Short answer: For hot flashes or vaginal atrophy, the Vivelle-Dot label starts at a 0.0375 mg per day patch; for osteoporosis prevention, 0.025 mg per day. The patch is changed twice weekly on the lower abdomen or buttocks, never the breasts, and adjusted by response. Women with a uterus may use a cycle such as 3 weeks on and 1 week off. A forgotten patch is applied as soon as possible.
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 Vivelle-Dot is approved for: Vivelle-Dot is an estrogen patch approved to treat moderate to severe hot flashes and moderate to severe vulvar and vaginal atrophy due to menopause, to treat low estrogen from hypogonadism, castration or primary ovarian failure, and to prevent postmenopausal osteoporosis (sections 1.1 to 1.4). For vaginal symptoms alone, topical vaginal products are considered first; for osteoporosis prevention alone, non-estrogen medicines are considered first.
Source
VIVELLE-DOT (estradiol transdermal system), prescribing information and Patient Information. Sandoz. DailyMed, version published July 4, 2024. DailyMed setid 5ccb77f9-d47b-4381-ad5c-5b92524e1c4a
Vivelle-Dot comes in five strengths: 0.025, 0.0375, 0.05, 0.075 and 0.1 mg of estradiol delivered per day (section 3).
The patch is placed on a clean, dry area of the trunk, including the abdomen or buttocks, not on the breasts, and is replaced twice weekly. Sites are rotated with at least 1 week before reusing a site, avoiding oily, damaged or irritated skin and the waistline (section 2.5).
It is applied right after opening the pouch and pressed firmly with the palm for about 10 seconds, especially around the edges (section 2.5).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Use | Starting dose and schedule |
|---|---|
| Moderate to severe hot flashes | 0.0375 mg/day applied twice weekly; adjust by clinical response; try to taper or stop at 3 to 6-month intervals |
| Vulvar and vaginal atrophy | 0.0375 mg/day applied twice weekly; adjust by clinical response; try to taper or stop at 3 to 6-month intervals |
| Prevention of postmenopausal osteoporosis | 0.025 mg/day applied twice weekly |
| Woman without a uterus | Given continuously |
| Woman with a uterus | Cyclic schedule, for example 3 weeks on followed by 1 week off |
Vivelle-Dot can start at once in a woman not on oral estrogen or switching from another estradiol patch. A woman on oral estrogen starts 1 week after stopping it, or sooner if symptoms return in less than 1 week.
For a postmenopausal woman with a uterus, adding a progestogen is generally considered to reduce endometrial cancer risk. Women are re-evaluated periodically to see whether treatment is still needed.
If feasible, estrogen is stopped at least 4 to 6 weeks before surgery linked to a higher risk of blood clots, or during long immobilization.
The patch is changed 2 times a week, or every 3 to 4 days, on two chosen days marked on the calendar card inside the carton.
If a patch falls off, the same patch is reapplied or a new one is applied to another spot, keeping the original schedule. If a woman forgot to apply a patch, a new one is applied as soon as possible, still on the original schedule. The label notes that interrupting treatment may raise the chance of breakthrough bleeding, spotting and return of symptoms.
From another estradiol patch: Vivelle-Dot may be started at once. From oral estrogen: started 1 week after stopping it, or sooner if menopausal symptoms come back in less than 1 week.
In Dose Track you set up Vivelle-Dot 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.