Dotti at a Glance

Dotti is a prescription estradiol transdermal patch used to treat menopause symptoms. It delivers estradiol — the most potent naturally occurring form of estrogen — through the skin and into the bloodstream. It's made by Amneal Pharmaceuticals and is applied twice weekly (every 3 to 4 days).

If you've recently been prescribed Dotti or you're researching hormone replacement therapy (HRT) options, this guide covers everything you need to know: what it's used for, how it works, dosing, side effects, and how to find it in 2026.

What Is Dotti Used For?

Dotti is FDA-approved for three main uses:

1. Hot Flashes and Night Sweats

The most common reason women are prescribed Dotti is for moderate to severe vasomotor symptoms — the medical term for hot flashes and night sweats caused by menopause. As estrogen levels drop during menopause, the body's temperature regulation gets disrupted. Dotti restores estrogen levels to help reduce these symptoms.

2. Vaginal Atrophy

Declining estrogen can cause the vaginal tissues to become thin, dry, and inflamed — a condition called vulvar and vaginal atrophy. Dotti can help by restoring systemic estrogen levels, though localized estrogen treatments may also be used.

3. Osteoporosis Prevention

Estrogen plays a key role in maintaining bone density. After menopause, bone loss accelerates. Dotti is approved for the prevention of postmenopausal osteoporosis in women at significant risk, when non-estrogen therapies aren't appropriate.

Off-Label Uses

Dotti and other estradiol patches are also used off-label for:

• Feminizing hormone therapy for transgender women
• Hypoestrogenism due to hypogonadism, castration, or primary ovarian failure

How Does Dotti Work?

Dotti is a transdermal patch — meaning it delivers medication through the skin. The patch contains estradiol (17β-estradiol), which is chemically identical to the estrogen your body produces naturally.

When you apply the patch, estradiol passes through the skin into tiny blood vessels and enters the bloodstream. This bypasses the liver (unlike oral estrogen pills), which is one reason patches may have a lower risk of blood clots.

For a deeper dive, read: How Does Dotti Work? Mechanism of Action Explained.

Available Doses

Dotti comes in five dose strengths, measured by how much estradiol is delivered per day:

• 0.025 mg/day — the lowest dose, often used as a starting point
• 0.0375 mg/day
• 0.05 mg/day — a common mid-range dose
• 0.075 mg/day
• 0.1 mg/day — the highest dose

Your doctor will typically start you on the lowest effective dose and adjust based on how well your symptoms respond and how you tolerate the medication.

How to Apply Dotti

Applying Dotti is straightforward, but there are some important rules to follow:

1. Choose a site: Apply to clean, dry skin on the lower abdomen or upper buttocks. Do NOT apply to the breasts.
2. Peel and stick: Remove the protective liner and press the patch firmly against your skin for about 10 seconds.
3. Wear it for 3-4 days: Replace the patch twice per week. Many patients pick two consistent days (like Monday and Thursday) to make it easy to remember.
4. Rotate sites: Don't apply to the same spot two times in a row. Wait at least one week before reusing a site to reduce skin irritation.
5. Avoid lotions and oils: Don't apply creams, lotions, or powders to the area where the patch will go — they can prevent it from sticking properly.

What If the Patch Falls Off?

If your Dotti patch falls off, try to reapply it. If it won't stick, apply a new patch and keep your regular schedule. Don't use tape or bandages to hold a patch that isn't sticking — it may not deliver the medication properly.

Who Should NOT Use Dotti?

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

• Undiagnosed abnormal vaginal bleeding
• Known or suspected breast cancer (or a history of it)
• Known or suspected estrogen-dependent cancer
• Active or recent blood clots (DVT or PE)
• Active stroke or heart attack
• Liver disease or impairment
• A known allergy to estradiol or any patch components
• Known blood clotting disorders (protein C, protein S, or antithrombin deficiency)
• Pregnancy

Important: Progestogen Use

If you still have your uterus, your doctor will prescribe a progestogen (like progesterone) alongside Dotti. Using estrogen without a progestogen increases the risk of endometrial cancer. If you've had a hysterectomy, you typically don't need a progestogen.

Common Side Effects

Most side effects are mild and improve with time:

• Skin irritation at the patch site
• Headache
• Breast tenderness
• Nausea
• Bloating
• Mood changes
• Back pain

For a complete breakdown, read: Dotti Side Effects: What to Expect and When to Call Your Doctor.

Serious Risks

Like all estrogen products, Dotti carries risks of blood clots, stroke, heart attack, and (with long-term use) breast cancer. However, the FDA removed the black box warning from transdermal estradiol products in November 2025, reflecting updated safety data showing that patches carry lower risks than oral estrogen.

These risks still exist and are listed in the prescribing information. Discuss your personal risk factors with your doctor.

Drug Interactions

Several medications and supplements can affect how Dotti works:

• CYP3A4 inducers (rifampin, carbamazepine, St. John's Wort) may reduce estradiol levels
• CYP3A4 inhibitors (ketoconazole, erythromycin) may increase estradiol levels
• Thyroid medications may need dose adjustments
• Grapefruit juice may increase estradiol levels

Full details here: Dotti Drug Interactions: What to Avoid.

How Much Does Dotti Cost?

Without insurance, Dotti typically costs $105 to $191 for a one-month supply (8 patches). However, with a GoodRx coupon, you may pay as little as $25.

Most insurance plans cover generic estradiol patches with copays ranging from $10 to $30. Some plans may require prior authorization or step therapy (trying oral estradiol first).

Learn how to save: How to Save Money on Dotti: Coupons, Discounts, and Patient Assistance.

Why Is Dotti Hard to Find in 2026?

Dotti and other estradiol patches are currently experiencing supply shortages. The main driver is a surge in demand after the FDA removed the black box warning from transdermal HRT in November 2025. More women are asking for patches, and manufacturers haven't been able to scale up fast enough.

For the full picture: Why Is Dotti So Hard to Find?

If you need help locating it: How to Find Dotti in Stock Near You or try checking stock online: How to Check If a Pharmacy Has Dotti in Stock.

Dotti vs. Other Estradiol Patches

Dotti isn't the only estradiol patch available. Here's how it compares:

• Climara — once-weekly patch (vs. twice-weekly for Dotti). More convenient but some patients prefer the steadier levels of a twice-weekly patch.
• Vivelle-Dot — the original brand that Dotti is based on. Essentially the same product.
• Minivelle — another twice-weekly patch, similar in design to Dotti.
• Generic estradiol patches — various manufacturers make generic twice-weekly patches that are equivalent to Dotti.

If you can't find Dotti, read: Alternatives to Dotti.

Final Thoughts

Dotti is a well-established estradiol patch that helps millions of women manage menopause symptoms. It's effective, generally well-tolerated, and — thanks to the FDA's 2025 update — now carries less alarming labeling than it once did.

The biggest challenge in 2026 isn't the medication itself — it's finding it. Use MedFinder to check availability near you, and don't hesitate to ask your doctor about alternatives if you need them.