Twirla (levonorgestrel/ethinyl estradiol) is a brand-name patch that’s prescribed for helping prevent pregnancy. As with other drugs, Twirla can cause side effects, such as application site reactions and weight gain.

Twirla has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Side effect specifics” section below.

Twirla can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took Twirla in clinical trials:

  • application site reactions*
  • headache
  • menstrual cramps
  • nausea
  • weight gain*

* For more information about this side effect, see “Side effect specifics” below.

Mild side effects can occur with Twirla use. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to Twirla’s prescribing information.

Mild side effects that have been reported with Twirla include:

These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the FDA approves a drug, it tracks and reviews side effects of the medication. If you develop a side effect while taking Twirla and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “Side effect specifics” below.

Twirla may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to Twirla’s prescribing information.

If you develop serious side effects while taking Twirla, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

  • depression, which may include symptoms such as:
    • feelings of ongoing sadness, hopelessness, or worthlessness
    • sleep problems
    • suicidal thoughts or behaviors
  • gallbladder problems, which may include symptoms such as:
    • abdominal pain after eating that may last for several hours
    • fever
    • nausea or vomiting
  • high blood sugar levels, which may include symptoms such as:
    • excessive thirst
    • frequent hunger
    • urinating more than usual
  • liver problems, including liver tumors, which may include symptoms such as:
    • abdominal pain
    • jaundice (yellowing of the skin or whites of the eyes)
    • nausea
  • possible increased risk of cervical cancer, which may include symptoms such as:
    • bleeding after sex
    • irregular menstrual bleeding
    • pain during sex
  • severe menstrual bleeding problems, which may include symptoms such as:
    • heavy bleeding
    • painful menstrual cramps
  • severe headache
  • absence of menstrual bleeding, which may or may not indicate pregnancy
  • chloasma (dark patches that develop on the skin of the face)
  • high cholesterol, which typically doesn’t cause symptoms
  • high blood pressure, which typically doesn’t cause symptoms
  • risk of serious heart problems in females† who smoke*
  • risk of serious blood clots in females† with a body mass index (BMI) of 30 or more*

* For more information about this side effect, see “Side effect specifics” below.

† Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

ALLERGIC REACTION

For some people, Twirla patch can cause an allergic reaction.

In general, symptoms of allergic reaction can be mild or serious.

Ways to manage

For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep taking the medication.

For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Twirla patch, your doctor may recommend taking a different medication instead.

Twirla may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

How do the side effects of Twirla vs Xulane compare?

The side effects of Twirla and Xulane are very similar. Xulane is also a transdermal patch used to help prevent pregnancy. Like Twirla, Xulane contains two hormones, including a form of estrogen and a form of progestin. Because they contain similar hormones, they’ll have the same warnings and the same general side effects.

To learn more about how these two drugs compare, talk with your doctor or pharmacist.

What if I don’t get my period on Twirla?

It’s possible to have lighter periods or even no period while using Twirla. However, there’s also the possibility that you could be pregnant.

Talk with your doctor if you don’t get your period while using Twirla. They can check to see if you’re pregnant or not.

Learn more about some of the side effects that Twirla may cause. To find out how often side effects occurred in clinical trials, see the prescribing information for Twirla.

Boxed warnings

Twirla has boxed warnings about the risk of serious heart problems in females* who smoke and the risk of serious blood clots in females with a body mass index (BMI) of 30 or higher. A boxed warning is the most serious warning from the FDA.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Risk of serious heart problems in females who smoke

While rare, Twirla was shown to increase the risk of serious cardiovascular events in clinical trials. A cardiovascular event is a problem that occurs in the heart or blood vessels, such as a blood clot, heart attack, or stroke. Symptoms can include:

  • chest pain
  • double vision or other vision problems
  • pain, swelling, or warmth in a lower leg
  • shortness of breath
  • sudden problems speaking, understanding speech, or moving one side of the face or body

What you can do

Cigarette smoking increases the risk of a serious cardiovascular event with certain hormonal contraceptives. This risk increases with age, specifically after 35 years of age.

Before you start using Twirla, tell your doctor if you’ve ever smoked. If you currently smoke cigarettes and are age 35 years or older, your doctor will likely not recommend Twirla. However, they can prescribe a safer birth control option for you.

Risk of serious side effects in females with a BMI of 30 or more

If you have a BMI of 30 or higher, you may have a higher risk of developing certain blood clots while using Twirla. These can include a deep vein thrombosis (DVT) or pulmonary embolism (PE).

Symptoms of a DVT or PE may include:

  • pain in the calf or behind the knee
  • red or discolored skin
  • sharp chest pain that may worsen when inhaling
  • difficulty breathing
  • swelling and warmth

What you can do

Before you start using Twirla, your doctor will explain talk with you about risk factors for blood clots, which includes your BMI. If you have a BMI of 30 or higher, your doctor will likely not recommend Twirla. However, they can prescribe a safer birth control option for you.

Application site reactions

Application site reactions were a common side effect in clinical trials of Twirla. These reactions happen at the site where you apply the patch.

Symptoms of an application site reaction can include:

  • acne
  • bleeding
  • bumps
  • dryness
  • itching
  • pain
  • rash
  • skin discoloration
  • sores
  • swelling

What you can do

If you experience symptoms of an application site reaction, talk with your doctor. They may be able to suggest ways to help relieve your symptoms. In some cases, your doctor may also recommend a different form of birth control.

Weight gain

Weight gain was a common side effect in Twirla’s clinical trials. However, there isn’t information about how much weight was gained while using Twirla.

What you can do

If you’re concerned about weight gain while using Twirla, talk with your doctor. They can recommend ways to help maintain a weight that is healthy for you.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

Below is important information you should consider before taking Twirla.

Twirla has boxed warnings. A boxed warning is the most serious warning from the FDA. For details, see the “Side effect specifics” section above.

Other precautions

Before taking Twirla, discuss your health history with your doctor. Twirla may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:

  • angioedema in yourself or a family member
  • history of blood clots
  • depression
  • diabetes
  • family or personal history of breast cancer or other hormone-sensitive cancers
  • gallbladder disease
  • headaches or migraine episodes
  • heart attack
  • heart disease
  • high blood pressure
  • high cholesterol or triglycerides
  • kidney disease
  • liver disease
  • history of jaundice due to pregnancy or hormonal birth control
  • history of melasma
  • recent delivery, miscarriage, or abortion
  • smoking
  • stroke
  • unexplained vaginal bleeding
  • upcoming surgery
  • previous allergic reaction to this or a similar drug
  • pregnancy
  • breastfeeding

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.