Short answer: The Divigel label starts at 0.25 g of gel once a day, holding 0.25 mg estradiol, on the skin of the right or left upper thigh. The dose is adjusted as needed up to 1.25 g. The whole packet is spread over about 5 by 7 inches, alternating thighs each day. The Patient Information gives a 12-hour missed-dose rule.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Divigel is approved for: Divigel is an estrogen gel approved to treat moderate to severe hot flashes (vasomotor symptoms) due to menopause (section 1.1). The label says timing matters for the overall benefit and risk, and to consider starting it in women under 60 or within 10 years of menopause onset (section 2.1).
Source
DIVIGEL (estradiol gel) 0.1% for topical use, prescribing information and Patient Information. Vertical Pharmaceuticals. DailyMed, version published March 5, 2026. DailyMed setid 59e610dc-883e-4f07-9ec6-a5841b0bf9fb
Divigel comes in single-dose foil packets of 0.25, 0.5, 0.75, 1.0 and 1.25 g, holding 0.25, 0.5, 0.75, 1.0 and 1.25 mg estradiol (section 3).
The entire packet is applied once a day to the skin of the right or left upper thigh, alternating thighs from day to day to avoid skin irritation. The area is about 5 by 7 inches, roughly two palm prints (section 2.2).
The gel is allowed to dry before dressing, the site is not washed for 1 hour, and hands are washed after use. It is not applied to the face, breasts, irritated skin, or in or around the vagina, and contact with the eyes is avoided (section 2.2).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Item | What the label says |
|---|---|
| Starting dose | 0.25 g applied once daily on the skin of either the right or left upper thigh |
| Adjustment | Adjust the dose up to a maximum of 1.25 g, as needed |
| Strengths | 0.25, 0.5, 0.75, 1.0 and 1.25 g packets (0.25, 0.5, 0.75, 1.0 and 1.25 mg estradiol) |
| Where | Right or left upper thigh, on alternating days |
| Area | About 5 by 7 inches (approximately the size of two palm prints) |
| Washing | Do not wash the application site within 1 hour after applying |
Women are started at the lowest effective dose, and the dose is evaluated periodically.
For a menopausal woman with a uterus, adding a progestogen has been shown to reduce endometrial cancer risk. A woman without a uterus generally does not need one, though some with a history of endometriosis may benefit.
If feasible, Divigel is stopped at least 4 to 6 weeks before surgery linked to a higher risk of blood clots, or during long immobilization.
The gel is flammable until dry, and covering the area with clothing is not recommended until it has completely dried.
FSH and estradiol blood levels are not useful in managing moderate to severe hot flashes.
If a dose is missed, the dose is not doubled the next day. If the next dose is less than 12 hours away, the person waits and applies the normal dose the next day. If it is more than 12 hours away, the missed dose is applied and normal dosing resumes the next day. Divigel is not applied more than once a day, and a spilled packet is not replaced with a new one that day.
More on this: missed a dose of Divigel.
In Dose Track you set up Divigel as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.