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Twirla Review

Twirla (ethinyl estradiol and levonorgestrel) is a low-dose combined hormonal contraceptive patch used by women to prevent pregnancy.


Indications for use

The product is indicated as a method of birth control for use in women of reproductive agefor whom a combined hormonal contraceptive is appropriate.

Mechanism of action

The patch works just like oral hormonal contraceptives in terms of preventing pregnancy by delaying ovulation.

Dosage and mode of application

Twirla is designed for transdermal use only. It delivers 120mcg of levonorgestrel and 30mcg of ethinyl estradiol daily through the patch.

The patch is used in a 28-day cycle. A new patch is applied and worn for 7 days for 3 consecutive weeks. No patch is worn during Week 4, when withdrawal bleeding occurs.

On the day after Week 4 ends, a new patch is applied. Never make more than a 7-day interval between patches.

If unscheduled spotting or bleeding occurs, continue the same regimen. If the bleeding is persistent or prolonged, consult your doctor as it may be caused not by the patch.

Apply the patch to abdomen / buttock / upper torso (excluding breasts).

Every new patch should be applied on the same day of the week. For example, if the first patch is applied on a Monday, all subsequent patches should be applied on a Monday.

Side effects

Common Twirla side effects include:

  • vaginal bleeding;
  • weight gain;
  • headache;
  • uncomfortable irritation;
  • abdominal cramps.


  • Breast cancer or other estrogen- or progestin-sensitive cancer;
  • Acute viral hepatitis;
  • Undiagnosed abnormal uterine bleeding;
  • Decompensated cirrhosis;
  • High risk of arterial or venous thromboembolism diseases;
  • Liver tumors;
  • BMI ≥ 30 kg/m2.


Enzyme inducers (for example CYP3A4) may decrease the effectiveness of the contraceptive or increase breakthrough bleeding.

You should use an additional non-hormonal method of birth control when enzyme inducers are used with Twirla.

Pregnancy and breastfeeding

Pregnancy: Stop using Twirla if you get pregnant.

Lactation: It’s recommended to use another method of birth control. This product can decrease milk production.


This product not protect you and your partner against HIV infection (AIDS) and other sexually transmitted infections.

Although the transdermal patch lowers the risk of blood clots, there remains a risk of blood clots with hormonal patches compared to oral birth control pills. Studies have also revealed an increased risk in blood clots in women who are overweight and those who smoke. This risk increases with age, particularly in women over 35 years of age. For this reason, Twirla is contraindicated in smoking women who are over 35 years of age.

Discontinue the product if a thromboembolic event, jaundice, or significant change in headaches occur. Stop using it at least 4 weeks before and through 2 weeks after major surgery. Start using the patch no earlier than 4 weeks after delivery provided that you are not breastfeeding.

If you have well-controlled hypertension, monitor blood pressure and stop use the product if blood pressure rises significantly.

The product may cause or worsen gallbladder disease.

If you have diabetes or a prediabetic condition, monitor glucose when using this birth control method.

Choose another method of birth control if you have uncontrolled dyslipidemia.

The patch may cause irregular bleeding or amenorrhea. Exclude other causes if symptoms persist.

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