Twirla Is a Once-Weekly Contraceptive Patch That Prevents Pregnancy by Delivering Levonorgestrel and Ethinyl Estradiol Through the Skin

If you're exploring birth control options beyond the daily pill, Twirla might be on your radar. It's one of only two contraceptive patches available in the United States, and it offers a convenient once-weekly application schedule. But what exactly is Twirla, how does it work, and is it right for you? Here's everything you need to know in 2026.

What Is Twirla?

Twirla is a prescription contraceptive patch — a small, round adhesive patch that you wear on your skin to prevent pregnancy. Here are the key details:

• Brand name: Twirla
• Generic name: Levonorgestrel and Ethinyl Estradiol transdermal system
• Drug class: Combined hormonal contraceptive (CHC) — it contains both a progestin (Levonorgestrel) and an estrogen (Ethinyl Estradiol)
• Manufacturer: Agile Therapeutics, Inc.
• FDA approval: Approved by the FDA for the prevention of pregnancy
• Controlled substance: No — Twirla is not a controlled substance and has no DEA schedule
• Generic available: No — as of 2026, there is no generic version of Twirla

Twirla uses Skinfusion® technology, a proprietary adhesive system designed to help the patch stay in place on your skin throughout the week.

What Is Twirla Used For?

Twirla is FDA-approved for one indication: preventing pregnancy in women with a body mass index (BMI) less than 30 kg/m².

That BMI restriction is important and unique to Twirla. Unlike some other contraceptives, Twirla is specifically contraindicated (not approved for use) in women with a BMI of 30 or above. In clinical trials, the patch was less effective at preventing pregnancy in women with higher BMI and carried an increased risk of blood clots. Women with a BMI between 25 and 30 should know that the patch may be somewhat less effective for them as well.

Twirla does not have any FDA-approved off-label uses. It is used solely for contraception.

How Is Twirla Taken?

Twirla follows a simple 4-week cycle:

1. Week 1: Apply one patch to clean, dry skin on your buttock, abdomen, or upper torso (not the breast). Wear it for 7 days.
2. Week 2: Remove the old patch and apply a new one on the same day of the week. Choose a different spot if possible to reduce skin irritation.
3. Week 3: Same as Week 2 — remove and replace with a fresh patch.
4. Week 4: Patch-free week. Don't wear a patch this week. You'll likely have your period (withdrawal bleeding) during this time.
5. Start again: After the patch-free week, begin a new 4-week cycle with a fresh patch.

Each patch delivers 120 mcg of Levonorgestrel and 30 mcg of Ethinyl Estradiol per day through your skin. Each patch contains a total of 2.60 mg of Levonorgestrel and 2.30 mg of Ethinyl Estradiol. The patch is round and measures 28 cm².

Twirla comes in a box of 3 patches, which is a one-month supply (3 weeks of patches + 1 patch-free week).

Application Tips

• Apply to clean, dry skin — no lotions, oils, or powders on the area
• Press the patch firmly for 10 seconds to ensure good adhesion
• Check daily that the patch is sticking properly
• If a patch falls off for less than 24 hours, reapply it or apply a new patch — no backup contraception needed
• If a patch has been off for more than 24 hours, apply a new patch and use backup contraception (like condoms) for 7 days

For a deeper explanation of how Twirla prevents pregnancy, read our guide: How Does Twirla Work? Mechanism of Action Explained.

Who Should Not Take Twirla?

Twirla is not safe for everyone. You should not use Twirla if you have any of the following:

• BMI of 30 kg/m² or above — Twirla is contraindicated due to reduced efficacy and increased risk of blood clots
• Smoke and are over 35 years old — Dramatically increased cardiovascular risk
• History of blood clots (deep vein thrombosis or pulmonary embolism)
• Cerebrovascular disease or coronary artery disease (history of stroke or heart attack)
• Valvular heart disease with complications
• Uncontrolled hypertension or hypertension with vascular disease
• Diabetes with vascular disease or diabetes lasting more than 20 years
• Migraine headaches with aura, or any migraines if you're over 35
• Breast cancer or other estrogen/progestin-sensitive cancer (current or past)
• Liver tumors (benign or malignant) or active liver disease
• Pregnancy
• Taking Hepatitis C drugs containing Ombitasvir/Paritaprevir/Ritonavir

Twirla carries an FDA boxed warning about two risks: cardiovascular events in women over 35 who smoke, and reduced efficacy plus increased VTE risk in women with BMI ≥30. Read more about Twirla's side effects and when to call your doctor.

How Much Does Twirla Cost?

Without insurance, Twirla costs approximately $250–$290 per month (one box of 3 patches) at retail pharmacies. Because there's no generic version, prices remain high.

Here's how to bring the cost down:

• Insurance: Under the ACA, most commercial insurance plans must cover at least one contraceptive per FDA category at $0 cost-sharing. Your plan may cover Twirla with no copay, or may prefer the Xulane patch and require prior authorization for Twirla.
• Twirla Patient Savings Card: Eligible commercially insured patients may pay as little as $0 for the first month and $25/month for up to 5 months of refills. Visit twirla.com or call 1-866-747-7108.
• Discount cards: GoodRx and similar services may bring the cash price down to $200–$210 per month.
• Telehealth: Some platforms like Pandia Health offer Twirla for around $50 per month.

For a full breakdown of savings options, see our guide: How to Save Money on Twirla.

How Does Twirla Compare to Other Options?

Twirla isn't the only contraceptive patch or non-daily birth control option. Here's how it stacks up:

• Xulane (Norelgestromin/Ethinyl Estradiol patch) — The other contraceptive patch available in the U.S. Xulane uses a different progestin, delivers a slightly higher estrogen dose (35 mcg vs. 30 mcg), has no BMI restriction in its labeling, and is available as a generic — making it significantly cheaper.
• NuvaRing (Etonogestrel/Ethinyl Estradiol vaginal ring) — A flexible ring inserted vaginally for 3 weeks, then removed for 1 week. Another non-daily option. Generic version (EluRyng) available.
• Oral contraceptive pills — Many options with the same active hormones (Levonorgestrel/Ethinyl Estradiol) at much lower cost, but require daily adherence.

For a detailed comparison, check out: Alternatives to Twirla If You Can't Fill Your Prescription.

Final Thoughts

Twirla is a convenient once-weekly contraceptive patch that offers a non-daily alternative to birth control pills. It's best suited for women with a BMI under 30 who want a "set it and forget it" approach to contraception. The main trade-offs are cost (no generic available, with a retail price of $250–$290/month), limited pharmacy availability, and the BMI restriction that doesn't apply to competing products.

If Twirla sounds right for you, the next step is finding a doctor who can prescribe it and then locating a pharmacy that has it in stock. Ready to search? Find Twirla on Medfinder.