There are currently three contraceptive patches available in the United States:
1. Xulane®
Xulane (the generic Zafemy) contains 150 micrograms of norelgestromin (a progestin) and 35 micrograms of ethinyl estradiol (an estrogen). It is applied weekly for three consecutive weeks, followed by a patch-free week. [dailymed.nlm.nih.gov], [medlibrary.org]
2. Twirla®
Twirla delivers 120 micrograms of levonorgestrel (a progestin) and 30 micrograms of ethinyl estradiol daily. Like Xulane, it is worn weekly for three weeks with a patch-free week afterward. [empr.com], [twirla.com]
Where Can You Wear a Contraceptive Patch?
- Do not place the patch on your breasts. [medlibrary.org], [drugs.com]
- Xulane may be placed on the upper outer arm, abdomen, buttock, or upper back/torso. [medlibrary.org], [dailymed.nlm.nih.gov]
- Twirla is approved for the abdomen, buttocks, or upper torso/back. [empr.com], [hcp.twirla.com]
- Choose an area where tight clothing, waistbands, bra straps, jewelry, or frequent rubbing won’t dislodge the patch. [medlibrary.org], [hcp.twirla.com]
The Most Important Step: Clean, Dry Skin
Before applying a new patch:
- Make sure the skin is clean and completely dry.
- Do not apply the patch over areas after lotions, creams, moisturizers, oils, powders, makeup, or sunscreen. These products can interfere with adhesion and increase the risk of the patch lifting or falling off. [medlibrary.org], [twirla.com], [healthy.ka…anente.org]
- There is very little direct research measuring hormone levels when sunscreen or body oils are applied under a contraceptive patch. However, manufacturers specifically advise avoiding these products because they can impair adhesion, which may reduce reliable hormone delivery. [medlibrary.org], [twirla.com]
Does Placement Affect Hormone Levels?
Not enough to matter clinically for most users.
Research on contraceptive patches suggests drug delivery is generally reliable across approved application sites. Some pharmacokinetic studies have found small differences in absorption between locations. These differences have not led to recommendations favoring one approved site over another. [dailymed.nlm.nih.gov], [pharmexec.com]
In practical terms, the best location is:
- a site where the patch sticks well,
- is comfortable,
- and stays attached for the full week.
What About Sunscreen, Oils, and Swimming?
This is where adhesion becomes important. Contraceptive patches do not protect the skin from UVA or UVB radiation. There is no evidence in the medical literature or FDA labeling that transdermal contraceptive patches provide any sun-protective effect. In fact, the FDA label for the norelgestromin/ethinyl estradiol patch notes that patients should avoid exposing the patch to direct sunlight, as this could theoretically affect drug release or absorption.
- Avoid placing sunscreen, oils, or lotions under or immediately around the patch. [twirla.com], [hcp.twirla.com], [healthy.ka…anente.org]
- You can still use sunscreen elsewhere on your body, and protective clothing or bathing gear may be a better choice.
- Twirla studies found that complete patch detachment occurred in about 5% of patches, with detachment more likely after water exposure. Adhesion was best on the abdomen. [hcp.twirla.com], [twirla.com]
- Check your patch daily, especially after swimming, prolonged water exposure, or intense exercise. [twirla.com], [hcp.twirla.com]
Rotating Patch Sites
- When replacing a patch, apply the new patch on the same day of the week.
- Do not place the new patch on exactly the same spot where the previous patch was worn. Rotating sites helps reduce skin irritation. [medlibrary.org], [empr.com]
If the Patch Starts to Peel
- Partial or complete detachment happens in roughly 5% of users. [hcp.twirla.com], [twirla.com]
- Check the patch every day.
- If it comes off completely and you are unsure how long it has been detached, follow the product instructions and use backup contraception if recommended. [drugs.com]
- Do not use tape or bandages to hold a patch in place. If a patch is no longer sticky, replace it with a new one. [drugs.com]
Common Questions
Will placing the patch closer to my breasts cause breast tenderness?
No. Breast fullness or tenderness can occur with any estrogen-containing contraceptive, but patch location does not appear to influence those symptoms. Hormones are absorbed into the bloodstream and circulate throughout the body. [dailymed.nlm.nih.gov], [empr.com]
Does body fat determine how well the patch works?
The patch delivers medication through the skin into the bloodstream. There is no evidence that placing it over a fattier versus more muscular approved site meaningfully changes effectiveness for most users. [dailymed.nlm.nih.gov], [pharmexec.com]
Bottom Line
The biggest factor you can control is adhesion. Apply your patch to clean, dry skin free of lotions, oils, powders, and sunscreen. Choose a location where clothing won’t rub it, check it daily, and rotate sites each week. While hormone absorption appears fairly consistent across approved body locations, a patch that stays firmly attached is the patch most likely to work as intended. [medlibrary.org], [twirla.com], [hcp.twirla.com]
