Twirla

What is Twirla

Twirla is an FDA-approved birth control patch that you change once a week to prevent pregnancy. It contains hormones similar to those found in combined contraceptive pills, but you only have to remember to change it once a week instead of taking a daily tablet.

Like combined pills, you’ll use your patch in four week cycles. You’ll wear a patch a week for three weeks, and won’t wear one at all for the fourth week. This is when you’ll have a withdrawal bleed, similar to a period. Then, you’ll start the four week cycle again.

Who is Twirla for?

Twirla is most effective for people who have a BMI lower than 30 kg/m2, as it doesn’t work as well if your BMI is higher than this. Studies also show an increased risk of blood clots forming in a vein (VTE) in people with a BMI over 30 using Twirla.^[1]
Smokers over 35 shouldn’t use it as well, as smoking can increase the risk of heart problems for people using combined hormonal birth control.^[2]

How does Twirla work?

Twirla contraceptive patches are a type of combined hormonal birth control, which means they contain two different types of hormones as their active ingredients. Levonorgestrel is a synthetic version of the hormone progesterone, and estradiol is a type of estrogen.

The combination of these hormones prevents pregnancy by inhibiting a surge in luteinizing hormone, which is what makes your ovary release an egg during your menstrual cycle. This helps to suppress ovulation, thickens your cervical mucus, and makes it more difficult for the egg to pass through the fallopian tubes.^[3] It also causes the lining of your womb to thicken less, which should make it more difficult for eggs to attach to it – but currently there’s no scientific proof for this.^[4]

While estradiol does help prevent pregnancy a little, most of the contraceptive effects of Twirla are from the progesterone levonorgestrel – Estradiol mainly helps stop irregular or unplanned bleeding.^[3]

What doses does Twirla come in?

There’s only one Twirla dosage, which contains 120 mcg/day of levonorgestrel and 30 mcg per day of ethinyl estradiol. It’s a lower dose than other hormonal skin patches, like Xulane patches (which expose you to about 60% more estrogen than a typical birth control pill containing 35 mcg of estrogen). But it’s still just as effective at preventing pregnancy.^[5]

How to use Twirla

You should always use Twirla patches as your doctor tells you to. Twirla patches are used in four week cycles: you’ll wear one patch a week for three weeks, then in the fourth week you’ll take a break from it. This is when you’ll have a monthly bleed.

Starting your Twirla patch is a little different depending on your circumstances when you begin using it.

If you haven’t been on another form of birth control before Twirla, put your first patch on during the first 24 hours of your period. This day will be your patch change day each week. Starting Twirla after the first day of your period means you’ll need to use barrier methods (like condoms) for the first 7 days.

If you’re changing to Twirla from birth control pills, a vaginal birth control ring, or a different contraceptive skin patch, you should finish your current cycle of contraception. Then, apply your Twirla patch when you would start your next contraceptive pill, patch, or ring cycle. If you haven’t had your period within a week of finishing your last birth control method, speak to your doctor to make sure you’re not pregnant. If you apply your first Twirla patch more than a week after taking the last dose of your previous birth control method, you’ll need to use back-up contraception (such as a condom) for the first week of Twirla.

If you aren’t breastfeeding and plan to start Twirla after giving birth, you’ll need to wait four weeks before beginning Twirla. While you’re waiting, you’ll need to use a back-up, non-hormonal method of birth control, like a condom. If you want to start Twirla after giving birth, and haven’t had your period yet, you should speak to your doctor. They’ll make sure you’re not ovulating or pregnant before you start treatment. If you’re not, you’ll still need to use non-hormonal contraception for the first week of using Twirla.

Wondering where to put your Twirla patch, and how to apply it? Here’s everything you need to know about using your Twirla patch:

• Only ever wear one patch at a time;
• Before you apply your patch, make sure the area of skin is clean, dry, and free from make-up, creams, lotions, oils, powders, or other skin products;
• The best Twirla patch placement options are the lower stomach, buttocks, or upper torso (but not on or around your breasts). Try not to put it directly on your waistline, as your clothes might rub it off;
• Tear open the pouch containing the patch along the notch, and remove the patch;
• Holding the patch with the clear protective lining facing you, you should see a large section and a small section of liner. Holding the smaller section, peel off and throw away the larger section of liner;
• Still holding the smaller section of liner, apply the sticky side of the patch to your chosen area of skin. Press down firmly onto the patch to smooth it down;
• If it hasn’t stuck down flat, or there are large wrinkles, gently pull it off your skin and re-apply it;
• When you’re happy that your patch is flat to your skin without any wrinkles, peel away the remaining protective liner and press the entire patch firmly into your skin for around 10 seconds. Make sure the edges are stuck down well by smoothing over them with your fingertips;
• Check your patch each day to make sure it hasn’t fallen off or moved – especially after showering, bathing, or swimming, as water can affect how well Twirla sticks to your skin;
• You’ll wear each patch for 7 days, and every fourth week you’ll take a seven-day break from wearing a patch. When it’s time to change your patch, remove the old one and immediately put on a new one (unless it’s your week break). Do not apply the new patch to the same patch of skin where your old one was – always use a new site when swapping patches.

How long does it take Twirla to work?

If you apply your Twirla patch on the first day of your period, or immediately after changing from a different form of contraception, you’ll be protected from getting pregnant right away. If you don’t start Twirla on the first day of your period, or there’s a gap between finishing your old birth control and starting Twirla, you’ll need to use a back-up form of contraception (like condoms) for seven days to ensure you’re protected.

What should I do if I make a mistake taking Twirla?

If you forget to change your patch, it can affect your protection from pregnancy (depending on when in your cycle it happens).

If you forget to change your patch at the start of a new 4-week cycle, you might not be protected from getting pregnant. Apply your first patch from the new cycle as soon as you remember, and make a note of the day. This will be your new patch change day, and the first day of your four-week cycle from now on. You’ll also need to use barrier methods, such as condoms, for the first week of this new cycle to ensure you’re protected.

If you’ve forgotten to change the patch in the middle of your four-week cycle (on day 8 or 15), you have up to 48 hours to apply your new patch as soon as you remember. Don’t change your patch change day, just change your patch as you normally would; no back-up birth control is needed.

If it’s been more than 48 hours since you forgot to change your patch, you might not be protected from getting pregnant. Stop your current four-week cycle immediately and start a new cycle with a new patch. This is your new patch change day and the first day of a new four-week cycle. You’ll need a non-hormonal back-up birth control, like condoms, for the first week of your new cycle.

If you accidentally apply more patches than you should, or accidentally swallow a patch – you should remove all of your Twirla patches right away and speak to a clinician. Likewise, if you or someone around you swallows a patch accidentally, seek medical advice. Possible symptoms of Twirla overdose are uterine bleeding and nausea, but no serious side effects have been reported from overdose or ingestion.