Special warnings about Ortho Evra

Hormonal contraceptives, including Ortho Evra, should be used with caution if you are over 40 years old; smoke tobacco; have liver, heart, gallbladder, or kidney disease; have high blood pressure, high cholesterol, diabetes, or epilepsy; or tend to be seriously overweight. Caution is also advised if you have blood circulation problems or have had a heart attack or stroke in the past. Be cautious, too, if you have problems with depression, migraine or other headaches, irregular menstrual periods, or visual disturbances.

There have been conflicting reports on whether using hormonal contraceptives increases the risk of breast cancer. It appears that using hormonal contraceptives may slightly increase the chance of breast cancer, particularly if they're used before age 20. After hormonal contraceptives are stopped, the risk begins to go back down. If you use Ortho Evra, you should examine your breasts monthly and have yearly breast exams by a doctor. Also tell your doctor if you have a family history of breast cancer or if you have had breast nodules, fibrocystic breast disease, or an abnormal mammogram.

You should also be aware that some experts think hormonal contraceptives may increase the risk of cervical cancer. This remains controversial, however. Many doctors think other factors are to blame.

Since the blood's clotting ability may be affected by hormonal contraceptives, your doctor may take you off Ortho Evra prior to surgery or during a period of prolonged bed rest. You should wait at least 4 weeks after having a baby before starting Ortho Evra; and if you're breastfeeding, wait until the child is weaned before starting the drug. If you are recovering from a second trimester miscarriage or abortion, talk to your doctor before using Ortho Evra.

If you develop a migraine or severe headache that does not let up or keeps recurring while you are taking Ortho Evra, check with your doctor. You may need to switch to a different form of birth control.

You should also be aware that hormonal contraceptives have been know to cause rare cases of noncancerous—but dangerous—liver tumors. In people prone to high cholesterol and similar problems, hormonal contraceptives have been known to raise triglyceride levels, leading to pancreatitis.

If you miss a menstrual period but have followed the Ortho Evra regimen correctly, contact your doctor but do not stop using the patches. If you miss a period and have not followed the regimen correctly, or if you miss two consecutive periods, you may be pregnant; stop using the patches and check with your doctor immediately to see if you are pregnant. Use another form of birth control while you're off the patch.

Ortho Evra may be less effective in women who weigh more than 198 pounds; if you fall into this category, ask your doctor which form of birth control is best for you.

Hormonal contraceptives do not protect against HIV infection (AIDS) or any other sexually transmitted disease. If there is a danger of infection, use a latex condom in addition to Ortho Evra.

Be sure to tell the doctor that you are taking Ortho Evra before having lab tests done, since certain blood tests may be affected by hormonal contraceptives.