When Dotti Isn't Available, You Still Have Options

If you've been prescribed Dotti for menopause symptoms and can't find it at your pharmacy, you're dealing with one of the most frustrating parts of the 2026 estradiol patch shortage. But here's the good news: Dotti isn't the only way to get estradiol into your system.

Several alternatives deliver the same active ingredient — estradiol — through different products or delivery methods. Your doctor can help you switch without missing a beat. In this post, we'll walk through the most common alternatives, how they compare, and what to ask your doctor.

What Is Dotti and How Does It Work?

Dotti is a twice-weekly estradiol transdermal patch made by Amneal Pharmaceuticals. It sticks to your skin (usually on the lower abdomen or upper buttocks) and slowly releases estradiol — the most potent naturally occurring form of estrogen — into your bloodstream over 3 to 4 days.

Doctors prescribe it for:

• Moderate to severe hot flashes due to menopause
• Vaginal dryness and discomfort (vulvar and vaginal atrophy)
• Prevention of postmenopausal osteoporosis

Dotti comes in doses from 0.025 mg/day up to 0.1 mg/day. For a deeper look, read What Is Dotti? Uses, Dosage, and What You Need to Know.

How Does Estradiol Work in the Body?

Estradiol binds to estrogen receptors throughout your body — in your brain, bones, heart, and reproductive tissues. During menopause, your ovaries produce dramatically less estrogen, leading to hot flashes, night sweats, vaginal dryness, mood changes, and bone loss.

Replacing that estrogen with a product like Dotti restores hormonal balance and relieves those symptoms. The key point: all of the alternatives below deliver the same estradiol molecule. The difference is in how they get it into your body. For more on the science, see How Does Dotti Work? Mechanism of Action Explained.

Alternative 1: Climara (Once-Weekly Estradiol Patch)

Climara is an estradiol transdermal patch made by Bayer. The biggest difference from Dotti? You only change it once a week instead of twice.

Key details:

• Available in 0.025, 0.0375, 0.05, 0.06, 0.075, and 0.1 mg/day doses
• Applied to the lower abdomen or upper buttocks
• Same active ingredient (estradiol) as Dotti
• May be easier to find during the current shortage since it's made by a different manufacturer
• Cash price: approximately $27 to $84 with a coupon (GoodRx)

Best for: Patients who prefer fewer patch changes and want a convenient once-weekly option.

Alternative 2: Generic Estradiol Patches (Vivelle-Dot Equivalents)

Dotti itself is essentially a reformulated version of Vivelle-Dot. Several manufacturers make generic estradiol transdermal patches that are bioequivalent — meaning they deliver the same dose of estradiol in the same way.

Key details:

• Applied twice weekly, just like Dotti
• Available in the same dose range (0.025 to 0.1 mg/day)
• Often significantly cheaper: as low as $25 to $50 with a coupon
• May be available when brand-name Dotti is not

Best for: Patients who want the same twice-weekly patch format and want to save money.

Alternative 3: EstroGel or Divigel (Estradiol Topical Gel)

If patches aren't available at all, estradiol gel is an excellent alternative. EstroGel and Divigel are applied directly to the skin daily, where the estradiol absorbs through your skin into your bloodstream.

Key details:

• Applied once daily to the arm (EstroGel) or thigh (Divigel)
• Same active ingredient as Dotti
• No adhesive — good for patients who get skin irritation from patches
• Must be careful not to let others (especially children) touch the application area
• EstroGel cash price: approximately $130 to $170 retail; less with coupons

Best for: Patients who have skin reactions to patch adhesive, or when no patches of any kind are available.

Alternative 4: Oral Estradiol (Estrace and Generics)

Oral estradiol tablets are the most widely available and cheapest form of estradiol. Generic oral estradiol can cost as little as $4 to $15 per month.

Key details:

• Taken once daily by mouth
• Available in 0.5 mg, 1 mg, and 2 mg tablets
• Very affordable and rarely in shortage
• Undergoes first-pass liver metabolism, which may slightly increase the risk of blood clots compared to transdermal delivery
• Your doctor may prefer transdermal for patients with clotting risk factors

Best for: Patients who need an affordable, readily available option and don't have elevated clotting risk.

How to Switch: What to Ask Your Doctor

Switching between estradiol products is usually straightforward, but always do it with your doctor's guidance. Here are good questions to ask:

• "Can you prescribe me an alternative estradiol product that's in stock?"
• "Is there a dose equivalent between my current Dotti patch and the alternative?"
• "Should I be concerned about any difference in side effects with a different delivery method?"
• "Do I need to adjust my progestogen if I switch estradiol formulations?"

Your doctor can also check Medfinder or ask your pharmacist which specific products are currently available in your area.

Final Thoughts

A shortage doesn't mean you have to go without hormone therapy. Dotti is one of many ways to get estradiol, and your doctor can help you transition smoothly to an alternative that's available right now.

Use Medfinder to check what's in stock near you, and read our guide on how to find Dotti in stock for more strategies. If cost is a concern, check out how to save money on Dotti.

The goal is keeping your treatment on track — and there are plenty of ways to do that.