| Medication Name | Vivelle Dot |
| Generic Name | Estradiol (Transdermal) |
| Boxed/Label Warning | Estrogen-alone therapy should not be used to prevent heart disease. The Women’s Health Initiative (WHI) estrogen-alone substudy reported increased risk of stroke and deep vein thrombosis (DVT). The WHI estrogen plus progestin substudy reported increased risk of stroke, DVT, heart attack, and pulmonary embolism. Estrogen-alone therapy has been reported to increase the risk of endometrial cancer. Estrogen-alone therapy should not be used in women with known or suspected breast cancer. The WHI estrogen-alone substudy reported increased risk of probable dementia in postmenopausal women 65 years of age and older. |
| Purpose | Hormone replacement therapy (HRT) to treat moderate to severe vasomotor symptoms (hot flashes) and vulvar and vaginal atrophy associated with menopause. |
| Mechanism of Action | Replaces estrogen that the body no longer produces, alleviating menopausal symptoms. Estradiol binds to estrogen receptors in target tissues (e.g., uterus, vagina, breast) to exert its effects. |
| Dosage Forms | Transdermal patch |
| Available Strengths | 0.025 mg/day, 0.0375 mg/day, 0.05 mg/day, 0.075 mg/day, 0.1 mg/day |
| Dosage Frequency | Applied to the skin twice weekly (every 3-4 days) |
| Common Side Effects | Headache, breast tenderness, skin irritation at application site, nausea, vomiting, abdominal cramps, bloating, hair loss, fluid retention. |
| Serious Side Effects | Blood clots (DVT, pulmonary embolism), stroke, heart attack, endometrial cancer, breast cancer, ovarian cancer, gallbladder disease, high blood pressure, elevated triglycerides. |
| Drug Interactions | Warfarin, thyroid hormones, corticosteroids, anticonvulsants (e.g., phenytoin, carbamazepine), St. John’s Wort, grapefruit juice. |
| Important Notes | Use the lowest effective dose for the shortest duration consistent with treatment goals. Rotate application sites to avoid skin irritation. Regular breast exams and mammograms are recommended. Discuss risks and benefits with your doctor. |
| Storage | Store at room temperature, away from heat and moisture. Keep out of reach of children and pets. |
| Missed Dose | Apply a new patch as soon as you remember. Do not double up on patches. Keep the original schedule. |
| Alternatives | Premarin, Estrace, Climara, Activella (estradiol/norethindrone) |