Most birth control pills have to be taken at the same time every day. The Evra patch works differently — you wear a small adhesive patch on your skin and change it just once a week, for three weeks out of every four.
The Evra patch is a combined hormonal contraceptive. It delivers two hormones through your skin, a progestin called norelgestromin and an estrogen called ethinyl estradiol. It’s the only birth control patch available in Canada, and you may recognise it by its former US name, Ortho Evra.
This article covers what the Evra patch is, how it works, and its side effects. We also look at how it compares to the oral contraceptive pill, and what Evra patches cost in Canada.
An Overview of the Evra Patch
The Evra patch is a thin, beige adhesive patch, about 4.5 cm (1¾ inches) square, that sticks to your skin. Each patch contains two hormones, norelgestromin and ethinyl estradiol. It releases a steady daily amount of each hormone, about 200 micrograms of the progestin and 35 micrograms of the estrogen, for a week at a time. That makes the Evra patch a combined hormonal contraceptive — the same class of hormones as the combined pill — but absorbed through the skin instead of swallowed.
You wear the Evra birth control patch on a simple weekly cycle. A new patch is applied on the same day each week for three weeks, then you take the fourth week patch-free, when you’ll usually have a withdrawal bleed similar to a period. The following week, you start the cycle again with a fresh patch. The appeal is the routine, with one change a week rather than something to remember every day.
Evra is currently the only contraceptive patch available in Canada, made by Searchlight Pharma. The same product was sold in the United States as Ortho Evra until 2014, where it’s now available as generics called Xulane and Zafemy. Health Canada has approved the Evra patch for preventing pregnancy, and it’s available by prescription only.
How the Evra Patch Works
The Evra patch works mainly by stopping ovulation. If no egg is released, there’s nothing for sperm to fertilise. This is the patch’s main contraceptive action, and it’s well established. Backing it up are two supporting effects: the hormones thicken the cervical mucus so sperm find it harder to get through, and they thin the lining of the womb.
Instead of passing through your stomach and liver like a swallowed pill, the two hormones delivered by the Evra patch are absorbed straight through your skin into your bloodstream. A single patch releases them at a steady rate for a full week, so hormone levels stay fairly constant rather than rising and falling with each daily dose.
That steady delivery has a practical upside. The patch keeps hormones high enough to prevent ovulation for at least nine days, which is why changing the birth control patch a day or two late mid-cycle doesn’t leave you unprotected.
How to Use the Evra Patch (Where to Apply It)
Using the Evra patch involves a weekly routine, plus a few guidelines about where to put it and what to do if it comes loose.
The weekly schedule: Apply a new patch on the same day each week for three weeks. That day becomes your “patch change day.” Take the fourth week patch-free, when you’ll have a withdrawal bleed, then apply a fresh patch to start the next cycle. Don’t go more than seven days without a patch.
Where to apply it: Evra patch placement is flexible. Put the patch on clean, dry, healthy skin where tight clothing won’t rub it. The approved spots are the:
- Buttock
- Abdomen
- Upper outer arm
- Upper torso, such as the back or shoulder
Never place the birth control patch on your breasts, or on skin that’s red, cut, or irritated. Skip creams, lotions, or powder on the spot where you will apply the patch, as they can stop it from sticking. When applying the patch, press it down firmly for about 10 seconds, move to a fresh spot each week to give your skin a break, and glance at it daily to check it’s still fully stuck on.
If a patch comes loose: Off for less than a day, reapply the same patch or replace it with a new one and keep your usual change day — no backup needed. Off for longer than 24 hours, you may not be protected: start a new cycle with a new patch and use backup contraception, such as condoms, for seven days. Don’t tape a patch back down or reuse one that’s lost its stick.
If a change day slips: A patch up to two days late when you’re mid-cycle can be changed right away with no backup. Beyond that (or if you’re late starting a new cycle), treat it as a gap in protection — apply a fresh patch and use backup for seven days. Unlike the pill, vomiting or diarrhoea won’t stop the patch working, since the hormones don’t go through your stomach.
How Effective Is the Evra Patch?
Used correctly, the Evra patch is about as effective as the pill. In clinical trials, fewer than 1 in 100 women using the patch became pregnant over a year. In real-world everyday use, which allows for the occasional late change, effectiveness is a little lower.
This is where the weekly routine of a birth control may improve effectiveness. Changing one birth control patch a week gives fewer chances to slip up than remembering a pill every day, and in one study, most cycles were completed with the patch used exactly as directed.
Health Canada notes the Evra patch may work less well in women who weigh 90 kg (about 198 lb) or more. This came from a small number of pregnancies in the trials, so the evidence is limited. If you’re at or above that weight, it’s worth raising with your doctor, who may suggest a different birth control option.
Evra Patch Side Effects
Most side effects of the Evra patch are mild and tend to settle over the first few cycles as your body adjusts. Birth control patch side effects are broadly the same as those of a combined pill, since the hormones involved are the same.
The most commonly reported Evra patch side effects include:
- Skin irritation or a rash at the patch site
- Headache
- Nausea
- Breast tenderness
- Period pain
- Spotting between periods, especially in the early months
- Mood changes
If the skin under a patch gets itchy or sore, applying the next one to a different spot usually settles it.
Weight gain is a common worry with hormonal birth control, but larger reviews of combined hormonal contraception haven’t found it causes meaningful weight gain. Any early change in body weight is usually fluid rather than fat.
Blood Clots and Estrogen Exposure
Like every combined hormonal contraceptive, the Evra patch carries a small increase in the risk of blood clots. One added consideration is that because the patch delivers hormones steadily through the skin, Evra exposes you to more estrogen overall than most combined pills.
Whether that extra estrogen leads to more clots than a pill is genuinely unsettled. Some studies have found up to twice the risk of a standard pill, while others reported no difference. Health Canada describes the clinical significance as unknown.
In absolute terms, around 6 to 12 in every 10,000 women using the Evra patch for a year develop a clot, compared with about 2 in 10,000 who use no hormonal contraception. The risk is real but small, and lower than the clot risk that comes with pregnancy itself.
Who Should Not Use the Evra Patch
Birth control patches aren’t suitable for everyone. Doctors generally won’t prescribe Evra for people who:
- Smoke and are over 35
- Have had a blood clot or have a clotting disorder
- Get migraines with aura
- Have had breast cancer or another hormone-sensitive cancer
- Have uncontrolled high blood pressure, serious liver disease, or certain heart conditions
Some medications, including certain epilepsy drugs, the antibiotic rifampin, and St. John’s wort, can make the patch less effective. These cautions are why a doctor reviews your health history, medications, and supplement use before prescribing the Evra patch.
Evra Patch vs the Pill
The biggest difference between the Evra patch and the pill is that the patch is weekly, while the pill is daily. For anyone who finds a daily pill easy to forget, that once-a-week routine is the main draw of a birth control patch.
The trade-offs are worth weighing. The patch is visible on your skin and can cause irritation where it sits. It also delivers slightly more estrogen than most pills, and it may be less reliable if you weigh 90 kg or more. The pill does not involve a patch, comes in a wider range of estrogen doses (including very low-dose options), and some combined pills are also approved to help with acne.
If you want the lowest possible hormone dose or a pill that also treats acne, one of the combined pills — such as Yaz, Yasmin, or Mya, Lolo, or Alesse — may suit you better. If remembering a daily pill is the real hurdle, the patch’s weekly rhythm is likely the deciding factor. Either way, it’s a choice worth making with a doctor who knows your health history.
Evra Patch Cost, Coverage, and Access in Canada
What you pay for the Evra patch depends on your province, insurance, and pharmacy. Here’s the general picture on cost, plus the specifics for British Columbia.
Cost
Evra patch prices aren’t fixed nationally, so treat any figure as a rough guide and confirm the current cost with your pharmacy. As a broad reference, a month’s supply tends to run about $15 to $25 before insurance. Because Evra is brand-only in Canada, with no generic patch, there isn’t a cheaper version to switch to.
Coverage in British Columbia
British Columbia covers most prescription contraception at no cost, but the patch is one of the few methods left out. Pills, IUDs, the implant, the injection, and the vaginal ring are all fully covered. A private or workplace plan may cover Evra, so it’s worth checking if you have coverage.
How to Get the Evra Patch in Canada
The Evra patch is prescription-only across Canada. You can see your family doctor, visit a walk-in clinic, or speak to a doctor online with Walk In to discuss whether it might be suitable. If so, a prescription can be provided or sent straight to your pharmacy.
Frequently Asked Questions
Does the Evra patch help with acne? No. Some combined pills, such as Yaz and Alesse, are approved to treat moderate acne, but the Evra patch isn’t, and it shouldn’t be relied on to clear breakouts. If acne matters to you alongside contraception, raise it with your doctor.
Can you get pregnant while using the Evra patch? Used correctly, the Evra patch is a reliable contraceptive — fewer than 1 in 100 women become pregnant over a year. The usual way it fails is a late change, so sticking to your weekly patch change day and not stretching the patch-free break beyond seven days are what keeps it working.
Is it normal to spot or bleed on the Evra patch? Light spotting between periods is common in the first few cycles after starting the birth control patch, and usually settles on its own. You will have a withdrawal bleed during the patch-free week. If bleeding is heavy, doesn’t settle, or comes with cramping that worries you, speak with your doctor.
Is the Evra patch the same as Ortho Evra? Yes. Ortho Evra was the name used in the United States, where it has since been replaced by generic patches called Xulane and Zafemy. In Canada, the same birth control patch is sold as Evra.
Is the Evra Patch Right for You?
The Evra patch suits people who want reliable contraception, without a daily pill to remember. A once-a-week patch eases the day-to-day pressure, and it keeps working even through a stomach bug.
A birth control patch is less of a fit if you’d rather not wear a visible patch or are prone to skin irritation. It might also not be suitable if you’d prefer to keep your estrogen dose to a minimum, or if you weigh 90 kg or more, where the patch may be less reliable. In those cases, one of the combined birth control pills may serve you better.
Whether the Evra patch is right for you comes down to your health history and what you want from your contraception, which is something a doctor can help you weigh up.
Speak to a Doctor Online About Birth Control
Please note:
Walk In does not provide medical advice. The contents of this website, including text, graphics, images and any other material are intended for informational and educational purposes only and are not intended to substitute for professional medical advice, diagnosis or treatment. Although efforts are taken to keep any medical information on the website updated, we cannot guarantee that the information on our website is correct or reflects the most up-to-date medical information.
Please consult your physician for medical advice. Always seek the advice of a physician or other qualified healthcare provider with any questions regarding a medical condition. Never disregard or delay seeking professional medical advice or treatment because of something you have read on this website or on the internet.
