The birth control patch is a popular method of hormonal contraception for its convenience, requiring just a weekly application rather than a daily pill. It releases a steady stream of hormones through the skin to prevent pregnancy. In the United States, three main patches are available: Xulane, Zafemy, and Twirla. While all work similarly, a closer look reveals important differences that make each a better fit for certain individuals.
Understanding How the Birth Control Patch Works
All combined hormonal birth control patches work by releasing synthetic forms of estrogen (ethinyl estradiol) and progestin into the bloodstream through the skin. These hormones prevent pregnancy primarily in three ways:
- Preventing ovulation: The hormones stop the ovaries from releasing an egg each month.
- Thickening cervical mucus: They make the mucus in the cervix thicker, blocking sperm from reaching any potential eggs.
- Thinning the uterine lining: They thin the lining of the uterus, making it difficult for a fertilized egg to implant.
The patch is worn for three weeks, with a new patch applied on the same day each week. The fourth week is a patch-free week, during which a person will experience withdrawal bleeding, similar to a period.
Comparing the Available Birth Control Patches
The most significant difference between the patches is their hormone formulation, which affects potential side effects and efficacy in certain individuals.
Xulane and Zafemy: The Higher-Dose Option
Xulane and Zafemy are generic versions of the original Ortho Evra patch, which was discontinued in the U.S.. They contain the same active ingredients: the progestin norelgestromin and the estrogen ethinyl estradiol.
- Hormone Dose: These patches deliver a daily dose of 150 mcg of norelgestromin and 35 mcg of ethinyl estradiol. This higher estrogen dose is a key distinction from Twirla.
- Effectiveness: Xulane and Zafemy are highly effective. With perfect use, they are 99% effective, but with typical use, their effectiveness rate is about 93%.
- Weight Limitations: The higher estrogen dose may make these patches less effective for individuals weighing 198 pounds or more.
- Adhesion and User Experience: While they share the same hormones, some user reviews on platforms like Drugs.com have reported differences in adhesion between Xulane and Zafemy, with some users noting that Zafemy patches may not stick as well as Xulane.
Twirla: The Lower-Dose Alternative
Twirla is a newer patch formulation that offers a lower estrogen dose, which may be a suitable option for those concerned about higher hormone levels. It uses a different progestin than Xulane and Zafemy.
- Hormone Dose: Twirla delivers a daily dose of 120 mcg of levonorgestrel (a progestin) and 30 mcg of ethinyl estradiol (an estrogen), the lowest estrogen dose of any patch available.
- Effectiveness: Twirla's effectiveness is slightly lower than Xulane/Zafemy in perfect-use scenarios, with a 95% effectiveness rate. Typical-use effectiveness is comparable to other patches at around 93%.
- Weight Limitations: Twirla's efficacy may be reduced in individuals with a body mass index (BMI) of 30 or greater.
- Design: Twirla is a circular patch that is larger in size than Xulane or Zafemy.
Birth Control Patch Comparison Table
| Feature | Xulane | Zafemy | Twirla |
|---|---|---|---|
| Hormones | Ethinyl Estradiol (35 mcg/day) & Norelgestromin (150 mcg/day) | Ethinyl Estradiol (35 mcg/day) & Norelgestromin (150 mcg/day) | Ethinyl Estradiol (30 mcg/day) & Levonorgestrel (120 mcg/day) |
| Hormone Dose | Higher Estrogen | Higher Estrogen | Lower Estrogen |
| Perfect Use Effectiveness | 99% effective | 99% effective | 95% effective |
| Weight Limitation | Less effective for those ≥198 lbs | Less effective for those ≥198 lbs | Less effective for those with BMI ≥30 |
| Appearance/Size | Square, 14 cm² | Square, 12.5 cm² | Circular, 28 cm² |
| Adhesion | Generally reliable, some user variation | Some user reports of poor adhesion | Adhesive formulation differs |
| Brand/Generic | Branded generic | Generic | Brand name |
Factors to Consider When Choosing
There is no single "best" birth control patch; the right choice is highly personal and requires a discussion with a healthcare provider. Several factors should influence your decision:
- Hormone Sensitivity: If you are particularly sensitive to hormones, Twirla's lower estrogen dose might lead to fewer side effects like nausea or breast tenderness, although individual responses vary.
- Body Weight and BMI: Your body weight is a crucial factor. If you weigh 198 pounds or more, Xulane and Zafemy may be less effective. If you have a BMI of 30 or greater, Twirla's efficacy may be compromised. Your doctor can help determine if the patch is a suitable option for you based on these considerations.
- Adhesion Concerns: For those with sensitive skin or who have had issues with patches adhering properly, exploring reviews and considering different products is wise. While Xulane is generally considered reliable, some Zafemy users report adhesion problems.
- Risk Profile: Combined hormonal contraceptives, including patches, carry a slightly increased risk of blood clots compared to no hormonal contraception. The higher estrogen dose in Xulane and Zafemy may elevate this risk slightly compared to Twirla, though the risk remains low for most healthy individuals. Your healthcare provider will assess your risk factors, including smoking history and blood pressure.
- Cost and Insurance Coverage: The cost of the patch can vary based on insurance coverage. As a branded generic, Xulane may be more readily covered or offered at a lower co-pay than the brand-name Twirla. Zafemy, as a generic, is also typically cost-effective.
Conclusion: Which Birth Control Patch is the Best?
Ultimately, the best birth control patch is the one that is most effective and tolerable for your unique body and lifestyle. For those without weight concerns and seeking maximum effectiveness, the higher-dose Xulane may be the best choice. For individuals with hormone sensitivities or who want a lower dose of estrogen, Twirla is a valuable alternative, provided their BMI is below 30. Zafemy offers a generic, potentially more affordable version of Xulane, though it's worth monitoring for adhesion issues based on some user feedback.
The decision should always be made in consultation with a healthcare provider who can evaluate your medical history, discuss your priorities, and help you select the most appropriate and safest option for you. A thorough consultation can ensure you receive a prescription that aligns with your health and family planning goals.
Planned Parenthood offers additional resources on contraceptive patches.
