Alternatives to an estrogen patch
When no patch in your strength can be found, a prescriber may move you to another form of estradiol. Here is what is sold in the US, and what menopause societies publish as roughly similar doses.
Other forms of estradiol in the US
| Product | Form | What one dose holds | Label |
|---|---|---|---|
| EstroGel 0.06%Ascend | Gel, metered pump, on the arm | 0.75 mg estradiol per pump. One pump a day is the single US-approved dose. | DailyMed |
| Divigel 0.1%Vertical; Amneal generic | Gel, single packets, on the thigh | 0.25, 0.5, 0.75, 1.0 or 1.25 mg a packet | DailyMed |
| ElestrinViatris | Gel, metered pump | 0.52 mg per pump | DailyMed |
| EvamistPadagis | Spray, inner forearm | 1.53 mg per spray, one to three sprays a morning | DailyMed |
| FemringMillicent | Vaginal ring, changed every 3 months | 0.05 or 0.10 mg a day; approved for hot flashes, so it acts on the whole body | DailyMed |
| Estradiol tabletsMany makers | Tablet, by mouth | 0.5, 1 or 2 mg | DailyMed |
Vaginal products such as Vagifem, Estring and Estrace cream are approved for vaginal symptoms, not hot flashes, so they are not a swap for a patch (Estring label, Vagifem label).
Tablets are a different route. The North American Menopause Society's 2022 position statement says transdermal routes and lower doses "may decrease risk of venous thromboembolism and stroke" (NAMS), which is one reason a prescriber may prefer a gel or spray to tablets for some people.
What the societies list as similar doses
These tables come from the Canadian, Australasian and British menopause societies. They are written for clinicians, all three call the figures approximate, and they disagree in places: at 50 mcg the Canadian table gives 1 mg of oral estradiol and the Australian sheet gives 2 mg. The US EstroGel label approves one pump a day only; the higher pump counts reflect use in other countries.
0.025 mg patch (25 mcg)
| Published by | Gel | Gel sachet | Tablet |
|---|---|---|---|
| Canadian Menopause SocietyCanada | EstroGel 1 pump | Divigel 0.5 mg | Estradiol 0.5 mg |
| Australasian Menopause SocietyAustralia | Estrogel 1 pump | Sandrena 0.5 mg | Estradiol 1 mg |
| British Menopause SocietyUK | Oestrogel 1 measure | Sandrena 0.5 mg | Not given |
0.0375 mg patch (37.5 mcg)
| Published by | Gel | Gel sachet | Tablet |
|---|---|---|---|
| Canadian Menopause SocietyCanada | EstroGel 1 pump | Divigel 0.5 mg | Estradiol 0.5 mg |
| Australasian Menopause SocietyAustralia | Estrogel 1 pump | Sandrena 0.5 mg | Estradiol 1 mg |
0.05 mg patch (50 mcg)
| Published by | Gel | Gel sachet | Tablet |
|---|---|---|---|
| Canadian Menopause SocietyCanada | EstroGel 1 to 2 pumps | Divigel 1.0 mg | Estradiol 1 mg |
| Australasian Menopause SocietyAustralia | Estrogel 2 pumps | Sandrena 1 mg | Estradiol 2 mg |
| British Menopause SocietyUK | Oestrogel 2 measures | Sandrena 1 mg | Not given |
0.075 mg patch (75 mcg)
| Published by | Gel | Gel sachet | Tablet |
|---|---|---|---|
| Canadian Menopause SocietyCanada | EstroGel 2 to 3 pumps | Divigel 1.0 mg + 0.5 mg | Estradiol 2 mg |
| Australasian Menopause SocietyAustralia | Estrogel 3 pumps | Sandrena 1.5 mg | Not given |
| British Menopause SocietyUK | Oestrogel 3 measures | Not given | Not given |
0.1 mg patch (100 mcg)
| Published by | Gel | Gel sachet | Tablet |
|---|---|---|---|
| Canadian Menopause SocietyCanada | EstroGel 4 pumps | Divigel 1.0 mg × 2 | Estradiol 3 to 4 mg |
| Australasian Menopause SocietyAustralia | Estrogel 3 or 4 pumps | Sandrena 1.5 mg | Not given |
| British Menopause SocietyUK | Oestrogel 4 measures | Not given | Not given |
Sandrena is a UK and Australian gel sachet, the counterpart of Divigel. Oestrogel is the UK name for EstroGel. None of the three tables gives a row for Evamist or for the 0.06 mg patch. The Australian sheet's layout is hard to read in places; open it for the exact wording.
These tables are for prescribers. Moving between forms means a new prescription, and absorption differs from person to person, so a dose often needs adjusting after a switch.
Get one email when your strength is back
Pick the strength on your box. When ASHP, the makers or Drug Shortages Canada list it as back in normal supply, we write once with what changed.
Sources
- EstroGel 0.06% label, DailyMed, Ascend Therapeutics, May 29, 2026.
- Divigel 0.1% label, DailyMed, Vertical Pharmaceuticals, February 27, 2026.
- Elestrin label, DailyMed, Viatris, December 15, 2023.
- Evamist label, DailyMed, Padagis, October 29, 2024.
- Femring label, DailyMed, Millicent, December 9, 2025.
- Estradiol tablets USP label, DailyMed, Teva, February 1, 2024.
- Estring label, DailyMed, Pfizer, April 23, 2026.
- Vagifem label, DailyMed, Novo Nordisk, February 12, 2025.
- The 2022 hormone therapy position statement, The North American Menopause Society, July 1, 2022.
- Systemic Menopause Hormone Therapy (MHT) Equivalency Table, Canadian Menopause Society, January 1, 2025.
- AMS Guide to MHT/HRT Doses, Australia, Australasian Menopause Society, December 20, 2024.
- HRT preparations and equivalent alternatives, British Menopause Society, August 1, 2026.
- Menopausal Hormone Therapy Shortage, Canadian Pharmacists Association, March 13, 2026.