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Ortho-Evra and Delayed Patch Change: Understanding Pregnancy Risk


Question
I am 30 years old, I have a 5 1/2 year old, and I had a miscarraige in 2002 at 10 weeks.  I am on Ortho-Evra, and have never forgotten to change a patch.  I started my period July 11th.  My patch change day was Sunday, July 17th.  I completely forgot to start my new patch cycle.  My husband and I had intercourse Sunday night, which would have been late on the patch change day.  I always change them around 7 am.  I remembered Monday morning and placed it on at 7:30.  The literature says to use other form of birth control for 7 days and change my patch change day.  I am not sure, but I think I have some pregnancy symptoms.  My previous two pregnancies were apparant almost immediately after conception with sore and tender breasts.  My breasts started being uncomfortable last night, and have not stopped. I am also very tired. I was also terribly sick Monday night, vomiting and nausea, but I thought I had a virus. If I am pregnant isn't it a little early to tell?  Could my breast tenderness, and fatigue be in my head?  I know that it is possible for me to be pregnant.  Should I remove the patch or is it alright to leave on until I know for sure?  Does it sound like I am pregnant, or just crazy?  thank you

Answer
Do not remove the patch. Even if you are pregnant, there is no danger in keeping the patch on (or continuing birth control pills) until the start of the second trimester of pregnancy. I doubt that you have become pregnant. If your last period started on July 11, then the EARLIEST that you could have ovulated (if you were not on birth control) would be July 24. You could only become pregnant if you had sex on July 23,24,25, or 26. You really did not miss changing the patch, but were a bit late. Certainly, if you do not get your period around August 7, then take  a pregnancy test. (A pregnancy test will not show a positive result until 14-21 days after conception). I don't think you are crazy, but I doubt that you are pregnant.