Short answer: Both are once-daily estradiol gels for menopause hot flashes.12 Elestrin 0.06% comes in a pump; one pump (0.52 mg estradiol) goes on the upper arm. Divigel 0.1% comes in packets from 0.25 to 1.25 g, applied to the upper thigh. Their boxed warnings differ: Divigel's now covers endometrial cancer only. Neither label compares them.
| Elestrin | Divigel | |
|---|---|---|
| Strength | Estradiol gel 0.06%; 0.87 g per pump holds 0.52 mg1 | Estradiol gel 0.1%; packets of 0.25 to 1.25 g (0.25 to 1.25 mg)2 |
| Starting dose | One pump a day1 | 0.25 g a day, up to 1.25 g as needed2 |
| Where | Upper arm to shoulder1 | Right or left upper thigh, alternating days2 |
| Approved for | Hot flashes from menopause1 | Hot flashes from menopause2 |
| Breast tenderness, 12 weeks | 6.6% (1 pump) and 7.7% (2 pumps) vs 3.6% on placebo1 | 8.8% on 1.0 g vs 1.6% on placebo2 |
| Bleeding between periods | 4.4% and 9.2% vs 2.2%1 | 9.6% on 1.0 g vs 1.6%2 |
| Skin care notes | Sunscreen 10 minutes before raised estradiol exposure about 55%1 | Washing 1 hour after lowered exposure 30% to 38%2 |
| Missed dose | Apply it unless the next dose is less than 12 hours away1 | Apply it unless the next dose is less than 12 hours away2 |
| Boxed warning | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA and BREAST CANCER1 | WARNING: ENDOMETRIAL CANCER WITH UNOPPOSED ESTROGEN IN WOMEN WITH A UTERUS2 |
In Elestrin's 12-week trial, daily hot flashes fell by 8.5 a day on one pump and 10.0 on two pumps, vs 5.4 on placebo, from about 13 a day at the start. Divigel's 12-week trial of 495 women reported breast tenderness of 8.8% and irregular bleeding of 9.6% on 1.0 g a day vs 1.6% each on placebo, with skin reactions under 1%.12 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
The Divigel label revised in February 2026 has a boxed warning on endometrial cancer with estrogen alone in women with a uterus only. The Elestrin label still has the four-part estrogen boxed warning covering endometrial cancer, heart and blood vessel problems, probable dementia and breast cancer.21 Both labels say a woman with a uterus generally also needs a progestogen.
Which, if either, fits is for your prescriber. More detail: Elestrin side effects, Divigel side effects, the Elestrin and Divigel dosing schedules, the Divigel missed-dose page, how to store EstroGel and Divigel and EstroGel vs Divigel: how do the two estradiol gels differ?.