Short answer: It depends on the product. The EstroGel label says to spread a thin layer over the whole arm, inside and outside, from wrist to shoulder. Divigel goes on one upper thigh, switching sides each day. Both labels say to apply after a bath or shower, on clean, dry, unbroken skin. Divigel says not to wash the area for at least 1 hour; washing at 1 hour cut the estradiol absorbed by 30% to 38%.
| Product | Where | How |
|---|---|---|
| EstroGel 0.06% (pump) | One arm, inside and outside, wrist to shoulder (section 2.1) | One pump into the palm, spread as thinly as possible; do not massage or rub in |
| Divigel 0.1% (packets) | Right or left upper thigh, alternating days (section 2.2) | Whole packet over about 5 by 7 inches, roughly two palm prints; no need to rub in |
Both labels say not to apply the gel to the breasts or in or around the vagina; the Divigel label adds the face and irritated skin. The Divigel label says to alternate thighs to avoid skin irritation.
The EstroGel patient instructions say to let the gel dry for 5 minutes before getting dressed. The Divigel label says to let it dry completely before dressing, and (section 5.18) that covering the area with clothing is not recommended until it has fully dried.
Both gels contain alcohol and are flammable until dry. The labels say to avoid fire, flame or smoking until the gel has dried (EstroGel section 5.17, Divigel section 5.18).
Both patient leaflets say to apply the gel after a bath or shower, once the skin is dry. Washing too soon lowers how much estradiol gets in:
Neither label gives a cut-off after which washing has no effect.
The EstroGel label (section 12.3) reports a study in 42 postmenopausal women of a 0.06% estradiol gel. Sunscreen put on 1 hour after the gel every day for 7 days lowered estradiol exposure by 16%. Moisturizer put on 1 hour after raised exposure by 38% and peak levels by 73%. Putting either on before the gel was not studied. Section 5.18 calls the moisturizer effect a significant increase. The Divigel label says the effect of sunscreen and other lotions has not been studied for Divigel.
If your routine changes, for example a new daily lotion or swimming most mornings, that is worth mentioning to your prescriber, since symptoms can shift with absorption. Dose Track can log the time of each application next to symptom notes. For other people touching the area, see whether estradiol gel can rub off on others.
Read more on Dose Track: EstroGel side effects · Divigel side effects · Missed a Divigel dose · Estradiol · Menopause