Estradiol Transdermal Patch (Twice-Weekly)
Vivelle-Dot · Estradot
Half-life
1.5 hr
Time to Peak
6 hr
Steady State
~1 days
Bioavailability
5%
Dose Range
25–400 mcg/day
Frequency
Twice weekly
Overview
Twice-weekly transdermal estradiol patch. Smaller and more discreet than weekly patches. Changed every 3.5 days (e.g., Monday and Thursday). Bypasses first-pass liver metabolism. For feminizing HRT, multiple patches are typically needed to reach target E2 levels of 100-200 pg/mL.
Mechanism of Action
Delivers unmodified 17β-estradiol transdermally. Absorbed through skin into systemic circulation, bypassing hepatic first-pass metabolism.
Dosing Information
| Route | Dose Range | Half-life | Tmax | Frequency |
|---|---|---|---|---|
| Transdermal Patch | 25–400 mcg/day | 1.5 hr | 6 hr | Twice weekly |
Storage & Handling
Room temperature — Store in sealed pouch until use. Apply to lower abdomen. Smaller than weekly patches. Rotate application sites with each change.
Used in Regimens
4 regimensMenopause — Combined HRT (Patches + Progesterone)
Standard combined menopausal HRT: oestradiol patches for symptom relief with cyclical or continuous progesterone for endometrial protection. The NICE 2024 menopause guideline recommends transdermal oestradiol as first-line for lower VTE risk vs oral.
Oestradiol patches 50–100mcg/day. Titrate to symptom control.
Menopause — Oestradiol Only (Post-Hysterectomy)
Oestradiol-only HRT for post-hysterectomy menopause. No progestogen required when there is no uterus. Simpler regimen, no endometrial cancer risk without a uterus.
Oestradiol patches — sole HRT component post-hysterectomy.
NHS Pathway — Patches + GnRH Analogue
NHS Gender Dysphoria Clinic standard pathway: oestradiol patches with goserelin (Zoladex) GnRH analogue for testosterone suppression. Safest VTE risk profile. Goserelin implant every 1 or 3 months administered by GP or GIC nurse.
Estradiol patches — start low (50mcg), titrate to target E2.
Patch + Sublingual E2 Combination
Transdermal patches as base estrogen delivery with sublingual estradiol tablets supplementing to reach T-suppression levels. Patches provide the lowest VTE risk of all estradiol routes but may not achieve high enough levels for monotherapy T-suppression. A middle-ground between safety (transdermal) and efficacy (injectable).
100–400mcg/day total via patches. Changed every 3.5 days (twice weekly).
Data Sources
- FDA Label Vivelle-Dot (estradiol transdermal system) — FDA Prescribing Information
Related Tools
Track Estradiol Transdermal Patch (Twice-Weekly) with Doseline
Reminders, medication level charts, injection site rotation, and protocol tracking — all free, all private.
Join the waitlistDoseline provides informational tools only. It is not a medical device and does not provide medical advice. Always consult a qualified healthcare provider.