When it comes to family planning, most women can easily name the usual options: pills, injections, implants and intrauterine devices (IUDs). But there is one method that rarely makes the conversation despite being highly effective, discreet and easy to use.
The contraceptive patch remains one of the least talked-about forms of birth control, leaving many women unaware that it even exists. So, what exactly is it, how does it work, and why has it remained in the shadows while other contraceptives dominate the spotlight?
Dr Felix Oindi, consultant obstetrician and gynaecologist at Aga Khan University Hospital, describes the contraceptive patch as a small, thin adhesive patch that sticks to the skin and releases two hormones, similar to those in a combined contraceptive pill (oestrogen and progestin), into the bloodstream through the skin.
"These hormones work continuously over a week to prevent pregnancy. The patch works by stopping the ovaries from releasing an egg (ovulation). It thickens cervical mucus, making it harder for sperm to reach an egg, and thins the lining of the uterus, making implantation less likely if fertilisation were to occur," he explains.
He notes that when used correctly, by changing it on schedule every week, it is more than 99 per cent effective. However, with typical use, which accounts for missed or delayed patch changes, it is about 93 per cent effective, similar to the combined oral contraceptive pill.
In his experience, Dr Oindi says the patch is not among the most commonly chosen contraceptive methods in Kenya. “The estimate may be about one per cent among those seeking contraception who choose the patch. This is partly due to lack of awareness and the scarcity of the patch," he says. "Long-acting reversible contraceptives such as implants and intrauterine devices (IUDs) are generally more popular because they require less user effort and provide protection for several years."
Still, he says fertility usually returns quickly after stopping the patch. Most women begin ovulating within a few weeks, and many can become pregnant during the first few months if they are not using another contraceptive method.
The patch is a good option for women who want an effective reversible method without taking a daily pill or who prefer a method that only requires attention once a week, provided they do not have medical conditions that prevent the use of oestrogen-containing contraception.
However, he cautions that the contraceptive patch is not suitable for everyone. It may not be recommended for women with a history of blood clots, stroke or certain heart conditions, as well as those who experience migraine with aura or have uncontrolled high blood pressure.
Women with certain liver diseases or current or previous breast cancer may also be advised against using it. The patch may also pose increased risks for heavy smokers aged 35 and older, while its effectiveness can be slightly reduced in women with severe obesity.
"Most women tolerate the contraceptive patch well, although some may experience mild side effects, particularly during the first few months as the body adjusts to the hormones. These can include skin irritation at the site where the patch is applied, breast tenderness, nausea, headaches, as well as spotting or irregular bleeding," he says.
He advises women to seek immediate medical attention if they develop symptoms that could signal a rare but serious complication, such as a blood clot.
Warning signs include sudden chest pain or difficulty breathing, severe pain or swelling in one leg, a sudden severe headache or changes in vision, weakness or numbness on one side of the body, or severe abdominal pain.
Dr Oindi notes that many women notice positive changes. "The patch often makes periods lighter, more regular and less painful. It may also improve acne in some women by reducing the effect of male hormones on the skin."
"Mood changes and changes in libido can occur, although these vary greatly between individuals. Some women notice improvement, while others may experience worsening symptoms. If troublesome symptoms persist, an alternative contraceptive method can be considered," he adds.
Dr Oindi advises that the patch should be changed once every week on the same day for three consecutive weeks, followed by one patch-free week during which a withdrawal bleed usually occurs.
"If the patch becomes loose or falls off for less than 24 hours, it should be reapplied or replaced immediately, and contraceptive protection is generally maintained," he says. "If it has been off for more than 24 hours, or if a woman forgets to change it on time, she should apply a new patch as soon as possible, start a new patch cycle, and use condoms or avoid sexual intercourse for the next seven days. Emergency contraception may be appropriate if unprotected intercourse has occurred recently."
Certain medications, however, can interfere with the contraceptive patch and reduce its effectiveness. These include some anti-epileptic medicines, tuberculosis treatments such as rifampicin, certain HIV medications and some medicines used to treat fungal infections.
Some women also believe that because the patch is visible, it can easily fall off. This, he says, is untrue. When applied correctly, it adheres well during bathing, swimming and normal physical activity.
"Others worry that everyone will notice it. The patch is relatively small and can be placed on discreet areas such as the buttock, abdomen, upper arm or upper back," he adds.
The contraceptive patch’s biggest limitation is that it depends on the user remembering to change it every week. Missing or delaying a patch change reduces its effectiveness.
"The patch does not protect against sexually transmitted infections (STIs), so condoms remain important for STI prevention," he warns.
