions: often - fungal infections of the vagina; very rarely - pustular rash;
on the part of the organs of vision: very rarely - intolerance to contact lenses;
on the part of the skin and subcutaneous tissues: often - skin reactions, itching, acne; infrequently - allergic dermatitis, urticaria, eczema, erythema, photosensitivity reactions, alopecia, chloasma; rarely - itchy rash, erythematous rash, generalized itching; very rarely - nodular, erythema polyform, seborrheic dermatitis, exfoliative rash, angioedema;
benign, malignant and undetermined etiology of the neoplasm: rarely - uterine leiomyoma; very rarely - breast fibroadenoma, cervical cancer, breast cancer, liver neoplasms, liver adenoma;
on the part of the reproductive system and mammary glands: very often - fibrocystic changes in the mammary glands, pain, swelling, swelling, discomfort, increased sensitivity and enlargement of the mammary gland; often - vaginal discharge, uterine spasm, painful menstrual bleeding; infrequently - discharge from the genital tract, dryness of the mucous membrane of the vagina and vulva, galactorrhea, breast tumors; rarely - rare menstrual bleeding or their absence; very rarely - acyclic, scanty or profuse bleeding, cervical dysplasia, suppression of lactation;
laboratory indicators: very rarely - an increase in the concentration of low-density lipoproteins, a change in the concentration of glucose in the blood, a change in the concentration of cholesterol in the blood.

Overdose

In case of an overdose, the following symptoms are noted: bleeding from the vagina, nausea, vomiting. In this case, the TTS should be removed as soon as possible and symptomatic therapy should be carried out. There is no specific antidote.

special instructions

You can use the Evra patch only after consulting a doctor, who must exclude pregnancy and assess the appropriateness of using the drug by collecting a detailed history of the patient and her immediate family, including data on heredity. It also requires a gynecological and general examination (including examination of the mammary glands, mammography, blood pressure measurement). If a hereditary predisposition to venous thromboembolism is suspected (for example, if the parents, sister or brother have this disease), the woman is referred for additional consultation with the appropriate specialist.

Evra does not protect against sexually transmitted infections. Every woman should be warned about this when prescribing the drug.

If any symptoms appear during the use of Evra, which may indicate the occurrence of thromboembolic complications, it is necessary to immediately stop using TTS. The risk of vascular complications is increased with obesity, varicose veins and thrombophlebitis of the superficial veins.

Also, the risk of developing venous thromboembolic complications increases with prolonged immobilization and surgical interventions on the lower extremities. For this reason, 4 weeks before a planned operation, within 2 weeks after an emergency surgery, during and after prolonged immobilization, the use of hormonal contraceptives is not recommended.

According to some epidemiological studies, long-term use of combined hormonal contraceptives at a young age (before the first pregnancy) increases the risk of developing breast cancer. Some studies have shown that taking hormonal contraception is associated with an increased risk of cervical tumors, including cancer.

Due to the risk of benign liver adenomas occurring when severe pain in the upper abdomen, symptoms of intra-abdominal bleeding or enlarged liver, you should consult a doctor for differential diagnosis and exclusion of liver tumors.

In case of pharmacologically uncontrolled arterial hypertension, the drug should be discontinued. The application can be resumed only after the pressure has returned to normal.

According to the instructions, Evra can affect some indicators of functional tests. In particular, while using a transdermal patch:

reduced glucose tolerance;
increases the concentration of prothrombin and coagulation factors VII, VIII, IX and X;
platelet aggregation increases;
decreased protein S levels;
the concentration of triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-X) and low-density lipoprotein cholesterol (LDL-X) increases, while the ratio of LDL-C / HDL-C can remain unchanged;
decreased levels of antithrombin III;
the content of thyroxine-binding globulin increases, as a result of which the concentration of total thyroid hormone increases. The binding of free triiodothyronine (TZ) by ion exchange resin decreases, as evidenced by an increase in the concentration of thyroxine-binding globulin. The concentration of free thyroxine (T4) does not change. It is also possible to increase the concentration of other binding proteins;
the concentration of serum folate decreases, which is why there is a risk of clinically significant consequences in the event of pregnancy soon after the withdrawal of the contraceptive (currently on early dates during pregnancy, it is recommended to take folic acid for all women with its deficiency);
the concentration of globulins that bind sex hormones increases, as a result of which the concentrations of general circulating endogenous sex hormones increase. At the same time, the concentrations of biologically active or free sex hormones decrease or remain unchanged.

Hormonal contraceptives can cause retinal vascular thrombosis. In the following cases, you should immediately stop using Evra and consult a doctor for diagnostic and therapeutic measures:

unexpected transient, partial or complete loss of vision;
bouts of blurred vision;
diplopia;
swelling of the papilla;
violation of the integrity of the retinal vessels.

During the period of application of the transdermal patch, women are advised to avoid exposure to sunlight or artificial ultraviolet light, since there is a risk of skin hyperpigmentation, including incompletely reversible ones.

In women weighing ≥ 90 kg, contraceptive effectiveness may be reduced.

Women who smoke are at increased risk of developing cardiovascular side effects, and therefore it is strongly recommended to refrain from smoking.

During the period of application of Evra, women should regularly undergo preventive medical examinations, the volume and frequency of which should be selected individually by the doctor depending on the clinical picture, but at least once every six months.

The transdermal patch should not be cut or damaged, as this may impair its contraceptive effectiveness.

Influence on the ability to drive vehicles and complex mechanisms

Evra has no or little effect on psychomotor and cognitive functions.

Application during pregnancy and lactation

Evra is contraindicated in women during these periods of life.

Childhood use

The efficacy and safety of Evra has been established for women from 18 years of age to the onset of menopause, therefore, the drug is not prescribed for adolescents under the age of 18.

With impaired renal function

Evru should be used with caution in case of functional impairment of the kidneys.

For violations of liver function

Evra should be used with caution in the following cases: liver dysfunction, acute liver dysfunction during a previous pregnancy or previous use of sex hormones.

Drug interactions

Antibiotics, certain drugs and medicines vegetable origin, which induce microsomal liver enzymes (including CYP3A4), metabolizing contraceptive hormones, reduce the effectiveness of Eura. In this case, during the period of taking such drugs and for 7 days after their cancellation (when taking rifampicin and St. John's wort drugs - within 28 days after cancellation), it is necessary to additionally use a barrier method of contraception. If therapy with such means is prolonged (more than 3 weeks), a new contraceptive cycle should be started without a withdrawal period. Drugs that may reduce the effectiveness of Eura include: griseofulvin, bosentan, barbiturates, modafinil, rifampicin and rifabutin, aprepitant (fosaprepitant), some of the HIV protease inhibitors or combinations thereof (eg ritonavir, nelfinavir), St. John's wort, some perforatum Non-nucleoside reverse transcriptase inhibitors (eg, nevirapine), certain antiepileptic drugs (eg, felbamate, rufinamide, eslicarbazepine acetate, phenytoin, carbamazepine, topiramate, oxcarbazepine).

The following drugs may increase plasma ethinyl estradiol levels: etoricoxib, ascorbic acid, paracetamol, HMG-CoA reductase inhibitors (including rosuvastatin and atorvastatin), CYP3A4 inhibitors (including grapefruit juice, fluconazole, some itraconazolazole, v reverse transcriptase inhibitors (eg etravirine), some HIV protease inhibitors (eg indinavir, atazanavir).

With the simultaneous use of Evra, it can increase (due to inhibition of CYP) the plasma concentrations of the following drugs: selegiline, omeprazole, tizanidine, cyclosporine, voriconazole, theophylline, prednisolone.

In the case of combined use, Evra can reduce (due to the induction of glucuronidation) the plasma concentrations of the following drugs: lamotrigine, temazepam, paracetamol, morphine, clofibrate, salicylic acid. Due to a decrease in the levels of these substances in the blood, undesirable reactions may develop, therefore, a correction of their doses is required.

Before taking any medication while using this TTS, it is recommended to consult your doctor.

Analogs

There is no information about the analogues of Evra.

Terms and conditions of storage

Store in its original packaging at temperatures up to 30 ° C out of reach of children.

Shelf life is 2 years.

One of the popular contraceptives used by women is the Evra patch. This hormonal contraceptive has its own characteristics, which are important to know in order to get good protection against premature pregnancy.

Hormonal contraceptive patch

Evra - a means that prevents unplanned conception, is a sticky square that looks like a regular adhesive plaster. For its manufacture, a thin material of synthetic origin and flesh-colored is used. Evra hormonal patch has three layers:

First... It is a fabric-backed adhesive tape that is directly attached to the skin.
Second... This layer contains synthetic sex hormones.
Third... The upper protective layer is breathable. Its task is to protect active substances from moisture and contamination.

The Evra patch contains synthetic hormones that suppress, provoke structural changes in the endometrium and make the cervical mucus more viscous. Due to its density, the movement of sperm is disrupted, and the reproduction of pathogenic flora is also prevented. This contraceptive option is suitable for women with one sexual partner.

The contraceptive patch has its own advantages and disadvantages. The pluses include the following facts:

the convenience of use;
high level of efficiency;
only need to be glued once a week;
does not cause discomfort.

Has a patch Evra and certain disadvantages that cannot be ignored:

hormones can affect weight;
does not protect against genital infections;
irritation may appear;
side effects are possible;
after cancellation, you need to postpone the pregnancy.

There are a number of things to consider when using a contraceptive patch:

The protective effect of this remedy occurs on the very first day of the uterine cycle. When using the patch in the middle of the cycle, additional methods of contraception are required during the first week after application.
When there is a break after removing the Evra patch (the fourth week of the cycle), the contraceptive effect will persist.
If, before gluing the patch, the woman used hormonal pills, then the interval after the end of their reception and before gluing the product should be no more than seven days. When more than a week has passed, then before starting to use the patch, you should make sure that conception has not occurred.
The hormonal patch can be used daily, but only if the gestation period is not more than 12 weeks. If more than 5 days have passed after the termination of pregnancy, then you need to glue the product only on the first day of menstruation. When the gestation period was more than 12 weeks, then the patch can be applied only after a month.
During the first three months of using this remedy, a brownish discharge may appear. If after this time the problem does not disappear, then you should definitely consult a doctor.
If after a break, that is, the fourth week, a woman forgets about gluing a contraceptive, then you need to remember the day when the error was corrected, from which the report will begin. During the week, it is recommended to apply additional methods of protection.
If the second or third contraceptive has not been replaced, then after sticking a new patch, you should remember the day and start a new report with it, that is, three weeks with a break. Additional protection methods should be used during the first week.
When the remedy is not used in the fourth week, and menstruation has not come, but the patch did not come off, and it was replaced in a timely manner, then you should not stop using the remedy. If your period does not come after two cycles, then be sure to see your doctor.
It is urgent to go to an appointment with a gynecologist if pregnancy occurs during the use of hormonal drugs. Then be sure to stop using the patch.

Hormonal patch for pregnancy - effectiveness

According to the information provided by the manufacturer, this contraceptive provides protection in 99.4% of cases. Slightly low rates are presented by independent expert commissions, for example, experiments have shown that the Evra transdermal patch will be 92% effective, but these are also high protection rates, which many other methods are simply not capable of. The difference between the values of the manufacturers and the commission is explained by the fact that, as it turned out, if a woman weighs more than 90 kg, then the chance of getting pregnant increases significantly.

Plaster Evra - when does your period start?

After a three-week course of using this contraceptive, you need to take a week break, during which menstruation begins. In most cases, this occurs on the second or third day after the cancellation. The new contraceptive patch Evra must be glued on after seven days, even if your period has not yet ended. Longer breaks are undesirable as it will increase the chance of getting pregnant.

Pregnancy after Evra patch

If a woman plans to become a mother, then you should prepare for this event. Doctors recommend giving up hormonal contraceptives three months before conception is expected. During this time, the woman's hormonal system will be restored, the menstrual cycle and the work of the ovaries will stabilize. Experts have studied the relationship between the Evra patch and pregnancy, so if a woman missed the time to apply a new patch, then in two days the risk of conception will be increased.

How to use Evra plaster?

The contraceptive provides an effect for four weeks, so a new copy is attached to the skin for three weeks, and then a break is taken for a week. At this time, menstruation occurs, which indicates that the hormones have stopped working. The instructions for the Evra patch indicate that seven days after removing the old product, a new one must be attached.

If you do not take a week break, then you can postpone menstruation for a certain period, so the longer the agent is on the body, the longer there will be no menstrual bleeding. It should be borne in mind that gynecologists do not recommend using the Evra troubles patch for a break longer than three menstrual cycles. If, for some reason, after the end of the first week monthly cycle the patch has not been replaced, then this must be done as soon as possible, taking additional local contraception for ten days.

How to glue Evra plaster?

Using this contraceptive is very simple, so first take it out of the packaging, remove the protective film and stick it on the chosen place. It is important that the Evra contraceptive patch fits snugly and evenly to the skin. The effectiveness of the product is significantly reduced if folds, folds are formed and an incomplete fit is observed. The manufacturer recommends every day to monitor the tightness of the patch to the skin, since it depends on how many hormones will enter the bloodstream, that is, effectiveness.

Where to glue the Evra plaster?

Protective agent is attached to clean and dry skin, which should not be pre-lubricated with cream or other skin care products. It is important to know where it is better to glue the Evra plaster, so the following areas of the body are considered suitable: the buttocks, the outer surface of the upper third of the shoulder, the abdomen and the area of the scapula. It is necessary to place the contraceptive in places that clothes do not rub against. Breasts, areas with hair and folds are not suitable for the patch. It is important that there is no damage on the selected area of the skin.

The Evra patch has come off - what to do?

The surface of the patch is covered with a special glue, which differs in composition from the usual medical composition, therefore it adheres well and can even be wetted. If the Evra contraceptive patch has come off, then you need to calculate the approximate time of what happened, and if 48 hours have not passed yet, then you can attach it in place. When the sticky surface deteriorates, the patch should be replaced with a new one, and the replacement is carried out on schedule. If more than two days have passed, use a new remedy, and count this day as the first in the cycle.

Cancellation of the Evra patch

According to the reviews and opinions of doctors, in most cases, it normalizes already in the first cycle, after refusing to use this remedy. Rarely, but the occurrence of ovarian hyperinhibition is possible, which is manifested by the absence of menstruation for six months or more. This condition does not require treatment, and the function will be restored by itself. As for ovulation, after applying the Evra patch, it takes a month to normalize it.

Plaster Evra - contraindications

For a contraceptive to be effective, its use must be coordinated. Plaster "Evra", the use of which should be according to the rules, has its own contraindications:

period of gestation and lactation;
hypertension;
problems with blood vessels;
diabetes;
oncology;
uterine bleeding;
age up to 18 and over 35;
frequent headaches;
smoking.

Plaster Evra for endometriosis

One of the most unexplained diseases in the fair sex is endometriosis, in which cells of the inner layer of the uterus appear in atypical places, for example, in the ovaries, cervix, tubes, and so on. Many women have noticed that the Evra hormonal patch is not only an excellent protection against unwanted pregnancy, but also helps in the presence of this disease. At the same time, doctors do not use this method of treatment, prescribing other methods.

Evra patch - side effects

Since protection is provided by hormones, the risk of side effects cannot be ruled out.

Problems in the functioning of the nervous system may arise, as evidenced by sleep disturbances, drowsiness and a drop in performance.
Hormone surges have an effect on the activity of the cardiovascular system.
The following side effects of the Evra patch are possible: hypertension, circulatory problems, thrombosis, increased blood density and coagulation.
Some women experience discharge and bleeding, as well as painful sensations. Violations of the cycle are not excluded.
The effect of the remedy can affect the functioning of the digestive system.
The possible development of individual tolerance cannot be ruled out. More often, an allergy to the Evra patch manifests itself in the form of urticaria.

Achievements in the pharmaceutical industry have made it possible to use hormonal contraceptives of various compositions. They are available in forms for oral, intrauterine, vaginal and cutaneous administration.

And if the history of the use of contraceptive pills for oral administration has more than fifty years, then the skin contraceptive patch was first registered only in 2002 in the United States.

General understanding of transdermal contraception

Cutaneous releasing (releasing) systems, after being introduced into various fields of practical medicine, quickly gained popularity. These include the Evra contraceptive patch containing the hormonal system ethinylestradiol (0.6 mg) and norelgestromin (6.0 mg). This contraceptive system is housed in a three-layer patch with an area of 20 cm 2.

It can be glued to the skin of various areas of the body - the outer surface of the upper third of the shoulder, the upper sections of the front surface chest(except for the mammary glands), on the gluteal region and lower sections belly. The next fixation should be carried out on a different area of the skin. Avoid using tight underwear and applying lotion in this area.

When the contraceptive system is located in the abdomen, the absorption of contraceptive drugs is approximately 20% lower, nevertheless, their average content in the blood serum still reaches the limits of the required norm.

The patch must be applied once a week for seven days for 3 weeks of each month. The fourth week is skipped, that is, from the 22nd day of the month, it is not used for 7 days. There is a special reminder system on its outer side to prevent violation of the sequence of replacement.

Advantages and disadvantages

The Evra contraceptive patch has three layers. Through them, steroid hormones evenly penetrate the skin, and from there into the blood capillaries. The steady concentration of hormones in the blood serum reaches its maximum after 48 hours and remains constant for 7 days, as long as the patch remains fixed to the skin.

When studying the action of steroidal contraceptives, special attention is always paid to their systemic effect on the body, in particular on the function of the liver and the entire biliary system, since they are a kind of "target" for estrogens and gestagens.

When tablets are taken orally, they are absorbed from the intestines into the bloodstream and enter the liver. Thus, the first "blow" of their impact falls on the liver, where, through liver enzymes, their active transformations (metabolism) and protein binding take place.

Some of the hormonal preparations with bile are excreted from the body (hepatic, pre-systemic, elimination) through the digestive tract, and sex steroids associated with proteins enter the general circulation system, where their biological activity is realized.

Contraceptive patch Evra

Simply put, with the help of the liver cells, the received tabletted steroid hormones are purified and further converted. The degree of their activity directly depends on the amount that can “reach” the receptor point of application, that is, it depends on the bioavailability of the drug. Liver dysfunctions can cause a decrease in the bioavailability of contraceptives and a decrease in the degree of their effectiveness.

In turn, a long-term uncontrolled, and also not taking into account contraindications, reception can lead to:

structural and functional disorders of the hepatobiliary system;
changes in the factors of the blood coagulation system, as a result of which its coagulation properties increase, which can lead to complications such as thrombosis and thromboembolism;
increased triglyceride levels;
changes in the size of low density lipoproteins;
negative impact on carbohydrate metabolism;
negative impact on drug interactions.

The Evra contraceptive patch, like the combined oral contraceptive pill, contains steroids that can have the same effect. However, the active components of the cutaneous contraceptive system, in contrast to oral contraceptive drugs, immediately enter the general circulatory system. They do not pass through the gastrointestinal tract and, bypassing the stages of metabolism in the liver, are much less degraded, which means they have a prolonged effect and higher efficiency.

In addition, when used by women who do not have pathological changes in the liver and biliary system, they have almost no negative effect on liver cells and their enzymatic activity.

The blood levels of ethinylestradiol and norelgestromin remain within the average prescribed values throughout the week, regardless of the patch fixation site. Even with an accidental delay in its next change (at the beginning of the 2nd and 3rd weeks) by 48 hours, there is no need for additional use of other contraceptives, due to the preservation of the clinical effectiveness of the contraceptive releasing system.

However, it should be borne in mind that if a woman has skin diseases or a tendency to allergic reactions, their exacerbation is possible, as well as a decrease in the rate of absorption of active ingredients into the blood.

Besides… the contraceptive effectiveness of the agent decreases with a body weight of more than 90 kg. Therefore, a delay in menstruation when using a contraceptive patch in obese women may indicate pregnancy. According to the studies of various authors, such cases are on average 3%.

Generalized analyzes of several studies found that within 1 year of using this contraceptive, the probability of an unwanted pregnancy due to its ineffectiveness is on average about 0.6%, and for various reasons - 0.8%, regardless of age groups.

These indicators are completely comparable with those with the use of combined oral contraceptives. The normal function of the hypothalamic-pituitary-ovarian system and, accordingly, fertility (the ability to conceive) in 90% of women is restored within 1-3 months after stopping the use of the Evra patch.

It is very important that the material has high adhesive properties. As a result of the testing, it was found that in hot and humid climatic conditions, when women are in the pool, sauna, bath, as well as during their intense sports activities, it does not peel off the skin. At the same time, a fairly high degree of unreliability of fixation was found among adolescents. They, in comparison with adults, have a more frequent partial or complete peeling off of one patch. In studies, this figure averaged 35%.

Some women also have such minor side effects as insufficient aesthetics, irritation of the skin, pain during removal.

In accordance with the WHO criteria for medical acceptability and in accordance with the instructions for the use of the Evra patch, it has significantly fewer contraindications compared to combined oral contraceptives. And the existing contraindications for both, in practice, are no different, with the exception of 2 cases.

The use of a patch is undesirable for:

The presence of dermatological diseases in a woman.
Body weight exceeding 90 kg.

Thus, the main advantages of the method of transdermal delivery of contraceptives into the body are:

Non-invasiveness, simplicity and ease of use.
Very low percentage of side effects.
Uniform release and intake of a constant dose of active ingredients into the body.
Absence of peak daily fluctuations in the concentration of steroid hormones in the blood.
Absence of negative effects associated with the primary passage of drugs through the digestive system and liver.
Absence of conditions for violation of the scheme of application.
Sufficiently fast recovery of fertility after discontinuation of use.
Minimal systemic effect (on lipid and carbohydrate metabolism).
Improving the quality of life, expressed in the improvement of the total indicators of physical, mental and sexual health.