What is the Twirla (ethinyl estradiol and levonorgestrel) contraceptive patch and how is it used?

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Last updated: May 31, 2025View editorial policy

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From the Guidelines

Twirla is a hormonal contraceptive patch containing ethinyl estradiol and levonorgestrel that is approximately 91-94% effective with perfect use, though its effectiveness may be reduced in women weighing more than 202 pounds. The patch is applied to clean, dry skin on the abdomen, buttock, or upper torso (excluding breasts) once weekly for three consecutive weeks, followed by one patch-free week during which menstruation typically occurs, creating a 28-day cycle pattern 1.

Key Points to Consider

  • Each patch should remain in place for exactly 7 days before being replaced with a new one at the same time of day.
  • Twirla works by suppressing ovulation, thickening cervical mucus to prevent sperm entry, and thinning the uterine lining to reduce the likelihood of implantation.
  • Side effects may include skin irritation at the application site, nausea, headaches, and spotting between periods.
  • Users should be aware that hormonal contraceptives like Twirla do not protect against sexually transmitted infections, and smoking while using this method increases the risk of serious cardiovascular side effects, especially in women over 35.

Comparison with Other Contraceptive Methods

According to the provided evidence, the effectiveness of Twirla is comparable to other hormonal contraceptive methods, such as the combined pill and the Evra patch, which have a similar effectiveness rate of 9% with typical use and 0.3% with perfect use 1.

Important Considerations

It is essential to note that the effectiveness of Twirla may be reduced in women weighing more than 202 pounds, and users should be aware of this potential limitation.

In Conclusion is not allowed so

The information provided in the study 1 is essential in understanding the effectiveness and potential side effects of Twirla, and users should consult with their healthcare provider to determine the best contraceptive method for their individual needs.

From the Research

Overview of Twirla Contraceptive Patch

  • The Twirla contraceptive patch is a transdermal delivery system (TDS) containing levonorgestrel (LNG) and ethinyl estradiol (EE) 2, 3.
  • It is used for contraception in women with a body mass index (BMI) < 30 kg/m2 2, 3, 4.
  • The patch is applied once a week for 3 consecutive weeks, followed by a 1-week patch-free period 2.

Efficacy and Safety

  • The efficacy of the Twirla patch was assessed in a Phase 3 clinical trial, which reported a Pearl Index (PI) of 5.8 pregnancies per 100 woman-years 2.
  • The PI was found to be higher in women with BMI ≥ 30 kg/m2, with a reported PI of 8.6 pregnancies per 100 woman-years 2.
  • Common hormone-related treatment-emergent adverse events included nausea and headache, with 11% of women discontinuing due to adverse events 2.
  • The safety and tolerability profile of the Twirla patch was found to be consistent with other similar dose combined hormonal contraceptives 2, 3.

Comparison with Other Contraceptives

  • The Twirla patch is one of several new contraceptive products available in the USA, including Annovera, Phexxi, and Slynd 4.
  • Each of these products has its own unique characteristics, benefits, and limitations, and the choice of contraceptive method depends on individual patient needs and preferences 4.
  • The Twirla patch offers an additional option for a user-controlled, combined hormonal contraceptive method without daily dosing, but its use is limited to patients with BMI < 30 kg/m2 due to decreased efficacy and VTE events in people with obesity 4.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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