Evra plaster 203 + 33.9mkg, No. 3

Contraception in women.

Dosage. To achieve the maximum contraceptive effect, women should use TTS EvraЃ in strict accordance with the directions. Instructions on how to start using TTS EvraЃ are given below in the section УHow to start using TTS EvraЃФ. Only one TTS EvraЃ can be used at a time. Each used TTS EvraЃ is removed and immediately replaced with a new one on the same day of the week ('replacement day'), on the 8th and 15th days of the menstrual cycle (2nd and 3rd weeks). TTS EvraЃ can be changed at any time of the day of replacement. During the 4th week, from the 22nd to the 28th day of the cycle, TTS EvraЃ is not used. A new contraceptive cycle begins the next day after the end of the 4th week; The next TTS EvraЃ should be glued on, even if there was no menstruation or it did not end.

Under no circumstances should the break in wearing TTS EvraЃ exceed 7 days, otherwise the risk of pregnancy increases. In such situations, for 7 days, it is necessary to simultaneously use a barrier method of contraception, because the risk of ovulation increases every day when the recommended duration of the period free from the use of TTS EvraЃ is exceeded. In the case of intercourse during such an extended period, the likelihood of conception is very high.

Mode of application. Locally. TTS EvraЃ should be glued to clean, dry, intact and healthy skin of the buttocks, abdomen, outer surface of the upper shoulder or upper body with minimal hair growth, in areas where it will not come into contact with tight-fitting clothing.

To avoid possible irritation, each subsequent TTS EvraЃ must be glued to a different area of ??the skin, this can be done within the same anatomical area. TTS EvraЃ must be pressed tightly so that its edges are in good contact with the skin. To prevent a decrease in the adhesive properties of TTS EvraЃ, do not apply makeup, creams, lotions, powders and other local remedies to those areas of the skin where it is glued or will be glued. A woman should inspect the TTS EvraЃ every day to be sure that it is firmly attached. Used TTS must be carefully disposed of in accordance with the instructions.

How to start using TTS EvraЃ

If during the previous menstrual cycle a woman did not use a hormonal contraceptive, contraception with TTS EvraЃ begins on the 1st day of menstruation. One TTS EvraЃ is glued to the skin and used all week (7 days). The day of gluing the first TTS EvraЃ (1st day - start day) determines the subsequent days of replacement. The day of replacement will fall on the same day of each week (8th and 15th days of the cycle). On the 22nd day of the cycle, the TTS is removed, and from the 22nd to the 28th day of the cycle, the woman does not use the TTS EvraЃ. The next day is considered the first day of a new contraceptive cycle. If a woman starts using TTS EvraЃ not from the first day of the cycle, then barrier methods of contraception should be used simultaneously during the first 7 days of the first contraceptive cycle.

If a woman switches from using a combined oral contraceptive to using TTS EvraЃ, it should be glued to the skin on the first day of menstruation that began after stopping the combined oral contraceptive. If menstruation does not start within 5 days after taking the contraceptive pill, then pregnancy must be excluded before using TTS EvraЃ. If the use of TTS EvraЃ begins later than the first day of menstruation, then within 7 days it is necessary to simultaneously use barrier methods of contraception. If more than 7 days have passed since taking the last contraceptive pill, the woman may ovulate, and therefore she should consult a doctor before using TTS EvraЃ. Sexual intercourse during this extended period,free from taking the contraceptive pill can lead to pregnancy.

If a woman switches from using drugs containing only a progestogen (on the day of removal of the implant, on the day when the next injection should be made) to using TTS EvraЃ, then during the first 7 days of using TTS EvraЃ, a barrier method should be used to enhance contraceptive effect.

After an abortion or miscarriage. After an abortion or miscarriage before the 20th week of pregnancy, you can immediately start using TTS EvraЃ. If a woman starts using TTS EvraЃ immediately after an abortion or miscarriage, it is not required to resort to an additional method of contraception. A woman should be aware that ovulation can occur within 10 days after an abortion or miscarriage. After an abortion or miscarriage in the 20th week of pregnancy or later, the use of TTS EvraЃ can be started on the 21st day after an abortion or miscarriage, or on the first day of the first menstrual period.

After childbirth. Women who are not breastfeeding should start using TTS EvraЃ no earlier than 4 weeks after delivery. If a woman starts using TTS EvraЃ later, then during the first 7 days she must additionally use a barrier method of contraception. If intercourse has taken place, then pregnancy must be excluded before starting to use TTS EvraЃ, or the woman must wait for the first menstruation.

With the complete or partial peeling off of TTS EvraЃ, an insufficient amount of its active ingredients enters the bloodstream.

Even with partial peeling off of TTS EvraЃ:

- in less than a day (up to 24 hours): re-stick the TTS EvraЃ in the same place or immediately replace it with a new TTS EvraЃ. Additional contraceptives are not required. The next TTS EvraЃ must be glued on the usual 'replacement day';

- for more than a day (24 hours and longer), as well as if the woman does not know exactly when TTS EvraЃ has partially or completely peeled off: pregnancy is possible. A woman should immediately start a new cycle by gluing a new TTS EvraЃ and consider this day as the first day of the contraceptive cycle. Barrier methods of contraception should be used simultaneously only in the first 7 days of a new cycle.

You should not try to re-glue TTS EvraЃ if it has lost its adhesive properties; instead, the new TTS EvraЃ must be glued on immediately. Do not use additional adhesive tapes or bandages to hold the TTS EvraЃ in place.

If the next days of TTS EvraЃ replacement are missed:

At the beginning of any contraceptive cycle (1st week / 1st day):

- with an increased risk of pregnancy, a woman should stick the first TTS EvraЃ of a new cycle as soon as she remembers about it. This day is considered a new '1st day' and a new 'replacement day' is counted. Non-hormonal contraception should be used simultaneously during the first 7 days of a new cycle. In the case of intercourse during such an extended period without the use of TTS EvraЃ, conception may occur.

In the middle of the cycle (2nd week / 8th day or 3rd week / 15th day):

- one or two days have passed from the day of replacement (up to 48 hours): the woman should immediately glue the new TTS EvraЃ. The next TTS EvraЃ must be glued on the usual 'replacement day'. If during the 7 days preceding the first missed day of TTS EvraЃ attachment, a woman correctly used TTS EvraЃ, then additional contraception is not required;

- more than two days have passed since the day of replacement (48 hours or more): there is an increased risk of pregnancy. The woman should stop the current contraceptive cycle and immediately start a new 4-week cycle by gluing a new TTS EvraЃ. This day is considered a new '1st day' and a new 'replacement day' is counted. Barrier contraception should be used simultaneously during the first 7 days of a new cycle;

- at the end of the cycle (4th week / 22nd day): if TTS EvraЃ is not removed at the beginning of the 4th week (22nd day), then it must be removed as soon as possible. The next contraceptive cycle should begin on the usual 'replacement day', which is the day after the 28th day. Additional contraception is not required.

Change of 'replacement day'. In order to postpone menstruation by one cycle, a woman should stick a new TTS EvraЃ at the beginning of the 4th week (22nd day), thereby skipping the period free from the use of TTS EvraЃ. Intermenstrual bleeding or spotting may occur. After 6 consecutive weeks of using TTS EvraЃ, there should be a 7-day interval free from using TTS EvraЃ. After the end of this interval, the regular use of the drug is resumed.

If on the day appointed for this (during the week free from use) a woman wants to change the 'replacement day', she must complete the current cycle by removing the third TTC EvraЃ. A woman can choose a new 'replacement day' by sticking the first TTC EvraЃ of the next cycle on the selected day. The period free from the use of TTS EvraЃ should in no case be more than 7 days. The shorter this period, the higher the likelihood that a woman will not have another period, and during the next contraceptive cycle, intermenstrual bleeding or spotting may occur.

hypersensitivity to drug components;

venous thrombosis, incl. history, including deep vein thrombosis, pulmonary thromboembolism;

arterial thrombosis, incl. a history of, including acute cerebrovascular accident, myocardial infarction, retinal artery thrombosis, or precursors of thrombosis (including angina pectoris or transient ischemic attack);

the presence of serious or multiple risk factors for arterial thrombosis (severe arterial hypertension - blood pressure more than 160/100 mm Hg; diabetes mellitus with vascular lesions; hereditary dyslipoproteinemia);

hereditary predisposition to venous or arterial thrombosis, for example, activated protein C resistance, antithrombin-III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia, and the presence of antiphospholipid antibodies (anti-cardiolipin antibodies, lupus anticoagulant);

migraine with aura;

confirmed or suspected breast cancer;

endometrial cancer and confirmed or suspected estrogen-dependent tumors;

adenoma and carcinoma of the liver;

genital bleeding;

postmenopausal period;

age under 18;

postpartum period (4 weeks);

lactation period;

it is unacceptable to use on the area of ??the mammary glands, as well as on hyperemic, irritated or damaged skin areas.

Carefully:

venous or arterial thromboembolism in siblings or parents at a relatively young age;

prolonged immobilization;

obesity (body mass index over 30 kg / m2, calculated as the ratio of body weight in kilograms to the square of height in meters);

thrombophlebitis of superficial veins and varicose veins;

dyslipoproteinemia;

arterial hypertension;

lesions of the valvular apparatus of the heart;

atrial fibrillation;

diabetes;

systemic lupus erythematosus;

hemolytic uremic syndrome;

Crohn's disease;

ulcerative colitis;

liver dysfunction;

hypertriglyceridemia, incl. family history;

acute liver dysfunction during a previous pregnancy or previous use of sex hormones;

menstrual irregularities;

impaired renal function.