Short answer: Both put estradiol on the skin once a day.12 Evamist is a spray on the inner forearm, 1 to 3 sprays of 1.53 mg each, for hot flashes only. EstroGel 0.06% is one pump of gel (0.75 mg) spread over the whole arm, for hot flashes and vaginal atrophy. Evamist's boxed warning adds a part on accidental exposure of others. Neither label compares them.
| Evamist | EstroGel | |
|---|---|---|
| Form | Spray, 1.53 mg estradiol per spray1 | Gel 0.06%, 1.25 g per pump press holds 0.75 mg2 |
| Dose | One spray each morning; 2 or 3 by response1 | 1.25 g a day, the single approved dose2 |
| Where | Inner forearm, starting near the elbow1 | Whole arm, inside and outside, wrist to shoulder2 |
| Approved for | Hot flashes from menopause1 | Hot flashes and vaginal atrophy from menopause2 |
| Headache | 9% to 12% vs 5% to 9% on placebo1 | 9.5% vs 2.7% on placebo2 |
| Per container | 56 sprays after 5 priming sprays1 | 30 doses after 5 priming presses2 |
| Missed dose | No instruction in the label1 | No instruction in the label2 |
| Boxed warning | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA, BREAST CANCER, and UNINTENTIONAL SECONDARY EXPOSURE TO ESTROGEN1 | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA and BREAST CANCER2 |
After approval, breast budding and masses in young girls and breast growth in young boys were reported after accidental contact with Evamist on a user's skin; most went away once exposure ended. The label says to cover the site with clothing if someone may touch it, and to wash any skin that touched it. Pets may also be exposed.1 The EstroGel label says others should avoid contact with the treated skin for at least 1 hour.2
Evamist dries for about 2 minutes and the site is not washed for at least an hour. Sunscreen put on about an hour after Evamist lowered absorption by 11%. EstroGel dries for 5 minutes and is flammable until dry; moisturizer an hour after the gel raised exposure by 38%, and sunscreen lowered it by 16%.12 Both labels say a woman with a uterus generally also needs a progestogen. 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: Evamist side effects, EstroGel side effects, the Evamist and EstroGel dosing schedules, the EstroGel missed-dose page, how to store EstroGel and EstroGel vs Divigel: how do the two estradiol gels differ?.