Xulane vs. Twirla for Birth Control: How Do They Compare?
Key takeaways:
Xulane (norelgestromin/ethinyl estradiol) and Twirla (levonorgestrel/ethinyl estradiol) are both birth control patches. They have many similarities, including how they’re applied and how they work to prevent pregnancy.
Xulane and Twirla have some unique features. There are differences between the blend of hormones in each patch. This can mean different side effects. The patches are different sizes and shapes as well.
There are many ways to save on Xulane and Twirla. If you’re eligible, manufacturer savings cards can help make your prescription more affordable. Patient assistance programs are also available.
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Table of contents
There are many forms of birth control (contraception) 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.
If you’re weighing your options, one form to consider are birth control patches. Birth control patches include Xulane (norelgestromin/ethinyl estradiol) and Twirla (levonorgestrel/ethinyl estradiol). They follow the same dosing schedule. And both contain an estrogen and a progestin (a form of progesterone).
When choosing between Xulane and Twirla, there are a few differences to consider. These include what hormones they contain, their possible side effects, and their effectiveness.
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Let’s dive in and find out more.
What is Xulane?
Xulane contains 150 mcg of norelgestromin (a progestin) and 35 mcg of ethinyl estradiol (an estrogen). Xulane is a branded generic of Ortho Evra, the original birth control patch. Ortho Evra has since been discontinued. You may also see Zafemy, another generic version of the same patch.
Xulane comes as a 14 cm2 (about 2.2 in2) square patch in a peach color. It can be placed on your abdomen, buttocks, or the upper outer arm. It can also be placed on your upper back, as long as it won’t be rubbed by straps or tight clothes. Don’t apply Xulane on your breasts.
What is Twirla?
Twirla contains 120 mcg of levonorgestrel (a progestin) and 30 mcg of ethinyl estradiol. Twirla is a brand-name medication, with no generic version available yet. It’s not interchangeable with Xulane.
Twirla is a larger patch. It’s a circle-shaped patch covering 28 cm2 (about 4.4 in2) in a beige color. It can be placed on your abdomen, buttocks, or upper torso (trunk). But, don’t apply Twirla to your breasts.
How do Xulane and Twirla prevent pregnancy?
Xulane and Twirla both contain an estrogen and a progestin. They 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
How are Xulane and Twirla dosed?
Both Xulane and Twirla are applied and removed in 4-week cycles. On weeks 1 through 3, apply 1 patch to your body once a week. The day of the week you apply your patch should be the same each week.
Also, 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 healthcare provider first before applying the patch this way.
How effective are Xulane and Twirla for birth control?
With perfect use, both 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 all birth control, the better you follow a schedule, the more effective it is. Xulane and Twirla will 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.
Both Xulane and Twirla may 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 30 kg/m2 or greater.
What are the known side effects of Xulane and Twirla?
Some side effects are similar between Xulane and Twirla. Others are more common with Xulane. This may be due to the higher dose of estrogen and the different type of progestin in Xulane.
Below is a table comparing side effects for each, along with how many people experienced them in clinical trials.
| Side effect | Xulane | Twirla |
|---|---|---|
| Application site side effects* | 17% | 6% |
| Nausea | 17% | 4% |
| Headache | 17% | 4% |
| Menstrual cramps | 8% | 2% |
| Breakthrough bleeding or spotting | 8%-18% (less common the longer women used Xulane) | 42%-60% (less common the longer women used Twirla) |
| Mood swings and/or anxiety | 6% | Not reported |
| Breast pain or swelling | 22% | Not reported |
| Acne | 3% | Not reported |
| Vaginal yeast infection | 4% | Not reported |
| Weight Gain | 3% | 2% |
| *Application site side effects can include itching, dryness, and pain or swelling where the patch was applied. can include itching, dryness, and pain or swelling where the patch was applied. | ||
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 unique risks for these side effects with your healthcare provider before starting either patch.
Serious side effects of Xulane and Twirla include:
Blood clots, especially if you’re 35 years of age or older and smoke
Liver disease, especially if you have a history of liver issues
Higher blood pressure
Breast cancer
Cervical cancer
What interactions do Xulane and Twirla have?
Even though they deliver medication through the skin, Xulane and Twirla have some 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 healthcare provider and pharmacist so they can screen for any possible interactions.
Xulane interactions and Twirla interactions to know about include:
Carbamazepine (Tegretol)
Phenytoin (Dilantin, Phenytek)
Topiramate (Topamax)
Certain HIV medications
Certain antibiotics, like rifampin (Rifadin)
If you’re taking one of these medications, you should use a back-up method of protection, like condoms. You can also discuss other contraception options with your healthcare provider.
How to save on Xulane and Twirla
There are many 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 many ways to save on your prescription.
Save with GoodRx. GoodRx can help you save over 70% off the average retail price of Xulane. Xulane’s price at certain pharmacies is as low as $46.97 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 $0 for your first fill using a savings card from the manufacturer. Each refill may cost as low as $25 with the same savings card.
The bottom line
Xulane and Twirla are both weekly birth control patches containing a progestin and an estrogen. They both work in the same ways to prevent pregnancy. But there are differences between them. These include differences in size, effectiveness, and side effects.
Talk to your healthcare provider about which birth control patch is right for you. GoodRx can help you save regardless of which you choose.
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References
Agile Therapeutics, Inc. (2022). Twirla [package insert].
American College of Obstetricians and Gynecologists. (n.d.). Combined hormonal birth control: Pill, patch, and ring.
Amneal Pharmaceuticals LLC. (2021). Zafemy [package insert].
Latwal, B., et al. (2020). Authorized generics vs. branded generics: A perspective. Journal of Generic Medicines.
Mylan Pharmaceuticals Inc. (2022). Xulane [package insert].
Planned Parenthood. (n.d.). How do I use the birth control patch?
Planned Parenthood. (n.d.). How effective is the birth control patch?
Planned Parenthood. (n.d.). What are the side effects of the birth control patch?
U.S. Food and Drug Association. (n.d.). FDA-approved drugs.
