Birth Control Patches: 6 Things to Know About Xulane and Twirla

There are many forms of contraception (birth control) to choose from. And there are many things to consider when choosing. Effectiveness, side effects, and ease of use are all important parts of this personal decision.

One form to consider is a birth control patch. Two examples are Xulane (norelgestromin / ethinyl estradiol) and Twirla (levonorgestrel / ethinyl estradiol). They follow the same dosage schedule. And both contain an estrogen and a progestin (a lab-made version of progesterone).

When choosing between Xulane and Twirla, there are a few differences to consider. These include the blend of hormones they contain and the patches’ appearance. Below, you’ll find six similarities and differences to know about Xulane and Twirla.

1. Xulane and Twirla have different active ingredients

Xulane and Twirla are combination hormonal birth control patches. This means they contain an estrogen and a progestin. But their specific active ingredients vary.

Xulane releases 150 mcg of norelgestromin (a progestin) and 35 mcg of ethinyl estradiol (an estrogen) per day. Xulane is a branded generic of Ortho Evra, the original birth control patch. Ortho Evra has since been discontinued. Your prescription label may also read Zafemy or norelgestromin / ethinyl estradiol, other generic versions of the same patch.

Twirla releases 120 mcg of levonorgestrel (a progestin) and 30 mcg of ethinyl estradiol per day. Twirla is a brand-name medication, with no generic version available.

Xulane and Twirla are not interchangeable.

Good to know: The makers of Xulane are studying a lower-estrogen version of the patch (called Xulane Lo). This patch releases 150 mcg norelgestromin and 17.5 mcg ethinyl estradiol per day. The company plans to submit Xulane Lo for FDA review before the end of 2025. We may see this patch approved and released in 2026.

2. Xulane and Twirla work in the same way to prevent pregnancy

Xulane and Twirla work in a few ways to prevent pregnancy:

• By preventing ovulation (the release of an egg) — this is the primary way they work

• By thickening cervical mucus and making it harder for sperm to reach an egg

• By thinning the lining of the uterus and making it less likely for a fertilized egg to implant

EXPERT PICKS: WHAT TO READ NEXT

• Other options: Birth control patches are one alternative to contraceptive pills. Read about other birth control options that aren’t the pill.

• Can you get birth control without seeing a doctor? Maybe. Find out which states allow pharmacists to prescribe birth control.

• How to save: Xulane (norelgestromin / ethinyl estradiol) shouldn’t have to break the bank. Find out how much this birth control patch costs and ways you can save.

With perfect use, Xulane and Twirla are about 99% effective. But people aren’t perfect. They may forget to replace the patch on time. Or the patch could fall off. So with typical use, birth control patches are closer to 93% effective.

As with most birth control methods, the better you follow a schedule, the more effective it is. Xulane and Twirla work best if you stick to a consistent day and time to change your patch. Check the patch each day to make sure it’s still securely attached.

Xulane and Twirla may also be less effective for women with larger bodies. In Xulane’s clinical studies, it was less effective in women with a body weight of 198 lbs or more. In Twirla’s clinical studies, it was less effective for women with a body mass index (BMI) of 25 kg/m2 or greater.

3. Xulane and Twirla have different shapes and sizes

Xulane and Twirla have distinct appearances. The places you can apply them are also slightly different.

Xulane comes as a 2.2 in2 (14 cm2) square patch in a peach color. It’s slightly larger than the size of a U.S. quarter. You can place it on your abdomen (stomach), buttocks, or the upper outer arm. You can also apply it to your upper back, as long as it won’t be rubbed by straps or tight clothes. Don’t apply Xulane on your breasts.

Twirla is a larger patch. It’s a circle-shaped patch covering about 4.4 in2 (28 cm2) in a beige color. It can be placed on your abdomen, buttocks, or upper back. Avoid applying Twirla underneath clothing straps or waistlines. Don’t apply Twirla to your breasts.

4. The dosage schedules for Xulane and Twirla are similar

Xulane and Twirla are applied and removed in 4-week cycles. For Weeks 1 to 3, apply one patch to your body once a week. The day of the week you apply your patch should be the same each week.

Make sure to take off the old patch before applying a new one. It’s a good idea to change the spot where you apply the patch. This can help prevent skin irritation from the adhesive on the patch.

On Week 4 of the cycle, don’t apply a new patch. You’ll get your period during this off week. Some women will skip their periods by applying a new patch every week (not having an off week). This is considered an off-label use of Xulane and Twirla. So ask your prescriber before applying the patch this way.

5. Xulane and Twirla have similar side effects

Xulane and Twirla have similar side effects. Many of these side effects are common with all combination hormonal birth control methods. These include:

• Irritation where the patch was applied

• Nausea

• Headache

• Menstrual cramps

• Sore or tender breasts

• Breakthrough bleeding or spotting, especially during the first 3 to 6 months of use

• Changes to your period

These side effects are generally mild and should improve the longer you use either patch. If they seem excessive or persistent, tell your prescriber.

What are the serious side effects of Xulane and Twirla?

Xulane and Twirla have a few serious side effects to know about. These issues can happen with all birth control methods that include both an estrogen and progestin. Discuss your risks for these side effects with your prescriber before starting either patch.

Serious side effects of Xulane and Twirla include:

• Blood clots, especially if you have risk factors such as smoking, high blood pressure, or high cholesterol

• Liver disease, especially if you have a history of liver issues

• Higher blood pressure

• Increased risk of breast cancer

• Increased risk of cervical cancer

Good to know: It’s not recommended to use Xulane or Twirla if you’re considered obese. There’s a higher risk of blood clots with birth control patches if you have a BMI of 30 or more.

6. Xulane and Twirla have similar drug interactions

Even though they deliver medication through the skin, Xulane and Twirla have drug interactions just like oral medications. This isn’t a complete list, but it includes some of the most notable.

Be sure to share a medication list with your prescriber and pharmacist so they can screen for possible interactions.

Xulane and Twirla interactions to know about include:

• Carbamazepine (Tegretol)

• Phenytoin (Dilantin, Phenytek)

• Certain antiviral medications, such as ritonavir (Norvir) and Paxlovid (nirmatrelvir / ritonavir)

• Certain antibiotics, such as rifampin (Rifadin)

If you’re taking one of these medications, you should use a backup method of protection, such as condoms. You can also discuss other contraception options with your prescriber.

How to save on Xulane and Twirla

There are ways to save on Xulane and Twirla. Xulane is available as a lower-cost generic. Twirla comes as a brand-name medication. GoodRx can help you navigate the ways to save on your prescription.

• Save with GoodRx. GoodRx can help you save over 60% off the average retail price of Xulane. Xulane’s price at certain pharmacies is as low as $46.97 for a 1-month supply with a free GoodRx discount.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Twirla’s price may be as little as $25 per prescription using a savings card from the manufacturer.

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Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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