Twirla

• Risk factors: Over age 35 years old who smoke cigarettes

Smoking while using combined hormonal birth control like Twirla (levonorgestrel / ethinyl estradiol) raises the risk for having a blood clot. Blood clots can sometimes lead to more serious problems, such as heart attack or stroke. This risk gets higher after the age of 35 and with the more cigarettes you smoke. For this reason, you can't use Twirla (levonorgestrel / ethinyl estradiol) if you're over 35 years of age and you smoke. Discuss with your prescriber about other birth control options or resources to quit smoking.

You can't use Twirla (levonorgestrel / ethinyl estradiol) if you have a body mass index (BMI) of 30 kg/m2 or greater. Studies show that this birth control patch might work less well at preventing pregnancy for people with a very high BMI than for those with a lower BMI. In addition, studies found that people with a BMI of 30 kg/m2 or more are at greater risk for blood clots than those with a lower BMI. Speak with your prescriber about alternative options if you have a larger body size.

• Risk factors: Personal or family history of blood clots | Over age 35 and smoke | High blood pressure | Diabetes (high blood sugar) | BMI of 30 kg/m2 or more | Migraine with aura | Not moving for a long period of time, like after surgery or on plane trips

There's a small risk that using combined hormonal birth control like Twirla (levonorgestrel / ethinyl estradiol) can cause blood clots. These clots can block blood from reaching other parts of your body, like your legs, lungs, heart, or brain. Some clots can lead to complications, such as heart attacks or strokes.

Before you start using Twirla (levonorgestrel / ethinyl estradiol), make sure to discuss with your prescriber about whether it's safe for you because there are many factors that raise your risk for blood clots. Let your prescriber know at least a month before a planned surgery so they can discuss when you should stop and restart Twirla (levonorgestrel / ethinyl estradiol) to lower your blood clot risk.

Be aware of the signs and symptoms of a blood clot, heart attack, and stroke.

• Clot in the leg (deep vein thrombosis, DVT): swelling, tenderness, or pain in the leg.
• Clot in the lung (pulmonary embolism, PE): shortness of breath.
• Stroke: sudden weakness on one side of your body, drooping face, bad headaches, trouble breathing, or changes in your speech or vision.
• Heart attack: arm pain, chest pain, or a cold sweat.
• Clot in the eye: double vision, partial or complete blindness, or trouble seeing.

Take off the Twirla (levonorgestrel / ethinyl estradiol) patch (or stop using it) and call 911 right away if you have any symptoms of a blood clot or complications of a blood clot.

• Risk factors: History of liver damage | Liver tumors | Taking certain hepatitis C treatments

Combined hormonal birth control like Twirla (levonorgestrel / ethinyl estradiol) can cause damage to your liver. Talk to your prescriber before you start using Twirla (levonorgestrel / ethinyl estradiol) if you're taking certain hepatitis C medications. You might not be able to use this birth control method because of a higher risk of liver damage when it's used along with certain hepatitis C medications. Although rare, combined hormonal birth control can also raise your risk for liver tumors, especially if you've been taking birth control for a long time.

Let your prescriber know as soon as possible if you notice symptoms of liver problems, like yellowing of your skin or the whites of your eyes, pain in the upper right stomach, or dark urine, while you're using Twirla (levonorgestrel / ethinyl estradiol).

• Risk factors: High blood pressure | Older age | Long-term use

Some people who've used combined hormonal birth control like Twirla (levonorgestrel / ethinyl estradiol) have had higher blood pressure. Let your prescriber know if you have a history of high blood pressure (hypertension). Your prescriber might recommend that you regularly check your blood pressure at home and keep a log of your readings. Tell your prescriber if you notice that your blood pressure is a lot higher than usual. Depending on how high your blood pressure is, you might need to stop using Twirla (levonorgestrel / ethinyl estradiol).

• Risk factors: History of gallbladder condition

Using Twirla (levonorgestrel / ethinyl estradiol) might raise your risk for new or worsening gallbladder problems. Tell your prescriber if you've had gallbladder problems in the past. And contact your prescriber if you have symptoms of gallbladder issues, like dark urine, light-colored stools, itchiness, or yellowing of the skin or eyes, while you're using Twirla (levonorgestrel / ethinyl estradiol).

• Risk factors: Prediabetes or diabetes (high blood sugar)

Twirla (levonorgestrel / ethinyl estradiol) can raise your blood sugar levels, since the medication can affect how well your body processes sugar. Tell your prescriber if you have high blood sugar levels or diabetes. Your prescriber might recommend that you check your blood sugar often to make sure it doesn't get too high. Contact your prescriber if you get very thirsty or hungry or if you urinate more often while you're using Twirla (levonorgestrel / ethinyl estradiol). These might be signs that your blood sugar levels are too high.

• Risk factors: Personal or family history of high triglyceride (fat) levels

Using Twirla (levonorgestrel / ethinyl estradiol) can raise your cholesterol levels, including your triglyceride levels. Having higher triglyceride levels can put you at risk for swelling in the pancreas (pancreatitis). Let your prescriber know if you have high cholesterol levels so they can consider whether Twirla (levonorgestrel / ethinyl estradiol) is safe for you. Contact your care team if you notice pain around your upper stomach, nausea, or vomiting. These can be signs of pancreatic problems.

You might notice changes to your menstrual bleeding patterns after you start using Twirla (levonorgestrel / ethinyl estradiol). It's normal to see some breakthrough bleeding and spotting, especially during the first 3 months of using this medication. Breakthrough bleeding and spotting typically lessens over time. But let your prescriber know if it doesn't eventually get better. Your prescriber might consider discussing changing to a different birth control with you.

It's also possible for you to not have your period at all during the week you aren't wearing a Twirla (levonorgestrel / ethinyl estradiol) patch (the last week in the 4-week cycle). Keep in mind that not having your period can be a sign that you might be pregnant, so consider whether pregnancy is a possibility and take a pregnancy test to check. This is especially important if you might not have followed the exact instructions on when to apply the patch.

• Risk factors: Currently have or have had breast cancer

Based on studies, it's unclear whether there's a link between using combined hormonal birth control and the risk for breast cancer or cervical cancer. But it's possible that combined hormonal birth control like Twirla (levonorgestrel / ethinyl estradiol) can potentially affect the risk of developing these cancers.

Twirla (levonorgestrel / ethinyl estradiol) contains estrogen and progestin hormones. Some cancers, such as breast and cervical cancers, can be hormone-dependent, which means that they can rely on hormones like estrogen to grow. Some studies suggest that there's a slightly higher risk of breast cancer or cervical cancer if you've been taking combined oral contraceptive pills for a longer period of time.

To be safe, don't use Twirla (levonorgestrel / ethinyl estradiol) if you currently have or have had breast cancer. Talk with your prescriber about your birth control options if you're worried about your risk for breast cancer or cervical cancer.