What Is Divigel?

Divigel is a prescription topical gel containing Estradiol, a form of estrogen. It's classified as hormone replacement therapy (HRT) and is manufactured by Vertical Pharmaceuticals, LLC (produced by Orion Corporation in Finland).

Divigel is FDA-approved to treat moderate to severe vasomotor symptoms due to menopause — commonly known as hot flashes and night sweats. It delivers Estradiol through the skin (transdermally), which many doctors consider a preferred route because it bypasses the liver.

What Is Divigel Used For?

FDA-Approved Use

Divigel is approved for one specific indication: treating moderate to severe hot flashes caused by menopause. These vasomotor symptoms occur when declining estrogen levels affect the brain's temperature-regulation center, causing sudden feelings of intense heat, sweating, and flushing.

Other Uses

While not FDA-approved for these purposes, doctors sometimes prescribe Estradiol gel for:

• Vaginal dryness related to menopause
• Bone loss prevention in postmenopausal women
• Gender-affirming hormone therapy

These off-label uses should be discussed with your doctor to determine if Divigel is appropriate for your situation.

How Does Divigel Work?

Divigel delivers Estradiol through the skin into your bloodstream. Once absorbed, Estradiol binds to estrogen receptors throughout the body, restoring the estrogen levels that drop during menopause. This helps stabilize the hypothalamic thermoregulatory center — the part of your brain that controls body temperature — reducing the frequency and severity of hot flashes.

For a more detailed explanation, see our article on how Divigel works.

Divigel Dosage Options

Divigel comes in single-dose foil packets in five strengths:

• 0.25 g (0.25 mg Estradiol)
• 0.5 g (0.5 mg Estradiol)
• 0.75 g (0.75 mg Estradiol)
• 1.0 g (1.0 mg Estradiol)
• 1.25 g (1.25 mg Estradiol)

Your doctor will typically start you on a low dose and adjust based on how well your symptoms respond. The goal is to use the lowest effective dose for the shortest time needed.

How to Apply Divigel

Applying Divigel correctly is important for it to work properly. Here's how:

1. Choose the application site. Apply to a clean, dry area on your upper thigh (about 5 by 7 inches). Alternate between your right and left thigh each day.
2. Open the packet. Tear open one foil packet and squeeze out the entire contents.
3. Spread the gel. Apply it in a thin layer on your thigh. Do not rub it in vigorously.
4. Let it dry. Allow the gel to dry completely before getting dressed. This takes a few minutes.
5. Wash your hands. Wash your hands thoroughly with soap and water after applying.
6. Wait before washing. Do not wash the application area for at least 1 hour after applying.

Important Application Tips

• Do NOT apply to: Face, breasts, irritated skin, or in/around the vagina
• Fire safety: The gel contains alcohol and is flammable until dry. Avoid fire, flames, or smoking until the gel has dried completely.
• Avoid skin contact with others: Until the gel is dry, avoid skin-to-skin contact with other people, especially children, at the application site.
• Apply at the same time daily for consistent hormone levels.

Who Should NOT Use Divigel?

Divigel is not safe for everyone. You should not use it if you have:

• Undiagnosed abnormal vaginal bleeding
• Known or suspected breast cancer (or a history of breast cancer)
• Known or suspected estrogen-dependent tumors
• Active or history of blood clots (deep vein thrombosis or pulmonary embolism)
• Active or recent stroke or heart attack
• Known allergy to Divigel or any of its ingredients
• Liver disease or impairment
• Known blood clotting disorders (protein C, protein S, or antithrombin deficiency)

If you have a uterus, your doctor will likely prescribe a progestogen alongside Divigel to protect against endometrial cancer.

Common Side Effects

Like all medications, Divigel can cause side effects. The most common include:

• Stuffy nose or cold-like symptoms
• Headache
• Breast tenderness
• Vaginal yeast infections
• Irregular bleeding or spotting
• Skin irritation at the application site

Most side effects are mild and improve within the first few months. For a complete breakdown, read our guide to Divigel side effects.

Drug Interactions

Some medications can affect how Divigel works:

• CYP3A4 inducers (St. John's Wort, Phenobarbital, Carbamazepine, Rifampin) can decrease Estradiol levels, making Divigel less effective.
• CYP3A4 inhibitors (Erythromycin, Ketoconazole, Ritonavir) can increase Estradiol levels, raising the risk of side effects.
• Thyroid medications may need dose adjustment because estrogen increases thyroid-binding globulin.

Always tell your doctor about every medication and supplement you take. Learn more in our Divigel drug interactions guide.

How Much Does Divigel Cost?

Cost depends on whether you use brand-name Divigel or generic Estradiol gel:

• Brand Divigel: $650 to $900 per month (retail price)
• Generic Estradiol gel: $32 to $50 per month with discount coupons (GoodRx, SingleCare)

Most insurance plans cover generic Estradiol gel. Brand Divigel may require prior authorization. The manufacturer also offers a savings program at divigel.com/start-saving/ that can save eligible patients up to $25 per copay.

For all your savings options, check out our guide to saving money on Divigel.

Divigel vs. Other Estrogen Products

Divigel isn't the only estrogen option available. Here's how it compares:

• EstroGel — Another Estradiol gel, applied via pump dispenser instead of packets. Available as brand and generic.
• Estradiol patches (Climara, Vivelle-Dot, Dotti) — Applied once or twice weekly. Provide steady hormone levels but may cause skin irritation.
• Estrace (oral Estradiol) — Taken daily as a pill. Convenient but goes through the liver, which may increase clot risk.
• Bijuva — Combines Estradiol and Progesterone in one capsule for women with a uterus.

For a detailed comparison, see Divigel alternatives.

Finding Divigel in 2026

While Divigel itself isn't on the FDA shortage list, broader HRT supply disruptions have made some estrogen products harder to find. If you're having trouble, Medfinder can help you check pharmacy stock near you without making phone calls.

Need a doctor who can prescribe Divigel? Read our guide to finding a Divigel prescriber near you.