Short answer: Both are once-daily estradiol products for menopause hot flashes, put on the arm.12 Elestrin is a 0.06% gel; one pump (0.52 mg) goes on the upper arm to shoulder. Evamist is a spray of 1.53 mg on the inner forearm, 1 to 3 sprays a day. Evamist's boxed warning adds a part on accidental exposure of others. Neither label compares them.
| Elestrin | Evamist | |
|---|---|---|
| Form | Gel 0.06%; 0.87 g per pump holds 0.52 mg1 | Spray; 1.53 mg per spray2 |
| Dose | Start with one pump a day; changed by response1 | One spray each morning; 2 or 3 by response2 |
| Where | Upper arm to shoulder1 | Inner forearm, near the elbow2 |
| Hot flashes, 12 weeks | −8.5 (1 pump) and −10.0 (2 pumps) a day vs −5.4 on placebo1 | −8.10, −8.66 and −8.44 (1 to 3 sprays) vs −4.76 to −6.19 on placebo2 |
| Breast tenderness | 6.6% and 7.7% vs 3.6%1 | 5% to 7% vs 0% to 5%2 |
| Contact with others | Men touching the site 2 or 8 hours later had no significant change in estradiol1 | Breast changes in children after accidental contact reported2 |
| Per container | 30 doses after priming1 | 56 sprays after priming2 |
| Missed dose | Apply it unless the next dose is less than 12 hours away1 | No instruction in the label2 |
| Boxed warning | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA and BREAST CANCER1 | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA, BREAST CANCER, and UNINTENTIONAL SECONDARY EXPOSURE TO ESTROGEN2 |
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. In Evamist's 12-week trial of 454 women, each spray dose had its own placebo group: hot flashes fell 8.10, 8.66 and 8.44 a day on 1, 2 and 3 sprays, vs 4.76, 6.19 and 5.32 on placebo.12 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Sunscreen put on 10 minutes before Elestrin raised estradiol exposure by about 55%, so the label says to wait at least 25 minutes after Elestrin. For Evamist, sunscreen about an hour after lowered absorption by 11%. The Evamist label reports breast changes in children after accidental contact and says to cover the site if someone may touch it.12 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, Evamist side effects, the Elestrin and Evamist dosing schedules and EstroGel vs Divigel: how do the two estradiol gels differ?.