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Twirla

levonorgestrel / ethinyl estradiol
Used for Birth Control
Used for Birth Control

Twirla (levonorgestrel / ethinyl estradiol) is a once-weekly birth control patch. It's a combination hormonal contraceptive that contains an estrogen and progestin. Twirla (levonorgestrel / ethinyl estradiol) is used to help prevent pregnancy in people with a body mass index (BMI) of less than 30 kg/m2. A new patch is placed on the skin every week for 3 weeks, followed by a patch-free week, and then the cycle is repeated. Side effects can include skin irritation where the patch is placed and nausea.

Reviewed by:
reviewer
Cydnee Ng, PharmD
reviewer
Kristianne Hannemann, PharmD
Last reviewed on June 23, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostContraindicationsAlternativesLatest newsReferencesPricesMedicare
basics-icon

What is Twirla (levonorgestrel / ethinyl estradiol)?

What is Twirla (levonorgestrel / ethinyl estradiol) used for?

  • Prevention of pregnancy

How Twirla (levonorgestrel / ethinyl estradiol) works

Twirla (levonorgestrel / ethinyl estradiol) contains a combination of two hormones: levonorgestrel (a progestin) and ethinyl estradiol (an estrogen). These hormones work together to prevent pregnancy by:

  • Stopping your ovaries from releasing an egg (also known as ovulation)

  • Making it harder for sperm to move through to fertilize an egg

  • Making it harder for a fertilized egg to attach to the uterus and grow

Are you looking for information on Vienva (levonorgestrel / ethinyl estradiol) tablets or Xulane (norelgestromin / ethinyl estradiol) patch instead?

Drug Facts

Common BrandsTwirla
Drug ClassProgestin / Estrogen combined contraceptive
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

More on Twirla (levonorgestrel / ethinyl estradiol) essentials

Birth control: sticking patch on arm 1485963341

Xulane vs. Twirla for Birth Control: How Do They Compare?

Written by Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP
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$249.44(save 15.41%)
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What are the side effects of Twirla (levonorgestrel / ethinyl estradiol)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Application site reactions (e.g., rash, skin color changes, irritation, itching; 6%)
  • Nausea (4%)
  • Headache (4%)
  • Pain with your menstrual period (2%)
  • Weight gain (2%)

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Blood clot in arm or leg: swelling, pain, or tenderness in the arm or leg; skin that's warm to the touch
  • Blood clot in the lung: trouble breathing
  • Heart attack: chest pain, arm pain, shortness of breath, cold sweat, lightheadedness
  • Stroke: sudden weakness on one side of the body, drooping face, changes in your speech or vision, confusion, bad headache
  • Liver or gallbladder problems: yellowing of skin or eyes, pain in the right upper stomach, dark urine, light-colored stool, nausea, vomiting
  • Depression: feeling sad, anxious, or hopeless

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
  • Gallbladder problems—severe stomach pain, nausea, vomiting, fever
  • Increase in blood pressure
  • Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
  • New or worsening migraines or headaches
  • Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
  • Unusual vaginal discharge, itching, or odor
  • Worsening mood, feelings of depression

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

  • Breast pain or tenderness
  • Dark patches of skin on the face or other sun-exposed areas
  • Irregular menstrual cycles or spotting
  • Irritation at application site
  • Nausea
  • Weight gain
pros-and-cons

Pros and cons of Twirla (levonorgestrel / ethinyl estradiol)

thumbs-up

Pros

When used correctly, 95% effective at preventing pregnancy

A patch that's placed on the skin; an alternative to the birth control pill

Applied once a week

thumbs-down

Cons

Can't use if you have a BMI of 30 kg/m2 or more because of risk for blood clots

Might fall off if you get the patch wet for too long (more than 30 minutes) or if you use too much body lotion or oil

No lower-cost generic available; brand-name medication only

pharmacist-tips

Pharmacist tips for Twirla (levonorgestrel / ethinyl estradiol)

pharmacist

  • It's important to follow the directions to make sure you apply Twirla (levonorgestrel / ethinyl estradiol) properly. Ask your prescriber or pharmacist if you have any questions about how to use the patch.

    • Apply the Twirla (levonorgestrel / ethinyl estradiol) patch to the upper body (e.g., upper back), lower stomach, or buttock. Avoid placing the patch on your breasts, in places where tight clothing can rub against the patch, or in the same spot as your last patch. Don't cut or tear the patch.

      • The Twirla (levonorgestrel / ethinyl estradiol) patch should stick to your skin completely for the whole week. Replace it with a new patch each week, on the same day of the week, for 3 weeks in a row. Then, take a week-long break before you start the cycle over again. Set reminders on your calendar to help you remember when to apply and take off each patch.

        • Your skin might be irritated where you placed the Twirla (levonorgestrel / ethinyl estradiol) patch. If the skin irritation becomes too bothersome, you can take off the patch and apply a new one to a different spot until the day that you typically replace your patch.

          • You can get your Twirla (levonorgestrel / ethinyl estradiol) patch wet, but not for too long (at most 30 minutes at a time). Also avoid using too much body lotions or oils where your patch is. Both of these things might make the patch stick less well to your skin and possibly fall off, which can make the medication work less well. Check that your Twirla (levonorgestrel / ethinyl estradiol) patch is attached to your skin every day and after you get out of the water.

            • Talk to your prescriber if you forget to apply or change your Twirla (levonorgestrel / ethinyl estradiol) patch or if your patch comes off your skin. In these situations, you might need to use a back-up, non-hormonal birth control method (e.g., condom) in addition to using Twirla (levonorgestrel / ethinyl estradiol). Your prescriber can let you know whether you need a back-up method and for how long.

              • You might notice some spotting or light vaginal bleeding while you have the Twirla (levonorgestrel / ethinyl estradiol) patch on. Spotting is more likely to happen during the first 3 months of using the patch, but it typically lessens over time. Let your prescriber know if spotting doesn't get better as you continue using the patch. You can consider switching to a different birth control to see if that helps.

                • Wear sunscreen and avoid tanning beds to protect your skin while you're using Twirla (levonorgestrel / ethinyl estradiol). This medication can cause areas of your skin on your face to darken. Exposure to ultraviolet (UV) rays can make these patches of skin even darker.

                  • Twirla (levonorgestrel / ethinyl estradiol) doesn't protect you against HIV (human immunodeficiency virus) or other sexually transmitted infections (STIs). Remember to use a condom during sex to lower your risk of getting HIV and other STIs.

                    • Don't use Twirla (levonorgestrel / ethinyl estradiol) during pregnancy. Stop using the patches if you become pregnant while you're using this medication. You won't need birth control at that point.

                      faqs

                      Frequently asked questions about Twirla (levonorgestrel / ethinyl estradiol)

                      Where can you put the Twirla (levonorgestrel / ethinyl estradiol) birth control patch?
                      You can put the Twirla (levonorgestrel / ethinyl estradiol) patch onto the upper body (e.g., upper back), lower stomach, or buttock. Don't apply the patch onto your breasts, onto areas of skin where tight clothing can rub against the patch, or in the same place as your last patch. Be sure to only wear one Twirla (levonorgestrel / ethinyl estradiol) patch at any given time.
                      Can I put tape over my Twirla (levonorgestrel / ethinyl estradiol) birth control patch?
                      No. Don't put tape over the Twirla (levonorgestrel / ethinyl estradiol) patch if the edge starts to lift up from the skin. First, try pressing down on the patch with your palm for 10 seconds to see whether you can get the whole patch to stick to your skin better. Be sure to smooth out any wrinkles that you can feel around the edges of the patch. But if the edge of your Twirla (levonorgestrel / ethinyl estradiol) patch is still lifting up even after you try to stick it back onto the skin, take off your current patch and replace it with a new one.
                      Does the Twirla (levonorgestrel / ethinyl estradiol) birth control patch make you gain weight?
                      In clinical studies, about 2% of people who used Twirla (levonorgestrel / ethinyl estradiol) reported weight gain. Twirla (levonorgestrel / ethinyl estradiol) contains estrogen and progestin hormones, which can cause your body hold onto more water. This means that reported weight gain might not be from more body fat, but rather from water weight. Most times, this water weight goes away with time. Tell your prescriber if you've gained a concerning amount of weight after you start Twirla (levonorgestrel / ethinyl estradiol).
                      Does the Twirla (levonorgestrel / ethinyl estradiol) birth control patch stop your period?
                      Typically, people who use Twirla (levonorgestrel / ethinyl estradiol) will have their menstrual period during the patch-free week (the last week in the 4-week cycle). But some people might not have a period at all during this patch-free week. Keep in mind that not having your period can be a sign that you might be pregnant, especially if you might not have followed the exact instructions on when to have the Twirla (levonorgestrel / ethinyl estradiol) patch on. Consider whether pregnancy is a possibility and take a pregnancy test to check if you don't have your period during the patch-free week.
                      How long does the Twirla (levonorgestrel / ethinyl estradiol) patch take to work?
                      The Twirla (levonorgestrel / ethinyl estradiol) patch typically starts to work to prevent pregnancy when you start using it, though it might take 7 days for the patch to fully work. For this reason, you might need to use a non-hormonal birth control method, like condoms, as back-up in addition to Twirla (levonorgestrel / ethinyl estradiol) for 7 days in certain situations where you might not have applied the patch on time. For example, you should apply your first Twirla (levonorgestrel / ethinyl estradiol) patch during the first 24 hours of your menstrual period if it's your first time starting hormonal birth control. But you'll need to use a non-hormonal back-up birth control method for 7 days if you apply your first patch anytime after the first 24 hours of your period as you wait for the patch to be fully effective.
                      When should you start the Twirla (levonorgestrel / ethinyl estradiol) birth control patch?
                      When you should start Twirla (levonorgestrel / ethinyl estradiol) can be different depending on the situation you're in. For example, you should apply your first Twirla (levonorgestrel / ethinyl estradiol) patch during the first 24 hours of a menstrual period if you've never used hormonal birth control before. And if you're switching between birth control methods, when you apply your first Twirla (levonorgestrel / ethinyl estradiol) patch will depend on the specific form of birth control that you're switching from. It'll also differ if you're starting Twirla (levonorgestrel / ethinyl estradiol) after you have a baby, an abortion, or a miscarriage. Speak with your prescriber for specific instructions on when you should apply your first Twirla (levonorgestrel / ethinyl estradiol) patch.
                      How effective is the Twirla (levonorgestrel / ethinyl estradiol) patch?
                      In clinical studies, Twirla (levonorgestrel / ethinyl estradiol) was 95% effective at preventing pregnancy in people between the ages of 18 and 35 when the patch was used correctly. Keep in mind that the Twirla (levonorgestrel / ethinyl estradiol) patch might not work as well if you don't apply the patch on time or if you don't apply the patch properly. And it might not work as well if you have a body mass index (BMI) of 25 kg/m2 or more. To compare, combination hormonal birth control pills are generally 91% effective with typical use, and implants and intrauterine devices (devices placed in your uterus, also called IUDs) are over 99% effective.
                      What's the difference between Twirla and Xulane?
                      Twirla (levonorgestrel / ethinyl estradiol) and Xulane (norelgestromin / ethinyl estradiol) are both once-weekly birth control patches. Both medications contain the same type of estrogen (ethinyl estradiol), but they have different progestins in them (Twirla contains levonorgestrel, and Xulane contains norelgestromin). Twirla has lower amounts of both estrogen and progestin hormones than Xulane. In addition, the Twirla patch is slightly bigger in size than Xulane. Both patches are over 90% effective, so they work well at preventing pregnancy. Speak with your prescriber to help you compare between Twirla and Xulane.
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                      What are the risks and warnings for Twirla (levonorgestrel / ethinyl estradiol)?

                      Twirla (levonorgestrel / ethinyl estradiol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                      risk-warning

                      Cigarette smoking and risk for blood clots

                      • 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.

                        risk-warning

                        Can't use if you have a BMI of 30 kg/m2 or greater

                        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-warning

                        Blood clots and other complications

                        • 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-warning

                                    Liver problems

                                    • 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-warning

                                      High blood pressure

                                      • 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-warning

                                        Gallbladder problems

                                        • 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-warning

                                          High blood sugar

                                          • 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-warning

                                            High cholesterol levels

                                            • 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.

                                              risk-warning

                                              Changes to your menstrual bleeding (period) patterns

                                              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-warning

                                              Breast cancer or cervical cancer

                                              • 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.

                                                dosage

                                                Twirla (levonorgestrel / ethinyl estradiol) dosage forms

                                                The average cost for 1 carton of 3 patches of 120mcg/30mcg of Twirla (levonorgestrel / ethinyl estradiol) is $211.01 with a free GoodRx coupon. This is 15.41% off the average retail price of $249.44.
                                                carton
                                                Carton
                                                DosageQuantityPrice as low asPrice per unit
                                                3 patches of 120mcg/30mcg1 carton$211.01$211.01

                                                Typical dosing for Twirla (levonorgestrel / ethinyl estradiol)

                                                • Weeks 1 to 3: Apply 1 patch to your skin once a week on the same day of the week. Be sure to take off your current patch before you apply a new one. The patch releases 120 mcg of levonorgestrel and 30 mcg of ethinyl estradiol each day.

                                                • Week 4: Don’t apply any patches this week.

                                                Each cycle lasts 4 weeks. Continue to repeat the cycle to prevent pregnancy.

                                                drug-cost

                                                How much does Twirla (levonorgestrel / ethinyl estradiol) cost?

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                                                Twirla (brand)
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                                                contraindications-icon

                                                Twirla (levonorgestrel / ethinyl estradiol) contraindications

                                                Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Twirla (levonorgestrel / ethinyl estradiol) will not be safe for you to take.
                                                alternatives

                                                What are alternatives to Twirla (levonorgestrel / ethinyl estradiol)?

                                                There are a number of medications that your doctor can prescribe in place of Twirla (levonorgestrel / ethinyl estradiol). Compare a few possible alternatives below.
                                                Twirla (levonorgestrel / ethinyl estradiol)
                                                Used for:

                                                • Prevention of pregnancy

                                                $211.01 Lowest GoodRx priceView Prices
                                                Xulane (norelgestromin / ethinyl estradiol)
                                                Used for:
                                                $46.97 Lowest GoodRx priceView Prices

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                                                References

                                                Best studies we found

                                                Agile Therapeutics, Inc. (2024). Twirla- levonorgestrel/ethinyl estradiol patch [package insert]. DailyMed.

                                                American Cancer Society. (2023). What is cervical cancer?

                                                American College of Obstetricians and Gynecologists. (2023). Abnormal uterine bleeding.

                                                View All References (5)

                                                French, V. (2023). What you should know about breakthrough bleeding with birth control. American College of Obstetricians and Gynecologists.

                                                Ludmann, P. (2022). Melasma: Causes. American Academy of Dermatology Association. 

                                                National Cancer Institute. (2018). Oral contraceptives and cancer risk.

                                                Nelson, A. L., et al. (2021). Efficacy, safety, and tolerability of a levonorgestrel/ethinyl estradiol transdermal delivery system: Phase 3 clinical trial results. Contraception.

                                                Tholey, D. (2023). Cholestasis. Merck Manual Consumer Version.

                                                GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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