Short answer: Climara and Vivelle-Dot are estradiol skin patches with the same approved uses: menopause hot flashes and vaginal atrophy, low estrogen from several causes, and preventing postmenopausal osteoporosis.12 Climara is changed once a week; Vivelle-Dot twice a week. Both carry the estrogen boxed warning. Neither label reports a trial against the other.
| Climara | Vivelle-Dot | |
|---|---|---|
| Patch change | Once a week1 | Twice a week2 |
| Strengths | 0.025 to 0.1 mg per day1 | 0.025 to 0.1 mg per day2 |
| Usual start | 0.025 mg per day1 | 0.0375 mg per day for hot flashes or vaginal atrophy; 0.025 mg for osteoporosis prevention2 |
| Where | Lower abdomen or upper buttock, never on or near the breasts1 | Lower abdomen or buttocks, never the breasts2 |
| Side effects in label trials | Breast pain 5% to 29% by dose vs 4%; headache 5% to 18% vs 10%1 | Headache 31.1% vs 23.6% on placebo (0.05 mg patch); patch site redness 3.2% or less2 |
| Boxed warning | Endometrial cancer, heart and stroke risk, probable dementia, breast cancer1 | Endometrial cancer, heart and stroke risk, probable dementia, breast cancer2 |
| Forgotten patch | Apply as soon as possible1 | Apply as soon as possible2 |
How often the patch is changed: once a week for Climara, twice a week for Vivelle-Dot.12 Both are adjusted by response at the lowest effective dose, and the Climara label adds tries to taper or stop every 3 to 6 months for menopause symptoms.1 The Vivelle-Dot label notes women with a uterus may use a cycle such as 3 weeks on and 1 week off.2
Side-effect rates rose with dose in Climara's trials.1 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Your prescriber sets the patch and strength. More detail: Climara side effects, Vivelle-Dot side effects, the Climara and Vivelle-Dot dosing schedules, and the Estradiol (oral tablets) guide.