Divigel Gel: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Divigel Gel is a prescription medicine containing estradiol, a form of estrogen, used to reduce moderate to severe hot flashes after menopause. It is a clear, colorless, odorless (when dry) gel applied once a day to the skin of the upper thigh. Divigel works by replacing estrogen that declines after menopause, which helps relieve hot flashes and related symptoms.

What is Divigel Gel

Divigel is a prescription gel that contains estradiol, a form of estrogen (a female sex hormone), belonging to the estrogen class of drugs. When applied to the skin of the upper thigh, it is absorbed into the bloodstream. It is a clear, colorless gel that is odorless when dry, and is used once a day.

Divigel Gel uses

• Reduce moderate to severe hot flashes after menopause
• Vaginal/vulvar atrophy symptoms such as vaginal dryness, burning, or itching (per some sources)

Benefits of Divigel Gel

• Helps relieve moderate to severe hot flashes associated with menopause
• Helps reduce night sweats and other vasomotor symptoms
• Provides estradiol replacement when estrogen levels fall after menopause
• Can help improve sleep and daily comfort when symptoms are driven by menopausal estrogen deficiency
• Offers a transdermal hormone therapy option, delivering estradiol through the skin

How Divigel Gel works

Divigel contains man-made estradiol, a type of estrogen the body naturally makes. During menopause, estrogen levels drop, causing symptoms like hot flashes and night sweats. Divigel works by replacing this estrogen, which helps relieve these symptoms.

Divigel Gel dosage

Apply the gel once a day, around the same time each day, to clean, dry, unbroken skin on the upper thigh. If you bathe or shower, apply the gel only after your skin is completely dry. Let the application site dry completely before dressing or swimming. Switch between your left and right upper thigh each day to help prevent skin irritation. Do not massage or rub the gel in — just spread it in a thin layer. Do not apply to the face, breasts, or irritated skin, and never apply in or around the vagina.

Do not let another person touch the area where you applied the gel for at least 1 hour afterward, and wash your hands with soap and water right after applying to avoid transferring the gel to others. Wait at least 25 minutes after applying before using sunscreen on the same area. Do not wash the application site for at least 1 hour after applying, as washing too soon can reduce how much estrogen your body absorbs. The gel contains alcohol and is flammable — avoid fire, flames, or smoking until it has dried. Usage does not depend on food timings.

Available forms and strengths

Divigel is available as a gel in single-dose foil packets, with available strengths of 0.25 mg, 0.5 mg, 0.75 mg, and 1.0 mg.

Side effects of Divigel Gel

Common

• Irregular vaginal bleeding or spotting
• Breast tenderness
• Vaginal yeast infection
• Upper respiratory tract infection (nose, sinuses, pharynx, or larynx)
• Common cold symptoms
• Headache
• Abdominal pain
• Weight changes
• Swelling (edema)
• Mood changes such as anxiety or depression
• Nausea and vomiting
• Loss of appetite
• Acne or skin color changes
• Vaginal pain, dryness, or discomfort
• Decreased sex drive
• Difficulty having an orgasm
• Migraine headaches
• Dizziness
• Break-through bleeding
• Vaginal itching or discharge

Serious

• Heart attack
• Stroke
• Blood clots
• Breast cancer
• Cancer of the lining of the uterus (womb)
• Cancer of the ovary
• Dementia
• High or low blood calcium (hypercalcemia)
• Gall bladder disease
• Visual abnormalities, including retinal vein occlusion
• High blood pressure
• High levels of fat (triglycerides) in the blood
• Liver problems
• Changes in thyroid hormone levels
• Fluid retention
• Cancerous change of endometriosis
• Enlargement of benign tumors of the uterus (fibroids)
• Worsening swelling of the face and tongue (angioedema)
• Changes in certain lab test results, such as high blood sugar

Warnings and precautions

• Divigel should not be used if you are pregnant or think you may be pregnant, as it is not intended for use in pregnant women. Estrogen in Divigel can pass into breast milk and may reduce the amount and quality of breast milk, so talk to your healthcare provider if you are breastfeeding.
• If you currently have or have had liver problems, you should not use Divigel, since estrogen is processed by the liver and liver problems can increase side effects. It isn't known exactly how Divigel interacts with alcohol you drink, so check with your doctor before drinking. Note that the gel itself contains alcohol and is flammable until dry.
• Using estrogen alone increases the chance of getting cancer of the uterus (womb)
• Report any unusual vaginal bleeding right away, since it may be a warning sign of uterine cancer after menopause
• Do not use estrogen alone to try to prevent heart disease, heart attacks, strokes, or dementia
• Using estrogen alone may increase the chance of having a stroke or blood clot
• Divigel can cause side effects in a child who touches the skin where the gel was applied
• The gel contains alcohol and is flammable, so avoid fire, flame, or smoking until it has fully dried
• Do not let another person touch the area of skin where you applied the gel for at least an hour, and avoid letting other people or pets have direct contact with the wet gel

Storage

• Store at 20–25°C (68–77°F) at controlled room temperature
• Keep individual packets in their original packaging until ready to use
• Protect from excessive heat, moisture, and direct sunlight
• Keep away from open flames, sparks, and smoking until the applied gel has dried
• Keep out of reach and sight of children and pets

When to see a doctor

Call your healthcare provider right away if you notice new breast lumps, unusual vaginal bleeding, changes in vision or speech, sudden severe headaches, severe chest or leg pain (with or without shortness of breath, weakness, or fatigue), or swelling of the face, lips, and tongue with or without red, itchy bumps.

If you get the gel in your eyes, flush your eyes right away with lukewarm water, and contact your healthcare provider if you have concerns. If you overdose, seek emergency medical help. Overdose may cause nausea, vomiting, stomach pain, breast tenderness, drowsiness, and vaginal bleeding.

Alternatives

• Climara
• Estradot
• Elestrin
• EstroGel