Contraception: To use hormonal patch or not

There are many factors to weigh when deciding on contraceptives. From pills and injections, implants to intrauterine devices, the generally held view among experts is that each woman’s needs and circumstances must be considered individually before choosing a contraceptive.

One contraceptive that is least used in Kenya is hormonal patches.

How the birth control patch works

The small patch is worn on the skin and it releases both oestrogen and progestogen hormones into your bloodstream.

“The hormones are absorbed through the skin into the blood and block the ovaries from ovulating. Once they block ovulation, you cannot get pregnant,” says Dr Alfred Mukomba, a gynaecologist at the Kenyatta National Hospital.

So, how do you use them?

Dr Joan Okemo, a consultant obstetrician gynaecologist at the Aga Khan University Hospital says that hormonal patches should be changed every week for three weeks then you take a one-week break off.

“A pack has three patches and you change them weekly. Then for the last week of the month, you remove the third patch and stay without a patch. You will then receive your monthly periods in that week,” she says.

“It is also one of the ways of getting regular periods if you usually have irregular, heavy and extremely painful periods,” she adds.

A one-month supply of hormonal patches costs about Sh2,400 while a year’s supply goes for anything between Sh25,440 and Sh30,000.

As long as you adhere to the instructions, Dr Okemo says, you will find the hormonal patch effective in preventing pregnancy.

Before determining whether to prescribe a hormonal patch for you, Dr Mukomba says that a doctor, “assesses your body, checks blood pressure, blood levels, examines the breasts, checks diabetes status and ensures that there is no growth in the uterus.”

Dr Okemo adds that gynaecologists also look at the body mass index (BMI). “For people who are overweight or obese, the hormonal patch may not work well. It may end up failing to prevent pregnancy.”

Where is it worn?

Hormonal patches are normally worn on a hidden part of the body, where they cannot be easily seen by everyone.

“You can choose to put it anywhere on your body, like on your lower back, your upper back, your tummy, on your chest or your thighs,” says Dr Okemo.

Do not take the hormonal patch off even when taking a shower. Before attaching the hormonal patch to your body, ensure the area is well-dried so that the patch sticks on well.

Ensure that you are also aware of the side effects of the hormonal patches. Dr Okemo says, “Information is power. If you know the side effects rather than being caught off guard, then you are in a better position to comply with the requirements for the proper use of the patch.”

Side effects of the hormonal patch

Just like most contraceptives, hormonal patches may cause side effects such as headaches, bloated tummy, tender breasts, and constipation.

“Hormonal patches can also lead to blood clots, a condition called deep vein thrombosis or pulmonary embolism,” Dr Okemo says.

Deep vein thrombosis is a medical emergency.

“Whenever you are using the hormonal patches or hormonal pills and you notice that you are having a lot of pain or swelling in your left leg, you need to go to the hospital as soon as possible. Pulmonary embolism can kill within 30 minutes or even less. You will also need to stop using the hormonal patches and you can’t use them again in the future,” the gynecologist says.

Hormonal patches can also cause weight gain.

Dr Mukomba says that some other side effects of the hormonal patch include an allergic reaction, nausea and dizziness. He advises that hormonal patches should not be used by women with high blood pressure.

“Also hormonal patches can affect your sexual libido, giving you very little interest in sex and also cause vaginal dryness,” Dr Okemo adds.

For all the side effects, apart from the blood clotting, she says that you should weigh the benefits against the risks.

Lactating mothers

A lactating mother can use a hormonal patch but only six months after giving birth.

“A woman has to wait for six months after giving birth to use a hormonal patch because the two hormones in the patches make you susceptible to getting blood clots. The risk of blood clots is generally high after you have just delivered a baby. A hormonal patch would then increase your chances of developing a blood clot, making it unsafe,” Dr Okemo says.

Dr Mukomba adds hormonal patches may also reduce the amount of breast milk production.

Common errors

The biggest mistake that people make with the use of hormonal patches is failing to follow instructions.

“There are people who think that you should only use a hormonal patch during the period when you are sexually active. For instance, women whose husbands work out in town think that if they use the patch only when the spouse is about to come back, the hormonal patch will be effective. This is a mistake,” Dr Okemo says, adding that the patch becomes effective after about one week of use.

Another common mistake is people tend to take hours or days before putting on the hormonal patch when they are replacing it.

“A hormonal patch needs to be replaced immediately. Failure to do this leaves you with insufficient hormones to protect you and you may end up getting pregnant. Some people also tend to remove the hormone patch when bathing or swimming,” says Dr Mukomba.

One can use the hormonal patch for as long as they need contraceptives, however, Dr Okemo advises you go for regular checkups.

“Go for an assessment at least once a year. Over time as you get older you realise that you develop some health conditions that may make you a poor candidate for a hormonal patch,” she says, adding the effectiveness of hormonal patches depends on how keen you are with following instructions.

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