What to Know About Xulane Side Effects

Every medication comes with potential side effects, and Xulane is no exception. The birth control patch is safe and effective for most women, but it's important to know what's normal, what's not, and when you should pick up the phone and call your doctor.

This guide breaks down everything you need to know about Xulane side effects — from the mild, temporary ones to the rare but serious warning signs you shouldn't ignore.

What Is Xulane?

Xulane is a transdermal contraceptive patch that delivers two hormones — Norelgestromin (a progestin) and Ethinyl Estradiol (an estrogen) — through your skin to prevent pregnancy. It's made by Mylan Pharmaceuticals (a Viatris company) and is the generic equivalent of the discontinued Ortho Evra patch.

You wear one patch per week for three weeks, then take one week off. For more details on how the patch works, see our guide on Xulane's mechanism of action.

Common Side Effects

Most side effects from Xulane are mild and tend to improve within the first two to three months of use. According to FDA labeling, the most commonly reported side effects include:

• Application site reactions — Redness, irritation, or itching where you apply the patch. This is the most frequently reported side effect.
• Nausea — Usually mild and most common during the first cycle. Taking the patch off briefly is not recommended; nausea typically resolves on its own.
• Headache — Can range from mild tension headaches to more persistent ones. If headaches become severe or come with visual changes, contact your doctor.
• Breast tenderness or pain — Hormonal changes can cause temporary breast discomfort, especially in early cycles.
• Mood changes — Some women report increased irritability, mood swings, or feeling more emotional. These usually stabilize over time.
• Menstrual cramps — Cramping may occur during the patch-free week when withdrawal bleeding happens.
• Abdominal pain — Mild stomach discomfort is occasionally reported.
• Weight gain — Some women notice a small amount of weight gain, though studies show it's typically modest (a few pounds).
• Skin irritation at the patch site — Rotating the patch location each week can help minimize this.

These side effects affect a meaningful percentage of users but are generally manageable. If any of them persist beyond three months or significantly affect your quality of life, talk to your provider about whether a different contraceptive method might be a better fit.

Serious Side Effects

Xulane carries a boxed warning — the FDA's most serious safety alert — for two reasons:

1. Cigarette smoking and serious cardiovascular events — Smoking while using Xulane significantly increases your risk of blood clots, heart attack, and stroke, especially if you're over 35.
2. Contraindicated in women with BMI ≥ 30 kg/m² — Women with a BMI of 30 or higher face increased risk of venous thromboembolism (VTE) and should not use Xulane.

Other serious side effects, though rare, include:

• Blood clots (venous thromboembolism) — Including deep vein thrombosis (DVT) and pulmonary embolism (PE). The patch may carry a slightly higher clot risk than oral contraceptive pills because it delivers a more constant level of estrogen.
• Stroke — Especially in women with other risk factors like high blood pressure or migraine with aura.
• Heart attack — Risk increases with smoking, age, and other cardiovascular risk factors.
• Liver tumors — Rare, but hepatic adenomas and hepatocellular carcinoma have been associated with hormonal contraceptive use.
• Gallbladder disease — Estrogen can increase the risk of gallstones.
• High blood pressure — Some women develop hypertension while on combined hormonal contraceptives.

When to Call Your Doctor or Go to the ER

Seek immediate medical attention if you experience:

• Sudden severe headache, especially with vision changes or difficulty speaking
• Sharp chest pain or sudden shortness of breath
• Pain, swelling, or warmth in one leg (possible DVT)
• Coughing up blood
• Sudden partial or complete loss of vision
• Yellowing of the skin or eyes (jaundice)
• Severe abdominal pain

These could be signs of a blood clot, stroke, or other serious complication. Don't wait — call 911 or go to the emergency room.

Specific Populations at Higher Risk

Xulane isn't right for everyone. Certain groups face higher risks:

• Women over 35 who smoke — Contraindicated. The combination of smoking, age, and estrogen dramatically increases cardiovascular risk.
• Women with BMI ≥ 30 kg/m² — Contraindicated due to increased VTE risk. Talk to your doctor about alternative contraceptives.
• Women weighing 198 lbs (90 kg) or more — Xulane may be less effective at preventing pregnancy.
• Women with migraine with aura — Increased stroke risk; combined hormonal contraceptives are not recommended.
• Postpartum women — Should not start Xulane until at least 4 weeks after delivery due to elevated clot risk in the postpartum period.
• Breastfeeding women — Xulane is not recommended during breastfeeding as hormones can pass into breast milk.

How to Manage Common Side Effects

If you're experiencing mild side effects, these tips can help:

• For skin irritation: Rotate your patch placement each week between the upper arm, abdomen, buttock, and back. Never apply to the same spot two weeks in a row. Make sure skin is clean and dry — no lotions, oils, or powders.
• For nausea: Apply the patch in the evening so the initial hormone surge happens while you sleep. This often reduces daytime nausea.
• For headaches: Stay hydrated and maintain consistent sleep habits. OTC pain relievers like ibuprofen can help, but avoid excessive acetaminophen (estrogen may decrease its effectiveness).
• For breast tenderness: A supportive bra and reducing caffeine intake may help. This usually resolves after 2–3 cycles.
• For mood changes: Track your moods for a few months. If they don't improve, your provider may suggest a different hormonal method or a lower-dose option like Twirla.

Final Thoughts

Most women who use Xulane tolerate it well. The common side effects — skin irritation, nausea, headaches, breast tenderness — are usually temporary and manageable. The serious risks are rare but real, which is why your doctor screens for risk factors before prescribing.

The most important thing is to know the warning signs. If you experience sudden severe symptoms — chest pain, leg swelling, vision changes, or severe headache — don't hesitate to get emergency care.

For more about what Xulane is and how to use it, or to find a pharmacy with Xulane in stock, visit Medfinder.