Is Twirla a Good Birth Control? An In-Depth Look at the Weekly Contraceptive Patch

October 10, 2025 •

3 min read

In clinical trials, Twirla demonstrated 95% effectiveness at preventing pregnancy for women with a BMI under 25. The question, is Twirla a good birth control option for you, depends on various personal health factors, including your body mass index (BMI), lifestyle, and sensitivity to hormonal effects.

Quick Summary

Twirla is a weekly birth control patch with specific BMI limitations that may not be suitable for everyone. This guide provides a detailed overview of Twirla's effectiveness, potential side effects, and key considerations to help you discuss this option with a healthcare provider.

Key Points

BMI Restrictions: Twirla is not approved for women with a BMI of 30 kg/m2 or more and is less effective in women with a BMI of 25 kg/m2 or more.
Weekly Convenience: The patch only needs to be applied once a week for three weeks, followed by a patch-free week, which is ideal for those who forget daily pills.
Lower Estrogen Dose: Twirla contains a lower dose of estrogen compared to the alternative Xulane patch, potentially offering a different side effect profile for some users.
Risk of Detachment: Patch detachment can occur, especially with water exposure, and can reduce the effectiveness of the birth control.
Serious Cardiovascular Risks: Like other combined hormonal contraceptives, Twirla carries a risk of serious cardiovascular events, especially for smokers over 35.
Consult a Professional: Due to specific BMI limitations, side effect profiles, and serious health risks, it is essential to consult with a healthcare provider to determine if Twirla is a good option for you.

What is the Twirla Contraceptive Patch?

Twirla (levonorgestrel/ethinyl estradiol) is a transdermal system used for hormonal contraception. It delivers a continuous, low dose of a progestin and an estrogen through the skin to prevent ovulation, thicken cervical mucus, and thin the uterine lining. The patch is used weekly for three weeks, followed by a patch-free week, offering a convenient alternative to daily pills.

Is Twirla Effective? A Look at the Numbers

Twirla's effectiveness is high with perfect use but is influenced by user adherence and body mass index (BMI).

Perfect Use: Around 99% effective, similar to other combined hormonal contraceptives.
Typical Use: Effectiveness drops to about 93%.
BMI Considerations: Effectiveness decreases in women with a BMI of 25 or higher. It is not recommended for those with a BMI of 30 or more due to reduced efficacy and increased risk of serious side effects like blood clots.

Who Is Twirla For? BMI and Other Considerations

Twirla is indicated for women of reproductive age with a BMI less than 30 kg/m2. It suits those who prefer a weekly method over daily pills or more invasive options. However, a healthcare provider must assess individual health profiles.

Twirla may not be suitable if you have a BMI of 30 or higher, are over 35 and smoke, have a history of blood clots, heart conditions, uncontrolled high blood pressure, certain migraines, or a history of specific cancers or liver problems.

Twirla vs. Xulane: A Hormonal Patch Comparison


Feature	Twirla (levonorgestrel / ethinyl estradiol)	Xulane (norelgestromin / ethinyl estradiol)
Hormone Type	Levonorgestrel and ethinyl estradiol.	Norelgestromin and ethinyl estradiol.
Hormone Dose	Lower estrogen dose (30 mcg/day).	Higher estrogen dose (35 mcg/day).
Patch Size & Shape	Circular, 28 cm2.	Square, 14 cm2.
Adhesive	Different formulation, potentially more comfortable.	Standard adhesive, detachment possible.
FDA Approval	Approved in 2020.	Approved earlier, generic of Ortho Evra.
BMI Suitability	BMI < 30 kg/m2. Less effective for BMI $\ge$ 25.	Potentially less effective for $\ge$ 198 lbs.
Risk of Blood Clots	Potentially lower risk due to lower estrogen.	Potentially higher risk due to higher estrogen.
Cost without Insurance	Variable, potentially lower than brand-name Xulane.	Variable, typically higher for brand-name.

Weighing the Pros and Cons of Twirla

Choosing Twirla involves considering its benefits and drawbacks relative to personal health.

Pros:

Weekly Convenience: Easy-to-follow weekly schedule.
Lower Estrogen Dose: May carry a potentially lower risk of blood clots compared to Xulane.
Non-Invasive: Less invasive than IUDs or implants.
User Reviews: Some users report positive experiences.

Cons:

BMI Limitations: Reduced effectiveness and contraindication at higher BMIs.
Patch Detachment: Risk of patch coming loose.
Application Site Reactions: Skin irritation is a common side effect.
Other Side Effects: Can cause nausea, headaches, and weight gain.

Common Side Effects and Important Safety Information

Understanding potential side effects and risks is crucial. Twirla has common minor issues and rare but serious complications.

Common Side Effects: Include skin reactions, nausea, headaches, cramps, and weight gain.
Serious Risks: Boxed warning due to increased risk of blood clots, stroke, and heart attack, especially for smokers over 35.
Contraindications: Not for use with certain heart conditions, hypertension, blood clot history, specific migraines, liver problems, or hormone-sensitive cancers.

How to Use the Twirla Patch Correctly

Proper application ensures effectiveness and helps prevent detachment.

Preparation: Apply to clean, dry skin on the abdomen, buttock, or upper torso, avoiding breasts and lotions.
Application: Press firmly for 10 seconds, ensuring sealed edges.
Weekly Cycle: Wear one patch for seven days for three weeks.
Patch-Free Week: Take a week off from the patch.
Daily Check: Verify the patch is secure daily.
Adherence Issues: If a patch detaches, follow instructions, which may involve replacing it and using backup birth control.

The Verdict: Is Twirla a Good Birth Control Choice?

Deciding if Twirla is a good birth control option is a personal choice made with a healthcare provider. It offers convenience and a lower estrogen dose. However, it has BMI limitations and is contraindicated for certain conditions. Consider the risk of detachment and skin irritation. For suitable candidates, Twirla can be effective and easy to use. Discuss your health history with your doctor.

Frequently Asked Questions

Twirla, when used perfectly, has a comparable effectiveness rate to other combined hormonal contraceptives like the birth control pill. However, its effectiveness is reduced by higher BMI and typical use errors, making long-acting reversible contraceptives (LARCs) like IUDs and implants more effective overall.

If a Twirla patch falls off and it has been less than 24 hours, you should reapply it or replace it with a new patch. If it has been off for more than 24 hours (or you are unsure), apply a new patch, start a new 4-week cycle, and use a backup birth control method for the first seven days.

No, Twirla is contraindicated in women with a BMI of 30 kg/m2 or higher. For these women, Twirla has reduced effectiveness and may pose a higher risk for serious side effects like blood clots.

Twirla has a lower estrogen dose compared to the Xulane patch, which may result in a lower risk of blood clots, but a risk still exists. The most significant risk factors for blood clots are age (over 35) combined with smoking.

The most common side effects of Twirla include skin irritation at the patch site, nausea, headache, menstrual cramps, and weight gain.

Twirla contains a lower dose of estrogen (30 mcg) and a different progestin than the Xulane patch (35 mcg). Twirla also has a specific BMI limitation (below 30 kg/m2), while Xulane may be less effective for women weighing 198 pounds or more.

Yes, it is possible to skip your period with the Twirla patch by continuously applying a new patch every week instead of taking a patch-free week. You should consult with your doctor before doing so.