Question:
Birth Control, specifically Ortho Evra (the patch)

Hello all. I am nine months post-op and currently using depo provera injections for birth control. I have been using this method since August of 2003 (the month before surgery). I am scheduled to get my next injection next week, but I've been feeling like I would like to switch birth control. I'm hearing that it can be extremely difficult to get pregnant later on after being on the injections, and since I want to start having children in about two years, I don't want to do anything to hinder my fertility. I would like to start using the Ortho Evra birth control patch. I talked to my ob/gyn about this and she stated that a person really needs to be under 150 pounds to use that patch for effectiveness. I am currently at 199 pounds (I've lost 133) and my goal weight is 166. So, unless I far surpass my goal, I don't see myself ever weighing under 150 pounds. I checked the ortho evra website and could find nothing regarding a weight restriction for users. Are any of you using the patch and weighing in at more than 150? Should I get a second opinion about using it (maybe from my PCP)? What do you guys think? Thanks in advance. Hugs, Kristy (lap RNY 9/18/03 - 332/199/166)    — kristynush (posted on June 30, 2004)


June 30, 2004
My OB says you should weight 190 and below for it to be effective I would check with another doctor
   — Cindi A.

June 30, 2004
I use the patch and weigh 170. I've been using it since I was 190 pounds. I started it in the beginning of May and I like it a lot. I wear it on my upper abdomen, alternating sides every week. It stays on really well. The only annoying thing is if I where a dark shirt, the fuzz from the shirt gets in any sticky residue surrounding the patch and looks dirty. Oh well, not a huge deal but annoying. I wore it on my upper buttcheek the first time I wore it and my jeans took it off. I don't like wearing it on my arm, either, because I wear a lot of sleeveless shirts. Anyway, almost 2 months now and no pregnancy-I think I can chalk this up as just fine and dandy! Also, if you google weight effective ortho evra, you can pull up some sites (such as plannedparenthood) that can reinforce that yes, this is an effective form of birth control if you are under I believe 193 pounds. Good luck!
   — jenn_jenn

June 30, 2004
"Ortho Evra may be less effective in women weighing more than 198 pounds." This is directly from the FDA's site, here's the link: http://www.fda.gov/cder/consumerinfo/druginfo/orthoevra.htm
   — jenn_jenn

June 30, 2004
I LOVED THE PATCH!!!! I used it when I was 250 pounds and never had a problem. My gyno said it may be less effective if you're over 200lbs. however the rate of effectiveness is still 90 some percent. I always wore it on my stomach under my undies and it NEVER came off. But now my husband just got a Vasectomy so soon I'll need nothing!!!
   — Kelly* P.

June 30, 2004
The OB/GYN who works with our bariatric program will not prescribe the patch for anyone over 170 lbs. I have a personal friend who saw her yesterday and basically begged and the OB/GYN stood hard and fast and refused. She said there are too many studies to show that it is not effective at the higher weights. I haven't every tried this (my plumbing was removed years ago) but lots of our patients are using the Neuvo Ring. It's a once monthly form of birth control but I'm not sure if it's what you're looking for. Thanks, Rona
   — ronascott

June 30, 2004
I agree with the others on the weight aspect. Just like being overweight affects birth control medication, it also lowers your chances of conception, however, there are many women who are obese that conceive with no problem whatsoever. I was using the pill, and then switched to the patch too. Unfortunately, after a year of using the patch, I developed horrible migraine headaches, and had to stop using it. A lot of people have developed this problem with the patch I find out. After several normal catscans and other tests with no findings, I gave up, until I stopped using the patch alltogether, and I stopped getting migraines with the following cycle. I'm not saying this will happen to you, but just be aware of how your body reacts to it, because when you think about it, you're essentially putting 7 days of hormones in one patch, and your body has to metabolize it, and everyone's metabolism is different. I absorbed it to quickly, and it was hormone overload. I weigh 262 pounds, and it affected me badly. Best of luck!
   — StephanieF

June 30, 2004
Your OB/GYN is wrong about one having to be under 150. I've heard many say you have to be under 170 pounds, but FDA states 198 pounds. You are almost there now. Maybe you can start some birth control pills and then switch to the patch after you've lost more weight. I loved the patch too for the convienence of having to only change it once a week, but had to go off it because I stayed on my period for over a month after being on the patch a year. I don't think it was the patch, I have that problem with birth control pills too.
   — Lisa N M.

June 30, 2004
My surgery was set for May of 2003 and I switched from the Pill to the Patch in March of 03 - at 336 pounds! My PCP did not know that there was a problem with overweight people using the Patch. A nurse from my surgeon's office actually was the one to bring it to my attention - I was MANY months post op by then and around 230+ pounds at that time. After discussing with my PCP (and she felt so bad about not knowing)alternative methods of BC, we decided to continue on the patch. I was only 30 some lbs from the 198lb recommendation and it had worked effectively for me when I was 330+ lbs. Thank goodness that an unwanted pregnancy did not occur. So, if you were my PCP's patient, based off of your weight, she would prescribe it to you. I have had little problems with the patch - occasionally my period starts during the 3rd wk instead of the 4th. I like the ease and the week long effect. Good luck whatever your decision. Jodie LAP RNY 05-02-03 336/166/??
   — Jodie P.

June 30, 2004
I'm on the patch now and I've heard 190 pounds is the limit. I wouldn't worry about being 199. I love the patch. I've had no side effects and it's so easy. It's been working for several months now!! :)
   — emilyfink

June 30, 2004
Per my instructions in the patch book it says "To have the full effectiveness the patient should weigh less than 198lbs" I have been on it for over a year now and love it, though its a good idea to keep some extra patches in case they do start to fall off. I mostly wear mine on the buttock.. cus its easy to conceal. Good luck!
   — Sunny4x4chick

July 1, 2004
YOu should probably print out the info from the FDA and take it to your physician. Seems like incontrovertable info to me. However, I'd like to comment on the DEPO you're going off of. Honey- It's my opinion after having taken depo that NO OBGYN should be recommending this drug to any woman who has plans of future pregnancy. There are SOOOO many horror stories out there about this, and too many unanswered questions. I, unfortunately, am one of them. I had normal cycles before starting Depo. I took 3 cycles of Depo and never had a problem with it, it did exactly what it was supposed to...stopped my periods. I started reading up a little more on it and what I read, especially about it's lasting effects, scared the heck out of me. So, I stopped it. That was back in March of 2003. I have yet to get my periods back. Seemingly, there is no reason for it. 2 doctors have told me that they blame it on the depo, but have no scientific proof. I am completely normal in every other way and have been checked by specialists too. There is seemingly no explanation. So- RUN to the dr and get yourself off Depo, no matter what you replace it with, it's better than Depo!!!
   — LMCLILLY

July 1, 2004
I have taken Depo on and off for about 8 yrs. I love it, it is my prefered method of birth control, due to the fact that I can take 4 BC Pills a day and still not stop bleeding. Personally, I do not want to have a period EVERY day, so I chose Depo. I have been off Depo a couple of times due to employer/insurance changes. Each time it took 18/24 months for my period to return. This last stint, It did not return on its own, and my OBGYN prescribed 10 days of Progesterone and Viola! a period. Now, of course 20 days later, it won't go away. My OBGYN will prescibe Depo and the Patch for her obese paitents. Under 200 is the rule for the Patch and for patients over 200 with Depo, they get it every 11 wks, not 12. My OBGYN and Surgeon both agree NO hormones 2 wks prior to surgery. It can cause blood clots. So I personally do not have enough time before surgery to get Depo and for it to wear off. So I am stuck bleeding. My sis wears the patch and she is about 175. She has not had any problems. If you can remember to take a pill every day, you should look into the NEW BC Pill that only makes you have a period 4 times a year. If you aren't trying to get pregnant right this second, there is no need to have a period. Good Luck!
   — Lelandmm

July 1, 2004
I was an OB/Gyn nurse until 3 mo. ago and it seems to me that the studies on Ortho Evra showed an increased rate of pregnancy in women over a certain weight. I was thinking that it was 175 pounds but I can't remember for sure. It is made by the Ortho Pharmaceutical co. They may have a consumer phone number you could call listed on their web site. Good luck to you.
   — Susan F.

July 1, 2004
Try the Nuva Ring!!!! It is wonderful. Took me 2 yrs to get Pregnant with my little guy after coming off of Depo, and my cycles were a mess. Now, once a month I switch rings and are good to go! I don't feel it, he doesn't feel it and no worrying whether I remembered my pill or not.
   — AJ N.

July 2, 2004
DO YOUR RESEARCH, ASK A DOCTOR. I FOUND GOOD INFORMATION ON THE PLANNED PARENTHOOD WEBSITE: http://www.plannedparenthood.org/bc/030109_OrthoEvra.html HERE IS PART OF WHAT I READ: You should not use the Patch if you smoke cigarettes and are 35 or older,have had a heart attack or certain kinds of stroke,have uncontrolled high blood pressure have controlled high blood pressure and smoke more than 15 cigarettes a day have a history of blood clots or vein inflammation have unexplained bleeding from your vagina have had an abnormal growth or cancer of the breast or uterus have a severe liver disease or have had growths on the liver, have certain vascular conditions associated with diabetes mellitus, are or think you might be pregnant, need prolonged bed rest after major surgery are allergic to the products that make up the Patch experienced jaundice (yellowing of the skin) during a previous pregnancy or use of birth control,have migraine headache with aura, weigh more than 198 pounds
   — CAYA M.

July 2, 2004
I am an OB/GYN Nurse Practitioner. The current weight limit for the patch is 198 lbs. I will give it to patients who weight more than that and explain that the pregnancy risk is increased. (It is double, but still pretty low) and I tell them to use a spermacide as a back up. I like VCF (Viginal Contraceptive Film)and they are available down the condom isle of any drug store. I am using the patch and I love it!
   — Kerijohnson

July 7, 2004
I've been using the patch for over 2 years now and would NEVER go back to pills. It's is soooooooo convenient and the same effectiveness as the pill, probably even more so because with pills, for them to be as effective as they say, you can never miss one or take one too late in the day, etc. With the patch, you just change it every Sunday for 3 weeks, then on the 4th Sunday, take it off and go without during that week (you'll have your period that week) and put a new one back on on Sunday. Piece of cake! Good luck!
   — Lynette B.

July 9, 2004
My body stopped "absorbing" the Loestrin b/c pill I was taking. How do I know this? I was put on b/c pills as a teenager to control my raging hormones. My PMS & migranes & cramps were unbearable, so a very nice ob/gyn put me on the pill. Before my surgery, I had been over 7 years intentionally w/o a period. Then, after my RNY, I started getting a period like every other week. Hell on earth. I was furious. So I went to my ob/gyn & together we determined that the hormones from the b/c pill weren't being absorbed. The solution: the patch. I started on it at about 280#, and guess what? The periods went back to the way they should be. Interesting. The hormones were effective enough to control my cycles, moods, migranes, cramps, etc. all while keeping me from not getting pregnant when I was over their "approved" weight. I'm not a medical person, but you are so close to the weight they would consider "safe". I would go for the patch. If it makes you feel better, use a back-up method until another 5 or 10# come off. Sorry to bore you with my gynecological history. Hope it helps.
   — klinzey




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