Ready for Twirla
    Save on Twirla
    Ready for Twirla

    Frequently Asked Questions

    Ready for Twirla

    What is Twirla?1

    Twirla is a birth control patch for women with a BMI less than 30 kg/m2 who can become pregnant. It contains two female hormones, a progestin called levonorgestrel, and an estrogen called ethinyl estradiol. Birth control methods that have both an estrogen and a progestin are called combination hormonal contraceptives (CHCs).

    Twirla is less effective in women with a BMI of 25 kg/m2 or more.

    Twirla does not protect against HIV infection (AIDS) and other sexually transmitted infections (STIs).

    Your chance of getting pregnant depends on how well you follow the directions for using TWIRLA. The better you follow the directions, the less chance you have of getting pregnant.

    For TWIRLA to be most effective, you must use TWIRLA exactly as your healthcare provider tells you to. Each patch must be fully attached to the skin during the 7 days in order for it to work the best.

    TWIRLA is less effective in women who have a BMI of 25 kg/m2 or more. If you have a BMI of 30 kg/m2 or more, talk to your healthcare provider about other methods of birth control which may be right for you.

    Do not use TWIRLA if you smoke cigarettes and are over 35 years old. Smoking increases your risk of serious cardiovascular side effects from combination hormonal contraceptives (CHCs), including death from heart attack, blood clots or stroke. This risk increases with age and the number of cigarettes you smoke.1

    Do not use TWIRLA if your Body Mass Index (BMI) is 30 kg/m2 or more. If you do not know what your BMI is, please talk to your health care provider. Women with a BMI of 30 kg/m2 or more who use CHCs may have a higher risk for developing side effects like blood clots compared to women with a BMI lower than 30 kg/m2.

    Do not use Twirla if you:

    • smoke and are over 35 years old.
    • have or have had blood clots in your arms, legs, eyes or lungs.
    • have had a stroke.
    • have had a heart attack.
    • have certain heart valve problems or heart rhythm problems that can cause blood clots to form in the heart.
    • have a problem that makes your blood clot more than normal that you were born with (inherited) or that has happened for other reasons such as medicines, surgery or injuries (acquired).
    • have high blood pressure that is not controlled.
    • have diabetes and you are over the age of 35, have high blood pressure or have kidney, eye, nerve, or blood vessel damage, or have had diabetes for more than 20 years.
    • have had certain kinds of severe migraine headaches with aura, numbness, weakness or changes in vision, or have any migraine headaches if you are over age 35.
    • have a BMI of 30 kg/m2 or more.
    • have liver problems including liver tumors, hepatitis, cirrhosis, or liver disease.
    • have unexplained vaginal bleeding.
    • are pregnant or think you may be pregnant. However, TWIRLA is not known to cause birth defects when used by accident during pregnancy.
    • have had breast cancer or any cancer that is sensitive to female hormones.
    • are allergic to any of the ingredients in TWIRLA. See a complete list of ingredients at the end of this Patient Information leaflet. Symptoms of an allergic reaction you may include itching and irritation at the patch site.
    • take any Hepatitis C drug combination containing ombitasvir, paritaprevir, ritonavir, with or without dasabuvir. This may increase levels of a liver enzyme called alanine aminotransferase (ALT) in the blood. TWIRLA may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy (also called cholestasis of pregnancy) or related to previous use of hormonal birth control. Tell your healthcare provider if you have ever had any of the above conditions. Your healthcare provider may recommend another method of birth control.

    TWIRLA may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy (also called cholestasis of pregnancy) or related to previous use of hormonal birth control.

    Tell your healthcare provider if you have ever had any of the above conditions. Your healthcare provider may recommend another method of birth control.

    You may stop using TWIRLA whenever you wish. Consider a visit with your healthcare provider for a pre-pregnancy check-up before you stop using TWIRLA.

    The most common side effects of TWIRLA include:

    • skin reactions at the patch site such as bumps, redness or changes in color of your skin, bleeding itching, rash, dryness, pain and swelling
    • nausea
    • headache
    • menstrual cramps
    • weight gain


    These are not all the possible side effects of TWIRLA.
    Talk to your healthcare provider for medical advice about side effects.
    You may report side effects to FDA at 1-800-FDA-1088.

    When you use TWIRLA you may have bleeding and spotting between periods, called unplanned bleeding. Unplanned bleeding may vary from light slight staining between menstrual periods to breakthrough bleeding which is a flow much like a regular period. Unplanned bleeding occurs most often during the first few months of hormonal contraceptive use but may also occur after you have been using the patch for some time. Such bleeding may be temporary and usually does not indicate any serious problems. It is important to continue using the patch on schedule. If the unplanned bleeding or spotting occurs in more cycles, is unusually heavy, or lasts for more than a few days, talk to your healthcare provider.

    You should consider the possibility that you are pregnant if you miss your scheduled period. Because scheduled periods may not happen as often when you are using TWIRLA, tell your healthcare provider that you have missed your period and that you are using TWIRLA. Also, notify your healthcare provider if you have symptoms of pregnancy such as morning sickness or unusual breast tenderness. It is important that your healthcare provider checks to see if you are pregnant. Stop using TWIRLA if you are pregnant.

    • If your patch starts to lift off your skin or completely comes off and you do not replace it, you may not get enough hormones to keep you from getting pregnant.
    • If a patch starts to lift off your skin or is completely off for less than one day (up to 24 hours), you should try and put it on again to the same place or replace it with a new patch immediately. No back up birth control is needed and your Patch Change Day will remain the same.
    • If a patch starts to lift off your skin or is completely off for more than 1 day (24 hours or more) or if you are not sure how long the patch has been not attached to your skin, you may not be protected from pregnancy. You should stop your current patch cycle and start over on a new patch cycle right away by putting on a new patch. The day you apply your new patch is now your new Day 1 and your new Patch Change Day. Non-hormonal back up birth control, (such as condoms and spermicide, or diaphragm and spermicide) must be used for the first week of the new patch cycle.
    • Do not put a patch on again if it is no longer sticky, if it has become stuck to itself or another surface or if it has other material stuck to it. If your patch cannot be put on again, a new patch should be put on right away. If you need help applying a patch, contact Exeltis at 1-877-324-9349.
    patch application table
    • Smoking
    • The following can cause the patch to not stick the right way making TWIRLA less effective:
      • Avoid using makeup, creams, lotions, oils, powders or any other products on the skin area where you put or plan to put the patch.
      • Swimming or contact with water often or for long periods of time (30 minutes or more). Talk with your healthcare provider about the best method of birth control if you are a swimmer or you often come in contact with water for 30 minutes or more.
    • Women who tend to get chloasma should avoid spending a long time in sunlight, tanning booths, and under sun lamps while using TWIRLA. Use sunscreen if you have to be in the sunlight.