Short answer: Both deliver estradiol through the skin. Divigel is a gel spread on the upper thigh once a day, 0.25 g to start, and is approved only for hot flashes.1 Vivelle-Dot is a patch changed twice a week, also approved for vaginal atrophy, low estrogen and bone loss prevention.2 Their boxed warnings differ in scope. Neither label compares the two.
| Divigel | Vivelle-Dot | |
|---|---|---|
| Approved for | Moderate to severe hot flashes due to menopause1 | Hot flashes, vaginal atrophy, low estrogen from hypogonadism, castration or ovarian failure, and osteoporosis prevention2 |
| How used | Whole packet on one upper thigh daily, alternating thighs, about 5 by 7 inches; no washing for 1 hour1 | Patch on the belly or buttocks, never the breasts, replaced twice weekly2 |
| Starting dose | 0.25 g gel (0.25 mg estradiol) daily, up to 1.25 g1 | 0.0375 mg a day for hot flashes; 0.025 mg a day for bone2 |
| Common side effects | On 1.0 g: irregular bleeding 9.6% and breast tenderness 8.8% vs 1.6% each on placebo; site reactions under 1%1 | Headache 31.1% on 0.05 mg vs 23.6% on placebo; patch site irritation 3.2% or less2 |
| Missed dose | If the next dose is more than 12 hours away, apply it; if less, wait for the next day; never double1 | Apply a new patch as soon as possible and keep the original schedule2 |
| Boxed warning | WARNING: ENDOMETRIAL CANCER WITH UNOPPOSED ESTROGEN IN WOMEN WITH A UTERUS1 | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA, and BREAST CANCER2 |
Divigel's boxed warning covers only endometrial cancer in a woman with a uterus who uses estrogen alone. Its stroke, clot and cancer findings from the Women's Health Initiative estrogen-alone trial sit in the regular warnings, and the label adds that starting before age 60 or within 10 years of menopause can affect the overall balance of benefit and risk.1 Vivelle-Dot's boxed warning also lists heart and clot risks, probable dementia and breast cancer.2 Both labels note those trials used oral conjugated estrogens, not a gel or patch.12
Gel has its own label points: it is flammable until dry, estradiol can pass to others by skin contact until it dries and is covered, and washing the site after 1 hour lowered exposure by 30 to 38%.1 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Divigel side effects, Vivelle-Dot side effects, the Divigel and Vivelle-Dot dosing schedules, the Divigel and estradiol patch missed-dose pages, the estradiol guide, and EstroGel vs Divigel: how do the two estradiol gels differ?.