Short answer: EstroGel and Divigel are both estradiol gels put on the skin once a day for menopause hot flashes.12 EstroGel is one pump press (0.75 mg estradiol) spread over one arm, and is also approved for vaginal atrophy. Divigel comes in packets from 0.25 g to 1.25 g, applied to the upper thigh. Both carry estrogen boxed warnings. Neither label reports a trial against the other.
| EstroGel | Divigel | |
|---|---|---|
| Approved for | Moderate to severe hot flashes; moderate to severe vulvar and vaginal atrophy from menopause1 | Moderate to severe hot flashes from menopause2 |
| Form | Metered pump; 1.25 g per press holds 0.75 mg estradiol1 | Single-dose packets, 0.25 g to 1.25 g2 |
| Dose | One press a day; the single approved dose1 | Start 0.25 g a day; adjust up to 1.25 g2 |
| Where | One whole arm, wrist to shoulder1 | Upper thigh, about 5 by 7 inches, alternating sides2 |
| Most common side effects | Breast pain 10.7% vs 8.2%; headache 9.5% vs 2.7%1 | Irregular bleeding 9.6% vs 1.6%; breast tenderness 8.8% vs 1.6% (1.0 g)2 |
| Boxed warning | Endometrial cancer, heart and stroke risk, probable dementia, breast cancer1 | Endometrial cancer with estrogen alone in women with a uterus2 |
| Missed dose | No rule in the label1 | 12-hour rule in the Patient Information2 |
EstroGel has one approved dose, a single pump press, and the label notes the lowest effective dose has not been set. A new pump is primed with 5 presses.1 Divigel starts at the lowest packet, 0.25 g (0.25 mg estradiol), and can be raised up to 1.25 g.2
The Divigel label also says timing matters and to consider starting in women under 60 or within 10 years of menopause.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
EstroGel carries the full estrogen boxed warning: endometrial cancer, cardiovascular disorders, probable dementia and, with a progestin, breast cancer.1 The current Divigel boxed warning covers endometrial cancer with estrogen alone in women with a uterus.2
Dose and product choices are for your prescriber. More detail: EstroGel side effects, Divigel side effects, the EstroGel and Divigel dosing schedules, the Divigel missed-dose page and the Estradiol (oral tablets) guide.