Topical Estradiol Dosages for Adults: Your GoodRx Guide
Key takeaways:
Topical estradiol medications are applied directly to the skin. They come in several dosage forms, including a spray, gels, and patches.
For menopause symptoms, you’ll likely start with 1 spray or 1 pump of Evamist, Elestrin, or Estrogel daily. The starting dosage of Divigel is one 0.25 g packet per day. And your provider may increase your dosage based on your symptoms.
Topical estradiol patches start at a dosage of 0.025 mg once a week and 0.0375 mg to 0.05 mg twice a week for menopause symptoms. Your dosage and how often you change your patch depends on what brand you’re prescribed.
There are many ways to save on topical estradiol medications. Several have lower-cost generics available, and there are copay savings programs for some of the brand-name medications. A GoodRx coupon can also help make your prescription more affordable.
Table of contents
If you’re going through menopause, you may be experiencing frustrating symptoms like vaginal dryness or hot flashes. Hormone replacement therapy (HRT) with topical estradiol is a popular way for many people to find relief.
Some topical forms of estradiol are also approved for preventing osteoporosis after menopause and for managing low estrogen levels caused by conditions other than menopause. Topical estradiol patches are also used as part of estrogen-based gender-affirming hormone therapy (GAHT), although this is an off-label use.
This guide covers topical estradiol dosages, as recommended by manufacturers. These products aren’t approved for children, so these dosages are meant for adults. Keep in mind that these are general dosage recommendations. Your healthcare provider may recommend you apply topical estradiol differently than discussed below.
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What dosage forms does estradiol come in?
Topical estradiol medications are applied directly to the skin. They come in several dosage forms, including patches, gels, and a spray. Estradiol also comes in oral tablets and vaginal inserts and creams. These oral and vaginal forms of estradiol are covered in separate GoodRx dosage guides.
The different topical forms of estradiol and their available doses are shown in the chart below.
Brand-name medications | Dosage form | Available estradiol doses |
Evamist (metered-dose spray) | Spray | • 1.53 mg per spray |
Elestrin (metered-dose pump) | Gel | • 0.52 mg per 0.87 g pump |
Estrogel (metered-dose pump) | Gel | • 0.75 mg per 1.25 g pump |
Divigel (single-use packets) | Gel | • 0.25 mg in 0.25 g • 0.5 mg in 0.5 g • 0.75mg in 0.75 g • 1 mg in 1 g • 1.25 mg in 1.25 g |
Twice-weekly patch | • 0.025 mg • 0.0375 mg (except Alora) • 0.05 mg • 0.075 mg • 0.1 mg | |
Once-weekly patch | • 0.025 mg • 0.0375 mg • 0.05 mg • 0.06 mg • 0.075 mg • 0.1 mg | |
Once-weekly patch | • 14 mcg |
Where and how you apply topical estradiol depends on the medication. So be sure to read the instructions carefully. And ask your healthcare provider or pharmacist for help if you have questions about how to apply your topical estradiol medication properly.
What’s the typical estradiol dosage for treating menopause, osteoporosis, or low estrogen levels in adults?
The recommended topical estradiol dosage for adults depends on the dosage form, the medication, and why you’re using it.
Good to know: If you’re using topical estradiol for HRT and you still have a uterus, it’s recommended that you take a progestin along with estradiol. This helps lower the risk of uterine cancer caused by estradiol treatment.
Estradiol spray
Evamist is approved to treat vasomotor symptoms, like hot flashes and night sweats, related to menopause. The recommended starting Evamist dosage is 1 spray on the inner forearm daily. Your healthcare provider may increase your dosage based on your symptoms. But the maximum recommended dosage is 3 sprays per day.
Estradiol gels
Divigel and Elestrin are both topical estradiol gels approved to treat vasomotor menopause symptoms.
The recommended starting Divigel dosage is one 0.25 g packet applied to the upper thigh once daily. Your provider may increase your dosage up to one 1.25 g packet daily if needed.
The recommended starting Elestrin dosage is 0.87 g of gel (one pump) per day applied to the upper arm and shoulder area. Your provider may increase your dosage based on your symptoms. But there isn’t a maximum recommended dosage from the manufacturer.
Estrogel treats both vasomotor and vaginal menopause symptoms. This includes vaginal dryness, thinning, and irritation. The recommended Estrogel dosage is 1.25 g (one pump) of gel applied over the entire arm once daily.
Good to know: If you’re only experiencing vaginal menopause symptoms, low-dose vaginal estradiol medications are the preferred treatment choice. They carry lower risks than topical estradiol, since most vaginal estradiol medications aren’t well absorbed into the bloodstream.
Estradiol patches
Some estradiol patches are only approved to treat vasomotor menopause symptoms. Others are approved to treat both vasomotor and vaginal symptoms.
Estradiol patches are also approved to treat postmenopausal osteoporosis, or a drop in estrogen levels after menopause that causes an increase in bone loss. Finally, most estradiol patches treat low estrogen levels due to conditions other than menopause.
Most estradiol patches are applied once or twice a week on an ongoing basis. But depending on your situation, your healthcare provider may recommend you wear a patch for 3 weeks and then take 1 week off before applying a new one.
Make sure you fully understand your healthcare provider’s instructions for applying your estradiol patch. And feel free to reach out to your provider or pharmacist if you have any questions.
Good to know: If you’re using an estradiol patch for HRT, your provider may increase your dosage based on how you respond to the medication. They’ll also likely assess you every 3 to 6 months to determine when it’s time to stop treatment. It’s best to only use topical estradiol for as long as truly necessary; it isn’t meant for long-term use.
Minivelle and Lyllana
For vasomotor menopause symptoms, the recommended starting dosage of both Minivelle and Lyllana is one 0.0375 mg patch applied twice a week, roughly 3 to 4 days apart.
Minivelle and Lyllana are also approved to treat postmenopausal osteoporosis. But recommended dosages for this use aren’t provided by the manufacturers.
Vivelle-dot and Dotti
For both Vivelle-Dot and Dotti, it’s recommended to start with one 0.0375 mg patch applied twice a week, roughly 3 to 4 days apart, for vaginal and vasomotor symptoms of menopause. To treat postmenopausal osteoporosis, the recommended dosage is one 0.025 mg patch applied twice a week for both.
Vivelle-Dot and Dotti are also approved to treat low estrogen levels caused by conditions other than menopause. But recommended dosages aren’t provided by the manufacturers.
Alora
With Alora, it’s best to start with one 0.05 mg patch applied twice a week, roughly 3 to 4 days apart, for vaginal and vasomotor symptoms of menopause. The same dosage is recommended for the treatment of low estrogen levels unrelated to menopause. For postmenopausal osteoporosis, a lower dosage of one 0.025 mg patch applied twice a week is recommended.
Climara
To treat vaginal and vasomotor symptoms of menopause, the starting dosage of Climara is one 0.025 mg patch applied once a week. The same dosage is recommended for the treatment of postmenopausal osteoporosis and low estrogen levels.
Menostar
Menostar is a topical estradiol patch that’s only FDA approved for the treatment of postmenopausal osteoporosis. The recommended Menostar dosage is one 14 mcg patch applied to the lower stomach area once a week.
What’s the recommended topical estradiol dosage for estrogen-based GAHT?
Estradiol patches are often used as part of feminizing hormone therapy. They aren’t FDA approved for this purpose, so it’s considered an off-label use.
The recommended dosage for an estradiol patch being used for estrogen-based GAHT is one patch containing 0.1 mg to 0.4 mg applied twice a week.
What happens if you miss a dose of estradiol?
If you apply topical estradiol gel or spray every day and forget a dose, apply it as soon as you remember. However, if it’s within 12 hours of your next dose, skip the missed dose. You shouldn’t double up on doses.
If your estradiol patch falls off, it’s fine to reapply it. If it won’t stick, apply a new patch. Reach out to your provider to let them know this happened, as you’ll likely run out of patches sooner than normal and may need a new prescription.
If you forget to change your patch, remove it and apply a new one as soon as possible. Your symptoms may return depending on how long you’ve been without a fresh patch.
What should you do if you take too much estradiol?
If you accidentally apply an extra dose of topical estradiol, it’s unlikely that it will cause much of an issue. For estradiol patches, a good way to avoid this is to get in the habit of removing your current patch before applying a new one.
Large amounts of estrogen may cause nausea, sore breasts, and fatigue. But this isn’t common with topical dosage forms.
Good to know: It’s possible for other people or pets to absorb estradiol from your skin after you’ve applied a topical estradiol spray or gel. This can cause premature breast development and nipple swelling over time. If you regularly hold your child or pet in your arms or on your lap, be sure your clothing covers the area where you apply estradiol. A patch may be a better dosage form if this is an issue for you.
If you, your child, or a loved one is concerned about being exposed to too much estrogen, contact your healthcare provider or Poison Control at 1-800-222-1222. They’ll let you know what the best course of action is.
How to save on estradiol
There are many ways to save on your topical estradiol medication. GoodRx can help you navigate your options, which may include GoodRx coupons or a copay savings card:
Evamist: This estradiol spray form is only available as a brand-name medication. But you may be able to pay as little as $25 for your monthly prescription using a savings card from the manufacturer.
Divigel: This version of estradiol gel is available as both a brand-name medication and a lower-cost generic. If you have commercial insurance, you may be able to save up to $25 off your monthly copay for brand-name Divigel with a savings card from the manufacturer. Or, with a GoodRx coupon, you may be able to save over 80% off the average retail price of the generic version at certain pharmacies.
Elestrin: This gel is only available as a brand-name medication. If you have commercial insurance, you may be able to pay as little as $0 a month for the medication using a savings card from the manufacturer.
Estrogel: Like Elestrin, Estrogel is also only available as a brand-name medication. If you have commercial insurance, you may be able to save up to $35 off your monthly costs with a savings card from the manufacturer.
Menostar: This once-weekly patch is only available as a brand-name medication. But if you’re uninsured or underinsured, you may be eligible for Menostar’s patient assistance program, which offers the medication free of cost.
Most estradiol patches, other than Menostar, have lower-cost generic versions available. You may be able to pay as little as $30.62 for the once-weekly patches and as little as $31.63 for the twice-weekly patches with a free GoodRx coupon.
The bottom line
Topical estradiol comes in a spray, gels, and patches. For menopause symptoms, the recommended starting dosage of Evamist is 1 spray per day. For Divigel, it’s best to start with one 0.25 g packet daily. The starting dosage for both Elestrin and Estrogel is 1 pump per day.
The starting dosage of estradiol patches for menopause symptoms is 0.025 mg once weekly or 0.0375 mg to 0.05 mg twice weekly. The starting dosage and how often you change the patch depends on what brand you’re prescribed. Lower dosages are typically prescribed for postmenopausal osteoporosis.
Your healthcare provider will adjust your topical estradiol dosage based on your symptoms. If you have questions about how to apply topical estradiol, reach out to your provider or pharmacist for guidance.
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References
Allergan, Inc. (2020). Alora - estradiol patch [package insert].
Amneal Pharmaceuticals LLC. (2022). Lyllana - estradiol patch, extended release [package insert].
ASCEND Therapeutics US, LLC. (2022). Estrogel - estradiol gel, metered [package insert].
Bayer HealthCare Pharmaceuticals Inc. (2021). Climara - estradiol patch [package insert].
Bayer HealthCare Pharmaceuticals Inc. (2023). Menostar - estradiol patch [package insert].
Bryant Ranch Prepack. (2023). Dotti - estradiol patch, extended release [package insert].
Meda Pharmaceuticals. (2020). Elestrin - estradiol gel, metered [package insert].
MedlinePlus. (2022). Estradiol transdermal patch.
MedlinePlus. (2023). Estradiol topical.
North American Menopause Society. (n.d.). Dangers of exposure to topical estrogen in children & pets.
Novartis Pharmaceuticals Corporation. (2022). Vivelle-Dot - estradiol patch, extended release [package insert].
Noven Therapeutics, LLC. (2021). Minivelle - estradiol film, extended release [package insert].
Padagis US LLC. (2021). Evamist - estradiol spray [package insert].
Unger, C. A. (2016). Hormone therapy for transgender patients. Translational Andrology and Urology.
Vertical Pharmaceuticals, LLC. (2023). Divigel - estradiol gel [package insert].
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