Short answer: Both deliver estradiol through the skin. EstroGel is one pump of gel a day, 1.25 g holding 0.75 mg estradiol, spread over a whole arm; it is the single approved dose.1 Vivelle-Dot is a patch changed twice a week in five strengths, starting at 0.0375 mg a day for hot flashes.2 Both carry the same estrogen boxed warning. Neither label compares the two.
| EstroGel | Vivelle-Dot | |
|---|---|---|
| Approved for | Hot flashes and vulvar and vaginal atrophy due to menopause1 | The same, plus low estrogen from hypogonadism, castration or ovarian failure, and osteoporosis prevention2 |
| How used | Thin layer over the whole arm, wrist to shoulder, once daily; prime a new pump with 5 presses1 | Patch on the belly or buttocks, never the breasts, replaced twice weekly2 |
| Dose | 1.25 g gel (0.75 mg estradiol) daily; lowest effective dose not determined1 | 0.025 to 0.1 mg a day; 0.0375 mg to start for hot flashes2 |
| Common side effects | Breast pain 10.7% vs 8.2%, headache 9.5% vs 2.7% on placebo; site reactions 0.6%1 | Headache 31.1% on 0.05 mg vs 23.6% on placebo; patch site irritation 3.2% or less2 |
| Missed dose | No rule in the label1 | Apply a new patch as soon as possible and keep the original schedule2 |
| Boxed warning | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA and BREAST CANCER1 | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA, and BREAST CANCER2 |
The EstroGel label reports that washing the arm 1 hour after use lowered estradiol levels by 22%, a moisturizer applied 1 hour later raised exposure by 38%, and sunscreen lowered it by 16%. The gel is flammable until dry, and others should avoid touching the treated skin for at least 1 hour.1 The Vivelle-Dot label covers patch sites instead: rotate them, wait at least 1 week before reusing one, and avoid the waistline, oily or irritated skin.2
Both boxed warnings rest on Women's Health Initiative studies of oral conjugated estrogens, with or without medroxyprogesterone acetate, not on the gel or the patch.12 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: EstroGel side effects, Vivelle-Dot side effects, the EstroGel and Vivelle-Dot dosing schedules, the EstroGel and estradiol patch missed-dose pages, the estradiol guide, and Evamist vs EstroGel: how do the estradiol spray and gel differ?.