Short answer: Both deliver estradiol. Vivelle-Dot is a patch changed twice a week, starting at 0.0375 mg a day for hot flashes.1 Estradiol tablets are taken by mouth, usually 1 to 2 mg daily to start, often in cycles.2 Both carry estrogen boxed warnings built on oral conjugated estrogen studies, and women with a uterus generally add a progestogen. Neither label compares the two.
| Vivelle-Dot | Estradiol tablets | |
|---|---|---|
| Form | Patch on the belly or buttocks, never the breasts; 0.025 to 0.1 mg a day1 | Tablet by mouth; 0.5, 1 and 2 mg2 |
| Hot flashes: starting dose | 0.0375 mg a day, patch changed twice weekly1 | 1 to 2 mg daily, adjusted; cyclic, for example 3 weeks on and 1 week off2 |
| Osteoporosis prevention | 0.025 mg a day1 | Lowest effective dose not determined; only if non-estrogen medicines are not suitable2 |
| Switching | From oral estrogen: start 1 week after stopping, or sooner if symptoms return1 | No switching section2 |
| Side effect data | Headache 31.1% on 0.05 mg vs 23.6% on placebo; patch site irritation 3.2% or less1 | Listed without percentages, including headache, breast pain and irregular bleeding2 |
| Missed dose | Apply a new patch as soon as possible and keep the original schedule1 | No rule in the label2 |
| Boxed warning | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, PROBABLE DEMENTIA, and BREAST CANCER1 | ESTROGENS INCREASE THE RISK OF ENDOMETRIAL CANCER; CARDIOVASCULAR AND OTHER RISKS2 |
Both boxed warnings come from the Women's Health Initiative studies of oral conjugated estrogens 0.625 mg, with or without medroxyprogesterone acetate: more strokes and blood clots, more breast cancer with the combined pill, and more probable dementia in women 65 and older. Neither label studied its own product in those trials; the Vivelle-Dot label says whether the findings apply to other routes such as a patch is not known, and the tablets label says the risks should be assumed similar.12
Both say to use the lowest effective dose for the shortest time, to stop 4 to 6 weeks before surgery linked to clots if feasible, and that women with a uterus generally take a progestogen to lower endometrial cancer risk.12 The tablets label also covers palliation of some breast and prostate cancers.2
Which, if either, fits is for your prescriber. More detail: Vivelle-Dot side effects, estradiol tablets side effects, the Vivelle-Dot and estradiol tablets dosing schedules, the estradiol patch and estradiol tablets missed-dose pages, the estradiol guide, and Climara vs Vivelle-Dot: how do the two estradiol patches differ?.