What to Know About Twirla (levonorgestrel and ethinyl estradiol)

Transdermal Hormonal Birth Control Patch

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Twirla is a birth control patch that is used to prevent pregnancy. It is a form of combined hormonal contraceptive similar to a combination pill. Unlike a birth control pill, you don't need to think about Twirla every day. Instead, you place a new patch once a week. This may make it easier to use correctly.

The Food and Drug Administration (FDA) first approved Twirla at the end of April 2020. Unlike the other birth control patches that have been or are on the market, it is round, not square. It also contains a different type of progestin.

Contraception, patch
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Twirla is a form of hormonal contraception. It is used to prevent pregnancy. As with other forms of combined hormonal contraception, Twirla works by blocking ovulation. In other words, it stops the ovaries from releasing an egg. Without an egg, it is not possible to get pregnant. Twirla may cause some people to stop having regular periods.

If you miss a period on Twirla, there may be a risk you are pregnant. Talk to your healthcare provider if you miss a period and have any problem using your patch. If you have not had any problems with your patch and miss two periods, talk to your practitioner.

Before Taking

Before starting any new form of hormonal birth control, your healthcare provider should test to see if you are pregnant. Twirla should not be used by people who are pregnant but is not known to cause birth defects. Twirla should also not be used during breastfeeding or before you have surgery.

Talk to your healthcare provider about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case. Certain medications may also make Twirla less effective.

Tell your healthcare provider if you smoke or if you have any history of venous or arterial thromboembolism (blood clot). You may be at increased risk of a serious adverse event if you start using Twirla. Your practitioner may also ask about other chronic health conditions, including those that affect your heart and liver.

Precautions and Contraindications

Twirla is contraindicated in women over 35 who smoke. Cigarette smoking increases the risk of serious cardiovascular events, including stroke.

Twirla is also contraindicated in women with a BMI greater than or equal to 30 kg/m2. They may have an increased risk of venous thromboembolism. The patch may also be less effective.

Other contraindications for using Twirla include:

Other Birth Control Patches

Xulane (norelgestromin and ethinyl estradiol) is also a currently FDA-approved hormonal birth control patch. It has a different form of progesterone than Twirla, and is considered generic. The discontinued Ortho Evra patch had the same hormones as in Xulane.

Twirla Dosage

Twirla contains 30 micrograms (mcg) ethinyl estradiol and 120 mcg levonorgestrel (per day). This is a lower dose than the other birth control patch. Twirla is less effective in people with a BMI of over 25 kg/m2.

How to Take and Store

Each week, at the same time, a new Twirla patch should be applied. The patch can be placed on the abdomen, buttocks, or upper torso. The patch should not be placed on the breasts.

When a new patch is placed, the old one should be removed and discarded. This is done for three weeks. On the fourth week, no patch is used.

Patches should be kept in their sealed packages until use. They should be stored at room temperature. When removed, the patch should be folded sticky-side together and placed in a container for disposal. The patch should not be flushed in the toilet.

Used patches may still contain some hormones. They should be kept away from children.

Side Effects

Side effects of Twirla are similar to other forms of hormonal contraception. The most common side effects of Twirla include:

  • Rash or discomfort at the patch site
  • Nausea
  • Headache
  • Changes in menstrual bleeding
  • Weight gain

Some people may also experience increased depression on Twirla.

Missed periods, and changes in periods, are more common in the first three months of using Twirla. Talk to your healthcare provider if you miss two or more periods.

Serious Side Effects

The severe side effect most associated with the use of hormonal birth control is a blood clot, sometimes called venous thromboembolism (VTE) or deep vein thrombosis. The risk of VTE in patch users is higher than in the general population but lower than the risk of VTE during pregnancy or the postpartum period.

Call a healthcare professional immediately if you have any of the following symptoms, which may indicate a blood clot:

  • Leg pain that will not go away
  • Sudden shortness of breath
  • Sudden changes in eyesight
  • Severe chest pain or pressure
  • Sudden, severe headache different from your usual headaches
  • Weakness or numbness in one arm or leg
  • Difficulty speaking

Other serious side effects that can occur with Twirla include:

  • Liver problems
  • High blood pressure
  • Gallbladder problems
  • Severe headaches
  • Angioedema

Call your healthcare provider right away if you experience yellowing of the skin or eyes. Talk to your practitionre right away if you have a swollen face, mouth, tongue, or throat, as these symptoms could affect breathing.

Warnings and Interactions

Twirla has a boxed warning stating that use is contraindicated in women 35 years or older who smoke. Use is also contraindicated in women with a BMI greater than or equal to 30 kg/m2.

You should stop using Twirla if you experience an arterial or venous thromboembolism (blood clot in the artery or vein). Twirla should be stopped if there are any changes in vision.

Twirla should be temporarily discontinued for people who are going to be immobile for a long period of time, such as after a surgery. Ideally, Twirla should be stopped at least four weeks before and through two weeks after a major surgery.

Twirla should not be used during pregnancy or sooner than four weeks after delivery in people who are not breastfeeding.


There are a number of drugs that may interact with combined hormonal contraceptives and make them less effective. Any drugs that interact with oral contraceptives are likely to similarly interact with a birth control patch.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lopez LM, Grimes DA, Gallo MF, Stockton LL, Schulz KF. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2013;2013(4):CD003552. doi:10.1002/14651858.CD003552.pub4

  2. National Institutes of Health DailyMed. Label: Twirla—levonorgestrel/ethinyl estradiol patch.

  3. MedlinePlus. Estrogen and progestin (transdermal patch contraceptives).

By Elizabeth Boskey, PhD
Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.