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Estradiol (Absorbed through the skin)

Estradiol (es-tra-DYE-ol)

Treats hot flashes and other symptoms of menopause or low amounts of estrogen.

Brand Name(s):

Divigel, Estrasorb, EstroGel, Evamist

There may be other brand names for this medicine.

When This Medicine Should Not Be Used:

Do not use this medicine if you have had an allergic reaction to estradiol. You should not use this medicine if you have liver disease, breast cancer, or other certain types of cancer. You should not use this medicine if you have a history of blood clots or a problem with blood clotting, or if you have had a heart attack or stroke. Do not use this medicine if you may be pregnant or if you have unusual vaginal bleeding that has not been checked by your doctor. This medicine should not be used to prevent heart disease, heart attack, stroke, or dementia.

How to Use This Medicine:

Liquid Mixture, Gel/Jelly, Spray

  • Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.This medicine is usually applied once a day, at the same time each day.
  • Use this medicine only on your skin. Rinse it off right away if it gets on a cut or scrape. Do not get the medicine in your eyes, nose, or mouth.
  • Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
  • Wash your hands with soap and water before and after you use this medicine.
  • To use the emulsion:
    • Apply the emulsion to your legs. The usual daily dose is 2 foil pouches, 1 for each leg.
    • Cut or tear open the first pouch at the notches near the top. Squeeze out all of the medicine from the pouch onto the top of your left thigh. Rub the medicine thoroughly into your thigh and calf, for about 3 minutes. Repeat these steps to apply the medicine in the second pouch to the right thigh and calf.
    • Allow the medicine to dry completely before you dress. Wait at least 25 minutes before you put on a sunscreen.
  • To use the gel:
    • The gel form of this medicine comes in a pump. You get the correct dose of estradiol each time you press the pump. You may need to prime the pump by pumping 2 or 10 times the first time you use it. Follow the patient instructions for the container you use. After you prime the pump, do not press the pump more than 1 time each time you use it.
    • Apply the gel to clean, dry, and unbroken skin. Spread the gel as thinly as possible over the entire area on the inside and outside of 1 arm from the wrist up to the shoulder area. Do not apply the medicine directly to your breasts or in or around your vagina.
    • Do not allow others to come in contact with the area of skin where you applied the gel for at least 1 to 2 hours hour after you use the medicine. Do not allow others to apply the gel for you. Allow the medicine to dry for at least 5 minutes before you dress.
    • Apply sunscreen at least 25 minutes after using Elestrin® gel. Avoid applying sunscreen on the same application site for 7 days or more.
  • To use the spray:
    • The spray form of this medicine comes in an applicator that delivers the same amount of estradiol with each spray. You need to prime the pump of a new spray applicator before you use it. Hold the spray upright and pump it 3 times. You only need to prime the pump the first time you use a new spray applicator; do not prime again.
    • Apply the medicine to clean, dry, and unbroken skin on the inside of the forearm between the elbow and the wrist. Do not apply the medicine directly to your breasts or in or around the vagina.
    • Allow the medicine to dry for at least 2 minutes before you dress. Wait at least 1 hour before you wash your skin.
    • If your doctor tells you to increase your dose, move the applicator to an area of the skin next to your previous application site before you apply the next dose. Do this for each spray.
    • Do not rub Evamist® spray into your skin.
    • Always place the protective cover back on the applicator.
    • Do not use the applicator for more than 75 sprays.
    • Apply sunscreen at least 1 hour before you apply Evamist®.
  • The estradiol gel and spray are flammable. Do not use these medicines near an open flame or while smoking.

If a dose is missed:

  • Apply a dose as soon as you can. If it is almost time for your next dose, wait until then and apply a regular dose. Do not apply extra medicine to make up for a missed dose. Do not use Evamist® spray if it has been more than 12 hours since you missed your last dose. Wait and apply your normal dose the next day.

How to Store and Dispose of This Medicine:

  • Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
  • Ask your pharmacist or doctor how to dispose of the medicine container and any leftover or expired medicine.
  • Keep all medicine out of the reach of children. Never share your medicine with anyone.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

  • Make sure your doctor knows if you also use a blood thinner (such as warfarin, Coumadin®), carbamazepine (Tegretol®), clarithromycin (Biaxin®), erythromycin (E.E.S.®, Ery-tab®), itraconazole (Sporanox®), ketoconazole (Nizoral®), phenobarbital (Luminal®), rifampin (Rifadin®, Rifater®, Rimactane®), ritonavir (Norvir®), St. John's wort, or thyroid medicine (levothyroxine, Synthroid®).
  • Do not put cosmetics or skin care products on the treated skin.
  • Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Warnings While Using This Medicine:

  • Pregnancy after menopause is not likely, but if you think you could be pregnant, tell your doctor. This medicine could harm an unborn baby.
  • Make sure your doctor knows if you are breastfeeding or if you have endometriosis or a history of cancer. Tell your doctor if you have asthma, diabetes, edema (body swelling), epilepsy, high or low calcium in the blood, inherited angioedema (swelling of the face, tongue, or throat), kidney disease, lupus, migraine headaches, porphyria, or thyroid problems. Your doctor should know if you have heart disease, high blood pressure, high cholesterol, or a family history of high cholesterol. Tell your doctor if you have ever had liver problems caused by pregnancy or estrogen.
  • Your risk of heart attack, stroke, or blood clots may increase if you use this medicine for a long time. This risk may continue even after you stop using the medicine. Your risk for these serious problems is even greater if you have high blood pressure, high cholesterol in your blood, or diabetes. Your risk is also greater if you are overweight or smoke cigarettes. Talk to your doctor about your personal risks compared with the benefits of this medicine.
  • Using this medicine over long periods of time may increase your risk of some kinds of cancer, including cancer of the uterus. Check with your doctor right away if you have unusual vaginal bleeding.
  • Tell your doctor if you have a severe headache or vision changes. Your doctor may want you to have your eyes checked by an eye doctor.
  • Do not allow children or pets to touch the skin where you applied the medicine. The medicine could be passed to any child or pet who touches the area. Check with your child's doctor right away if your child starts to have breast swelling or tenderness or other sexual changes.
  • Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine before you have surgery or if you need to stay in bed for a long time. This medicine may affect the results of certain medical tests.
  • This medicine may increase the risk of dementia (loss of some mental abilities, such as memory or judgment) in women over 65 years of age. Talk with your doctor about this risk.
  • Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.You should have regular pelvic exams, breast exams, and mammograms.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Breast lumps
  • Chest pain, shortness of breath, or coughing up blood
  • Numbness or weakness in your arm or leg, or on one side of your body
  • Pain in your lower leg (calf)
  • Seizures
  • Sudden and severe stomach pain, with or without nausea, vomiting, fever, and lightheadedness
  • Sudden or severe headache, problems with vision, speech, or walking
  • Swelling in your hands, ankles, or feet
  • Unusual vaginal bleeding
  • Yellowing of your skin or the whites of your eyes

If you notice these less serious side effects, talk with your doctor:

  • Back pain
  • Changes in weight or hair growth
  • Headache
  • Nausea, vomiting, or stomach cramps
  • Runny or stuffy nose, sore throat, or fever
  • Skin redness or itching where the medicine is applied
  • Swollen or tender breasts

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Last Updated: 4/4/2014

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