When You Can't Get Twirla, What Are Your Options?

You chose Twirla for a reason — maybe you wanted a once-weekly birth control method, or you liked the idea of a lower-estrogen patch. But now your pharmacy doesn't have it, your insurance won't cover it, or you're exploring other options.

Whatever the reason, going without birth control isn't an option if you're relying on it. Here are the best alternatives to Twirla, how they compare, and what to discuss with your provider.

Before switching, always talk to your healthcare provider. And if the issue is just finding Twirla in stock, try Medfinder first — you might not need to switch at all.

What Is Twirla and How Does It Work?

Twirla is a once-weekly contraceptive patch that delivers two hormones through the skin:

• Levonorgestrel (120 mcg/day) — a progestin
• Ethinyl Estradiol (30 mcg/day) — an estrogen

Together, these hormones prevent pregnancy by suppressing ovulation, thickening cervical mucus, and altering the uterine lining. You apply a new patch each week for three weeks, then take one week off.

What sets Twirla apart is its lower estrogen dose compared to other patch options, which may reduce estrogen-related side effects. It's also designed with Skinfusion® technology for better skin adhesion.

For a deeper dive, see our post on how Twirla works.

Alternative #1: Xulane (Norelgestromin/Ethinyl Estradiol Patch)

Xulane is the most direct alternative to Twirla. It's the other contraceptive patch available in the U.S. and is actually a generic version of the original Ortho Evra patch.

How it compares:

• Hormones: Xulane delivers Norelgestromin (a different progestin) and a higher dose of Ethinyl Estradiol (35 mcg/day vs. Twirla's 30 mcg/day)
• Application: Same weekly schedule — one patch per week for 3 weeks, 1 week off
• Size: Smaller square patch (14 cm²) vs. Twirla's round patch (28 cm²)
• BMI: Xulane doesn't have the same BMI restriction as Twirla (Twirla is contraindicated for BMI ≥30)
• Cost: As a generic, Xulane is significantly cheaper — often $30–$80/month without insurance, compared to Twirla's $250–$290/month
• Availability: Much more widely stocked at pharmacies

Best for: Women who want to stay on a patch method and don't have a specific medical reason to avoid the higher estrogen dose.

Note: Xulane and Twirla are not interchangeable. They contain different progestins and different estrogen doses. Your doctor needs to write a new prescription if you switch.

Zafemy

Zafemy is another generic of Ortho Evra, containing the same hormones as Xulane (Norelgestromin/Ethinyl Estradiol). It's essentially another option in the same category, and availability and pricing may vary by pharmacy.

Alternative #2: NuvaRing or EluRyng (Etonogestrel/Ethinyl Estradiol Vaginal Ring)

If you like the idea of non-daily birth control but aren't set on a patch, the vaginal ring is worth considering.

How it works: You insert a flexible ring into the vagina, leave it in for 3 weeks, then remove it for 1 week. The ring slowly releases Etonogestrel and Ethinyl Estradiol.

How it compares:

• Convenience: Also a once-a-month/set-it-and-forget-it method (changed every 3 weeks)
• No visible patch: The ring is invisible — no skin irritation or adhesion issues
• Hormones: Different progestin (Etonogestrel instead of Levonorgestrel)
• Cost: NuvaRing brand can be expensive (~$150–$200/month), but the generic EluRyng is much cheaper
• Availability: More widely stocked than Twirla

Best for: Women who want non-daily birth control, prefer no visible device on the skin, and are comfortable with vaginal insertion.

Alternative #3: Combined Oral Contraceptive Pills

Daily birth control pills remain the most widely available and affordable hormonal contraceptive option.

How they compare:

• Same hormones available: Many pills contain Levonorgestrel and Ethinyl Estradiol — the same active ingredients as Twirla
• Cost: Generic oral contraceptives can cost as little as $0–$15/month, making them the most affordable option
• Availability: Stocked at virtually every pharmacy
• Drawback: You have to take a pill at the same time every day. If daily adherence is difficult for you, a patch or ring may still be a better fit

Best for: Women who are comfortable taking a daily pill and want the most affordable, widely available option.

Alternative #4: Long-Acting Reversible Contraceptives (LARCs)

If you're open to something more long-term, LARCs like IUDs and implants offer highly effective birth control that lasts years:

• Hormonal IUDs (Mirena, Kyleena, Liletta, Skyla): Last 3–8 years depending on the brand. Release Levonorgestrel locally in the uterus.
• Copper IUD (Paragard): Non-hormonal, lasts up to 10 years.
• Arm implant (Nexplanon): A small rod placed under the skin of the upper arm. Lasts up to 3 years.

Best for: Women who want highly effective, long-term contraception without having to think about it weekly or daily.

How to Decide Which Alternative Is Right for You

Consider these factors when discussing alternatives with your provider:

• Why you chose Twirla: Was it the patch format? The lower estrogen? The once-weekly convenience? This helps narrow your options.
• Your BMI: Twirla is restricted to BMI under 30. If your BMI is over 30, Xulane or another method may actually be a better medical fit.
• Side effect history: If you had side effects on Twirla or previous contraceptives, share that history.
• Cost: If Twirla's price ($250–$290/month) is an issue, generics and savings programs for alternatives may help.
• Availability: If stock is your main issue, try these tips to find Twirla before switching.

Final Thoughts

Twirla is a unique contraceptive, but it's not the only option. If you can't fill your prescription, alternatives like Xulane, NuvaRing, oral contraceptives, or LARCs can keep you protected while you figure out your next steps.

Before switching, check Medfinder to see if Twirla is available at a pharmacy near you. And always talk to your healthcare provider before making any changes to your birth control.