ORTHO EVRA
FACT SHEET AND CONSENT

The contraceptive patch, Ortho Evra, is a thin, beige plastic patch that sticks to the skin. The patch contains hormones, which are absorbed continuously through the skin and into the bloodstream. It is approximately 99% effective in the prevention of pregnancy when used properly. The system contains three patches to be used for three weeks following your menstrual period.

HOW TO USE THE ORTHO EVRA SYSTEM

Apply the first patch on the first Sunday after your period begins. If you get your period on a Sunday, apply your first patch on that day. You must use a back-up method of birth control, such as condoms and spermicide, for the first week of your first cycle. Always apply the patch to clean, dry skin. Avoid the use of creams, oils, powder or makeup at the patch site.

The day you apply your first patch will be Day 1. Your "patch change day" will be on that day every week. Place the patch on your buttock, abdomen, upper outer arm or upper torso. Never put the patch on your breast. Wear the patch for 7 days. On your "patch change day", immediately replace the used patch with a new one. Only 1 patch should be worn at a time. To avoid irritation, apply each new patch to a different location on your skin. When applying a patch, put the sticky side against your skin. Press firmly with the palm of your hand for at least 10 seconds, making sure the edges stick well.

You will use 3 patches in 3 weeks. Do not wear a patch during week 4. Your period should begin during this time. Start a new prescription of Ortho Evra exactly 1 week after removing the third patch.

If your patch becomes loose or has fallen off…

For less than 1 day, try to re-apply or apply a new patch at once. No back-up contraception is needed. Your "patch change day" will remain the same.

For more than 1 day or if you are unsure of how long, you can become pregnant. Start a new 4 week cycle at once and use back-up contraception for 1 week. You will now have a new "patch change day". Do not attempt to re-apply the patch if it's no longer sticky, has become stuck to itself or another surface, has other material stuck to it, or has previously become loose or fallen off. No tapes or wraps should be used to keep the patch in place.

If you forget to change your patch…

At the start of any patch cycle: You can become pregnant. Apply the first patch of your new cycle as soon as you remember and use a back-up method of contraception. You now have a new "patch change day" and new Day 1.

In the middle of your patch cycle, week 2 or 3: If you forget to apply your patch for one or two days, apply a new patch as soon as you remember. Apply your next patch on your normal "patch change day". No back-up contraception is necessary. If you forget to change your patch for more than 2 days, you can become pregnant. Start a new 4-week system as soon as you remember. You now have a different "patch change day" and a new day 1. You must use back-up contraception for the first week of your new cycle.

At the end of your cycle, week 4: If you forget to remove your patch, take it off as soon as you remember. Start your next cycle on your normal "patch change day". No back-up contraception is needed.

You should never have the patch off for more than 7 days.

You should not use Ortho Evra if you have had, now have or develop:

blood clots in the veins or arteries heart disease, heart attack or stroke

chest pain (angina pectoris) serious liver disease

cancer of the breast, uterus or liver known or suspected pregnancy

high blood pressure diabetes

need for prolonged period of bed rest allergic reaction to components of Ortho Evra

Talk to your health care provider about using Ortho Evra if…

You smoke cigarettes, especially if you are older than 35 years of age
You are breastfeeding
You weigh more than 198 pounds, as Ortho Evra may be less effective in preventing pregnancy.
You are taking other medications, such as antibiotics, anticonvulsants, St. John's Wort, or drugs used to treat HIV/AIDS. These drugs can make Ortho Evra less effective in the prevention of pregnancy.
You have a family history of breast cancer.

Possible side effects of Ortho Evra include skin irritation at the patch site, spotting between periods during the first few months of use, fluid retention, possible elevated blood pressure, problems wearing contact lenses, spotty darkening of facial skin, nausea, vomiting, breast tenderness, headache, menstrual cramps, changes in appetite, nervousness, depression, dizziness, loss of scalp hair, rash and vaginal infections. Most of these side effects are similar to those of birth control pills and occur infrequently.

CALL US AT ONCE IF YOU EXPERIENCE ANY OF THE FOLLOWING SYMPTOMS

crushing chest pain	vision problems
unusual swelling/pain in the legs or arms	unusually heavy vaginal bleeding
yellowing of skin or eyes	absence of menstrual period
shortness of breath	sudden onset of severe headaches
severe depression	severe abdominal pain
new breast lump

I have read this fact sheet and request that Ortho Evra be prescribed to me

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ORTHO EVRAFACT SHEET AND CONSENT

HOW TO USE THE ORTHO EVRA SYSTEM

CALL US AT ONCE IF YOU EXPERIENCE ANY OF THE FOLLOWING SYMPTOMS

ORTHO EVRA
FACT SHEET AND CONSENT