Estrogel vs. Estradot: What’s the Difference?

According to a report published in 2025, more than 10 million Canadian women (equating to roughly one quarter of our nation’s population) are living with menopause. Of those, 80% report experiencing symptoms like hot flashes and night sweats, with 25% stating their symptoms are severe enough to disrupt daily life.    

Hormone replacement therapy (HRT) is an option for women seeking relief from troubling menopause symptoms. HRT may be delivered via transdermal patches or gels (applied to the skin) or oral tablets. Research shows that transdermal estrogen therapy may be a safer option than oral routes.

Two of the most popular transdermal HRT options available in Canada are Estrogel and Estradot. Both contain estradiol, a bioidentical form of estrogen, but they differ in how they’re applied and used. Understanding these differences can help you and your healthcare provider choose the option that best fits your lifestyle and medical needs.

An Overview of HRT for Women

When estrogen levels decline, many women experience uncomfortable symptoms that can significantly impact their quality of life, such as:

• Vasomotor symptoms (VMS) – Primarily hot flashes and night sweats.
• Sleep disturbances – Difficulty staying asleep through the night and waking up early.
• Trouble concentrating – Experiences of “brain fog” and difficulty concentrating.
• Tiredness and fatigue – Feeling run down (potentially related to sleep problems)
• Genitourinary symptoms – Vaginal dryness, frequent UTIs, and libido changes.
• Musculoskeletal issues – Aches and pains in joints. Loss of bone density.
• Changes in mood – Anxiety, irritability, and fluctuating mood. 

Hormone replacement therapy works by supplementing the estrogen that your body stops producing during menopause, with the goal of alleviating the symptoms described above. HRT may also be used in situations outside of menopause, when clinically warranted. 

Different Types of HRT

HRT comes in several forms, but they fall into two main categories: oral and transdermal.

Oral estrogen is taken as a pill and processed through the digestive system and liver before entering the bloodstream. While effective, this route of administration can increase certain health risks, including blood clots and stroke, particularly in women over 60.

Transdermal estrogen—delivered through patches, gels, or sprays—is absorbed directly through the skin into the bloodstream. This bypasses the liver and may carry a lower risk of blood clots compared to oral estrogen. For this reason, many healthcare providers now prefer transdermal options like Estrogel or Estradot as first-line therapy for menopause symptoms.

What is Estrogel?

Estrogel is the brand name for a topical estradiol gel used to treat moderate to severe menopause symptoms. It contains 0.06% estradiol and is applied directly to the skin once daily. The gel is absorbed through your skin and enters your bloodstream, providing systemic hormone replacement to alleviate symptoms like hot flashes and vaginal changes.

The most common way to get Estrogel is in a pump dispenser (sometimes called an Estrogel pump). The typical starting dose is one pump per day (0.75 mg of estradiol), though your doctor may adjust this based on your symptoms and response to treatment. Some women may require two to four pumps daily for adequate symptom relief.

One advantage of Estrogel is its flexibility. Because you apply it daily, your healthcare provider can easily adjust your dose by changing the number of pumps you use. This makes it particularly useful for women who need personalized dosing or are just starting HRT and need to find their optimal dose.

Estrogel is approved by Health Canada for hormone replacement therapy in postmenopausal women. It’s also sometimes used in gender-affirming hormone therapy, though this is considered an off-label use.

What is Estradot?

Estradot is the brand name for a transdermal patch that delivers estradiol through your skin over several days. Unlike Estrogel, which requires daily application, Estradot patches are applied twice weekly (typically changed every 3 to 4 days).

Estradot patches are available in five different strengths: 25 mcg, 37.5 mcg, 50 mcg, 75 mcg, and 100 mcg. The number refers to the amount of estradiol delivered per day. Most women start with a 50 mcg patch, and their healthcare provider adjusts the strength based on symptom control and side effects.

The patches are thin, transparent, and designed to stick to your skin even during activities like showering, swimming, and exercise. Each patch contains enough estradiol to last for several days, providing a steady, continuous release of hormone into your bloodstream.

Estradot is manufactured by Sandoz Canada and is one of several estradiol patch brands available in Canada. Like Estrogel, it’s approved for managing menopause symptoms and preventing osteoporosis in postmenopausal women.

Estrogel vs. Estradot: Key Differences

While both Estrogel and Estradot deliver estradiol through the skin, there are several important differences to consider when choosing between them.

1. Application Method and Frequency

The most obvious difference is how often you need to use each product. Estrogel requires daily application—you apply the gel to your arm or shoulder each morning or evening. Estradot patches, on the other hand, only need to be changed twice per week.

For some women, the daily routine of applying Estrogel feels more manageable and gives them a sense of control over their treatment. Others prefer the convenience of Estradot’s twice-weekly schedule, which requires less frequent attention.

2. Dosing Flexibility

Estrogel offers more flexibility in adjusting doses. Since you apply it daily, your doctor can increase or decrease your dose by simply changing the number of pumps you use. This can be adjusted in small increments (0.75 mg per pump).

With Estradot, dose adjustments require switching to a different patch strength. While patches come in multiple strengths, the increments are larger. Some women work around this by using multiple lower-dose patches to achieve their target dose, though this isn’t always practical.

3. Visibility and Discretion

Estrogel is invisible once absorbed into the skin, which takes just a few minutes. However, you need to avoid skin-to-skin contact with others for at least one hour after application to prevent transferring estrogen to them.

Estradot patches are small and transparent but still visible on the skin. Some women find this noticeable, especially during intimacy or when wearing certain clothing. Others don’t mind the visibility and appreciate the visual reminder that their medication is in place.

4. Lifestyle Considerations

Your daily routine and activities may influence which option works better for you. Estrogel requires that you allow time for the gel to dry (about 5 minutes) before getting dressed. You also need to avoid washing the application area for several hours.

Estradot patches can occasionally come loose or fall off, particularly with heavy sweating, swimming, or in hot, humid conditions. If a patch falls off, you need to apply a new one, which can be inconvenient if you’re traveling or don’t have extras on hand.

5. Estrogel and Estradot Cost in Canada

Pricing for both medications can vary depending on your location, pharmacy, and insurance coverage. Without insurance, Estrogel typically costs between $30-$60 per month, depending on your dose. Estradot patches generally cost $40-$70 per month.

Provincial drug plans in some Canadian provinces may cover these medications for specific indications, but coverage varies. Private insurance plans often provide some coverage for hormone replacement therapy, though you may still have out-of-pocket costs.

How to Apply Estrogel

Applying Estrogel correctly ensures you get the right dose and minimizes the risk of transferring estrogen to others. Here are the general instructions, but be sure to check the packaging of your particular product:

• Apply the gel once daily, at the same time each day if possible. 
• Pump the prescribed number of doses into your hand and spread it in a thin layer over a large area—typically from your shoulder to your wrist on one arm. 
• Some doctors recommend using both arms to spread the application over a larger surface area.
• Allow the gel to dry completely before getting dressed, which usually takes about 5 minutes. Avoid washing the application area for at least one hour after applying.
• Avoid direct skin-to-skin contact with others for at least one hour to prevent transferring estrogen.

You should never apply Estrogel to your breasts, face, or vaginal area. These areas have higher absorption rates and could lead to excessive estrogen levels. Also, take care to avoid applying the gel to irritated or broken skin.

How to Apply an Estradot Patch

Applying an Estradot patch is reasonably straightforward. Below are some standard practices, but always check the instructions that came with your patch:

• An estradot patch should be applied to clean, dry, intact skin on your lower abdomen or buttocks. Avoid applying patches to your breasts, waistline (where clothing might rub), or areas where you sit.
• Change your patch twice weekly—every 3 to 4 days. Many women find it helpful to change patches on the same days each week (like Sunday and Wednesday) to establish a routine.
• When removing the old Estradot patch, peel it off gently and fold it in half with the sticky sides together before disposing of it safely. Apply the new patch to a different area than the previous one to avoid skin irritation. Rotate between different spots on your abdomen or buttocks.

If an Estradot patch falls off before it’s time to change it, apply a new one immediately, but continue with your regular patch-changing schedule. Estradot patches are designed to stay on during normal activities, including showering and swimming, though excessive heat or friction may cause them to loosen.

Estrogel and Estradot Side Effects

Both Estrogel and Estradot can cause similar side effects since they contain the same active ingredient. 

Common Side Effects

The most frequently reported side effects of Estrogel and Estradot are:

• Headache
• Breast tenderness
• Nausea, and bloating

These effects usually improve as your body adjusts to the medication.

Irritation at the Application Site

Application site reactions differ between the two products. 

Estrogel can sometimes cause skin irritation, redness, or itching where you apply it. This usually resolves quickly, but can be uncomfortable for some women.

Estradot patches may cause skin irritation, redness, or itching under the patch. Some women develop contact dermatitis from the patch adhesive. If this happens, rotating application sites or switching to Estrogel may help.

Serious Side Effects (Rare)

More serious but less common side effects of estrogen therapy include blood clots, stroke, heart attack, and breast cancer. Transdermal estrogen (both gel and patch) may carry a lower risk of blood clots compared to oral estrogen, though the risk isn’t zero.

Be sure to contact your healthcare provider immediately if you experience unusual vaginal bleeding, severe headaches, chest pain, leg pain or swelling, vision changes, or signs of an allergic reaction.

Which One Is Right for You?

Choosing between Estrogel and Estradot is a decision that should be made in collaboration with your treating doctor. The right choice depends on several factors, including your lifestyle, preferences, and medical considerations.

Estrogel May Be Better If You:

• Prefer daily control over your medication
• Have experienced skin reactions to patch adhesives
• Need very precise dose adjustments
• Travel frequently and don’t want to worry about patches falling off
• Prefer medication that’s not visible on your skin
• Have a consistent daily routine where applying gel fits easily

Estradot May Be Better If You:

• Want to minimize how often you think about your medication
• Have trouble remembering daily medications
• Don’t want to worry about accidental transfer to others
• Prefer the convenience of twice-weekly application
• Have difficulty applying gel evenly
• Want steady hormone levels without daily fluctuations

Medical considerations also play a role. Women with certain skin conditions may find using an Estradot patch irritating. And those with arthritis or limited hand mobility might find Estrogel application challenging. Your healthcare provider can help assess which option suits your specific situation.

Important Safety Information

Certain safety considerations apply to all estrogen therapy (including Estrogel and Estradot).

If you still have your uterus, you’ll need to take a progestin medication alongside your estrogen therapy. Estrogen alone can cause thickening of the uterine lining, which increases the risk of endometrial cancer. Adding progestin protects against this risk.

Estrogen therapy is not suitable for everyone. Your doctor may advise against Estrogel or Estradot if you have a history of breast cancer, blood clots, stroke, liver disease, or unexplained vaginal bleeding. Women who are pregnant or may become pregnant should not use estrogen therapy.

Regular monitoring is important when taking hormone replacement therapy. Your healthcare provider will typically see you 3 months after starting treatment, then annually thereafter. They may order blood tests to check hormone levels and ensure your dose is appropriate.

The goal of HRT is to use the lowest effective dose for the shortest time necessary to manage your symptoms. Regular check-ins with your doctor help ensure you’re still benefiting from treatment and that the benefits continue to outweigh the risks.

Frequently Asked Questions

Is Estrogel or Estradot more effective?

Both are equally effective when dosed appropriately. Studies show similar symptom relief and hormone levels with both gel and patch formulations. The “better” option depends on which you’ll use consistently and which fits your lifestyle.

Can I switch between Estrogel and Estradot?

Yes, you can switch between them under medical supervision. Your doctor will calculate an equivalent dose when switching. Some women switch due to side effects, convenience, or medication availability.

How long does it take for HRT to work?

Most women notice improvement in hot flashes and night sweats within 2-4 weeks of starting treatment. Vaginal symptoms may take longer to improve, often 8-12 weeks. Full benefits of HRT are typically seen after 3 months of consistent use.

Are Estrogel and Estradot covered by insurance in Canada?

Coverage varies by province and insurance plan. Some provincial drug plans cover these medications for specific conditions, while private insurance often provides partial coverage. Check with your insurance provider for specific details about your coverage.

What should I do if I miss a dose?

For Estrogel, apply it as soon as you remember on the same day. If you remember the following day, skip the missed dose and continue with your regular schedule. For Estradot, apply a new patch as soon as you remember, then continue with your regular twice-weekly schedule. Contact your doctor for advice if you fall more than 24 hours behind on either medication.

Can I use Estrogel or Estradot long-term?

Duration of HRT is an individual decision made with your healthcare provider. Current guidelines recommend using the lowest effective dose for the shortest duration needed to manage symptoms. Many women use HRT to manage menopause for 3-5 years, though some continue longer depending on their benefits and risks.

Estrogel vs. Estradot: Final Thoughts

Estrogel and Estradot are both effective treatment options for managing menopause symptoms (and other situations in which HRT may be required). Estrogel offers daily application with flexible dosing, while Estradot provides convenient twice-weekly patches with steady hormone delivery.

The choice between them comes down to personal preference, lifestyle factors, and individual medical considerations. Both deliver the same hormone through the skin, avoiding some of the risks associated with oral estrogen while effectively relieving hot flashes, night sweats, and other menopause symptoms.

If you’re considering hormone replacement therapy or want to discuss whether Estrogel or Estradot might be right for you, speaking with a healthcare provider is the best next step. At Walk In, Canadian-licensed doctors are available for virtual consultations to discuss your menopause symptoms and HRT options from the comfort of your home.

Speak With a Doctor About Hormone Replacement Therapy