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Using the Patch (Xulane, Twirla)

How does the patch work?

When you are not using birth control, estrogen and progesterone are released from your ovaries. When the patch is applied to your skin, the estrogen and progesterone move from the patch, through your skin, and into your body. Your body then knows that estrogen and progesterone are coming from somewhere else (from the patch), so your ovaries don’t need to release hormones; they “take a little nap.” While the ovaries are “napping,” they don’t release hormones and don’t cause the release of an egg, which is how the patch works for birth control.

The patch can be used to treat other conditions affected by estrogen and progesterone. These include irregular or absent menstrual periods, heavy periods, menstrual cramps, endometriosis or polycystic ovary syndrome (PCOS). The patch can help regulate hormone levels, which may ease symptoms like headaches, or acne.

Forgetting to replace the patch on time can cause the ovaries to “wake up.” When that happens, the ovaries release hormones and may release an egg, which can cause irregular bleeding or result in pregnancy.

How do I use the patch?

Apply your first patch as directed.

  • The day you apply the 1st patch is your “patch change day.” After applying the first patch, replace the patch once a week for 3 weeks on the patch change day.
  • On the fourth week, you will not wear a patch. This is the “patch-free week.” You should start bleeding this week. Most people start bleeding on the second or third day of this week.
  • After 7 days off the patch, apply another patch on your “patch change day.” You might still be bleeding; putting the patch back on will help the bleeding to stop. You will again be using the patch for 3 weeks and then 1 week off the patch.

What if I forget to change a patch?

  • If an edge or corner of the patch becomes loose, try to press it down again. You can also apply a sticky tape called Tegederm on top of a loose patch. Tegederm is available at your pharmacy.
  • If the patch comes off and you are sure it has been off for less than 24 hours, apply a new patch. Stay on the same schedule with your patches and keep the same patch change day.
  • If the patch comes off and you have no idea when it came off, apply a new patch and start a new cycle. (This becomes patch #1 and this is your new patch change day.)
  • If you forget to replace a patch, your ovaries may “wake up.” Be sure to use condoms during intercourse to prevent pregnancy; start a new patch cycle.
  • If you have questions about what to do, call the clinic.

Are there side effects to the patch?

Most people don’t have any side effects with the patch. However, during the first 3 months you may experience:

  • Bleeding or spotting when the patch is on. This is called breakthrough bleeding and usually happens more during month 1, less during month 2, and by month 3 most people have regular periods during the patch-free week. If breakthrough bleeding continues after month 3, you may need a different method.
  • Note the dates of any bleeding that you have on a calendar or menstrual app. Bring the calendar to each visit with your doctor.
  • Other problems are not common, but you may have nausea, breast tenderness, headaches, or mood changes. If this happens, it is usually mild and doesn’t last long.
  • If you are having problems that are making you feel miserable, call the clinic, do not stop using the patch.
  • The patch does not cause weight gain.

When should I call the clinic?

Call the office immediately if you have

  • Dizziness
  • Vision changes

Consider immediate evaluation if you experience the following:

Rarely the patch can cause a blood clot. These typically form in the backs of the legs but can travel to other parts of the body.

  • Severe headaches (the worst headache you’ve ever had)
  • Chest pain
  • Shortness of breath

What else do I need to know?

  • The patch does not protect against sexually transmitted infections. Use condoms every time you have sex.
  • Never run out of patches. You can always call the clinic and ask for a refill.
  • Never use someone else’s patches or share your patch with anyone else.
  • If you are having a problem, don’t just stop using the patch. Call the clinic.


This is not specific to you but provides general information. If you have any questions, please call your clinic.

Reviewed by GYN 7/2022

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Minnesota Family Resource Center library, or visit

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