What Is Twirla?

Twirla is a prescription combined hormonal contraceptive (CHC) patch that prevents pregnancy. It contains two hormones — Levonorgestrel (a progestin) and Ethinyl Estradiol (an estrogen) — delivered through the skin via a small, round transdermal patch using Skinfusion® adhesive technology.

Twirla is FDA-approved for the prevention of pregnancy in women with a BMI less than 30 kg/m². It is applied once weekly for 3 weeks, followed by one patch-free week, making it a convenient non-daily contraceptive option. The patch is applied to clean, dry skin on the buttock, abdomen, or upper torso (not the breast).

Important: Twirla is contraindicated in women with a BMI of 30 kg/m² or higher due to reduced efficacy and increased risk of venous thromboembolism (VTE). Women over 35 who smoke should not use Twirla.

How does Twirla work?

Twirla delivers Levonorgestrel and Ethinyl Estradiol continuously through the skin into the bloodstream. These hormones work together to prevent pregnancy through three mechanisms:

• Suppresses ovulation — stops the ovaries from releasing an egg each month
• Thickens cervical mucus — makes it harder for sperm to reach and fertilize an egg
• Alters the uterine lining — reduces the likelihood of implantation if fertilization occurs

The patch delivers a lower dose of estrogen (30 mcg ethinyl estradiol per day) compared to the other contraceptive patch Xulane (35 mcg), which may result in fewer estrogen-related side effects for some patients.

What doses are available for Twirla?

• Transdermal patch — 120 mcg levonorgestrel / 30 mcg ethinyl estradiol per 24 hours (each patch contains 2.60 mg LNG and 2.30 mg EE total)

Twirla is available in a single dose formulation only. Each box contains 3 patches for one monthly cycle (3 weeks on, 1 week off).

How hard is it to find Twirla in stock?

Twirla scores a 55 out of 100 on our findability scale, meaning it can be moderately difficult to locate. As a single-source brand-name product made by the small manufacturer Agile Therapeutics, Twirla is not stocked at every pharmacy. There is no generic version available, and its limited distribution network means you may need to call around or use a specialty pharmacy. While Twirla is not on the FDA drug shortage list, patients have reported difficulty finding it in stock at local retail pharmacies since its 2020 launch.

If your local pharmacy doesn't carry Twirla, ask them to order it or try a larger chain pharmacy. You can also use Medfinder to locate pharmacies that have it in stock near you.

Who Can Prescribe Twirla?

Twirla can be prescribed by a variety of healthcare providers, including:

• OB/GYN (Obstetrics and Gynecology) — most commonly prescribe contraceptive patches
• Family Medicine physicians
• Internal Medicine physicians
• Adolescent Medicine specialists
• Women's Health Nurse Practitioners
• Certified Nurse-Midwives

Twirla is also available through telehealth platforms, making it accessible without an in-person visit. Some telehealth services like Pandia Health offer Twirla prescriptions and delivery for approximately $50/month.

Is Twirla a controlled substance?

No, Twirla is not a controlled substance. It does not have a DEA scheduling designation. As a hormonal contraceptive, it does not carry the abuse or dependence potential associated with controlled medications. You can get refills without the additional restrictions that apply to scheduled drugs.

Common Side Effects of Twirla

• Application site reactions (rash, irritation, itching, skin discoloration) — reported in about 6% of patients
• Nausea — about 4%
• Headache — about 4%
• Dysmenorrhea (painful periods) — about 2%
• Weight gain — about 2%
• Breast tenderness
• Irregular bleeding or spotting
• Mood changes

Serious side effects (rare but important): venous thromboembolism (blood clots), stroke, heart attack, liver problems, gallbladder disease, and hypertension. Seek immediate medical attention if you experience severe leg pain, sudden shortness of breath, chest pain, sudden severe headache, or vision changes.

Alternative Medications to Twirla

• Xulane (Norelgestromin/Ethinyl Estradiol patch) — the other contraceptive patch on the market, containing a slightly higher estrogen dose (35 mcg EE). Available as a generic, making it significantly cheaper. No BMI restriction in labeling.
• Zafemy (Norelgestromin/Ethinyl Estradiol patch) — another generic version of the Ortho Evra contraceptive patch, similar to Xulane.
• NuvaRing (Etonogestrel/Ethinyl Estradiol vaginal ring) — a flexible vaginal ring worn for 3 weeks, then removed for 1 week. Generic version (EluRyng) available.
• Combined oral contraceptive pills — daily birth control pills containing Levonorgestrel/Ethinyl Estradiol. Many generic options available at very low cost ($0–$20/month). Require daily adherence.

If cost is a concern, Xulane or generic oral contraceptives are significantly more affordable alternatives. Talk to your doctor about which option is right for you.

Drug Interactions with Twirla

• CYP3A4 inducers (Rifampin, Phenytoin, Carbamazepine, Phenobarbital, Topiramate, Felbamate, Oxcarbazepine, Bosentan) — may decrease contraceptive effectiveness, increasing pregnancy risk
• St. John's Wort — may decrease contraceptive effectiveness; avoid concurrent use
• HIV protease inhibitors and NNRTIs — may alter hormone levels in either direction
• Hepatitis C drugs containing Ombitasvir/Paritaprevir/Ritonavir — contraindicated due to risk of liver enzyme (ALT) elevations
• Lamotrigine — Twirla may decrease Lamotrigine levels, potentially increasing seizure risk
• Thyroid hormone replacement (Levothyroxine) — dose adjustments may be needed

Always tell your prescriber about all medications, supplements, and herbal products you take before starting Twirla.

Final Thoughts on Twirla

Twirla offers a convenient once-weekly contraceptive option with a lower estrogen dose than the competing Xulane patch. However, its availability can be a challenge — as a brand-only product from a small manufacturer, it's not stocked everywhere and costs $250–$290 per month without insurance.

The good news: most commercial insurance plans cover contraceptives at $0 copay under the ACA, and Twirla's manufacturer savings card can bring costs down to as low as $0 for the first month and $25/month thereafter. If you're having trouble finding Twirla in stock, use Medfinder to search pharmacies near you, or ask your pharmacy to special-order it.

Keep in mind that Twirla is not recommended for women with a BMI of 30 or higher. If cost or availability is a barrier, talk to your doctor about Xulane or generic oral contraceptives as alternatives.