Many women have questions when they begin using Divigel®—that’s to be expected!

Here are some of the most common questions about starting and staying on Divigel®.

General Information

Divigel® is a once-a-day medication to treat moderate to severe vasomotor symptoms (hot flashes and night sweats) due to menopause. It contains a plant-based, bioidentical estrogen hormone called estradiol. Bioidentical estrogen is chemically identical to estrogen produced by women naturally before menopause. Divigel® is formulated as a cool, clear, fast-drying gel that is applied to the skin. Divigel® is invisible, odorless and non-sticky when dry, so no one knows you're using medication.

Because every woman is different, one dose will not fit all. Divigel® has three FDA-approved doses, so your healthcare professional can choose the one that's right for you. Generally, women should be started at 0.25 mg/day, and increase the dose strength as needed to relieve hot flashes and night sweats.

Your doctor will recommend the appropriate starting dose for you, and he or she may adjust the dose depending on your response.

Patient Information is included in each box of Divigel®. Read this information before you start using Divigel® and each time you refill your Divigel® prescription. There may be new information. Refer to Patient Information on the package insert, and please be sure to speak with your doctor regarding other questions about Divigel®.

Application

No. Divigel® should only be applied to your upper thigh. You should alternate between your right and left thigh each day .
  • Application of Divigel® to other areas of the body, such as the arms or abdomen, has not been tested in clinical studies and, therefore, is not recommended.
  • Do not apply Divigel® to your face, breasts, or irritated skin. Never apply Divigel® in or around the vagina. Contact of the gel with the eyes should be avoided.
  • There is a potential risk for transdermal transmission of estradiol in Divigel® to another individual. To reduce the risk of transmission, cover the applied area until Divigel® has completely dried.

Divigel® should be applied to the skin once a day, around the same time each day. You can choose to apply it at the time that is most convenient for you.

Because Divigel® should be applied to clean and dry skin, many women choose to apply it after their daily bath or shower or at night before bed. The application site should be completely dry before dressing.

That depends.
  • If you have not had a hysterectomy (and your uterus is intact), then the answer is probably yes. That’s because taking estrogen alone may increase the chance of cancer of the uterus (also known as uterine or endometrial cancer). Taking progestogen helps reduce this risk. Your healthcare professional can help you make the right decisions and recommend the appropriate dose of progestogen.
  • If you have had a hysterectomy (removal of the uterus), then the answer is probably no. After a hysterectomy, your healthcare professional may recommend that you take estrogen therapy without progestogen.

Common Concerns

Common side effects that may occur with Divigel® include headache; breast pain; irregular vaginal bleeding or spotting; stomach or abdominal cramps, bloating; nausea and vomiting; hair loss; fluid retention and vaginal yeast infection.

These are not all the potential side effects. For more information, please read the Full Prescribing Information, or speak with your healthcare professional.

Yes serious, but less common side effects include:
  • Heart attack
  • Stroke
  • Blood clots
  • Dementia
  • Breast cancer
  • Cancer of the lining of the uterus (womb)
  • Cancer of the ovary
  • High blood pressure
  • High blood sugar
  • Gallbladder disease
  • Liver problems
  • Enlargement of benign tumors of the uterus (“fibroids”)
Call your healthcare professional right away if you get any of the following warning signs or any other unusual symptoms that concern you:
  • New breast lumps
  • Heavy vaginal bleeding or consistent bleeding on multiple consecutive days
  • Changes in vision or speech
  • Sudden new severe headaches
  • Severe pains in your chest or legs with or without shortness of breath, weakness and fatigue
In a 12 week clinical trial, less than 1% of subjects on Divigel® experienced application site reactions.
Do not start using Divigel® if you:
  • Have unusual heavy vaginal bleeding or consistent bleeding on multiple consecutive days.
  • Currently have or have had certain cancers
    • Estrogens may increase the chances of getting certain types of cancers, including cancer of the breast or uterus. If you have or have had cancer, talk with your healthcare professional about whether you should use Divigel®.
  • Had a stroke or heart attack, or currently have or had blood clots
  • Currently have or have had liver problems
  • Have been diagnosed with a bleeding disorder
  • Are allergic to Divigel® or any of its ingredients
    • See the list of ingredients in Divigel® at the end of the package insert.
  • Think you may be pregnant
Tell Your Doctor

About all of your medical conditions. Your healthcare professional may need to check you more carefully if you have certain conditions, such as asthma (wheezing), epilepsy (seizures), diabetes, migraine, endometriosis, or lupus; have problems with your heart, liver, thyroid, or kidneys; or have high calcium levels in your blood.

About all the medicines you take. This includes prescription and nonprescription medicines, vitamins, and herbal supplements. Some medicines may affect how Divigel® works. Divigel® may also affect how your other medicines work.

Practical Matters

Some medications may affect how Divigel® works. These include prescription and nonprescription medications, vitamins, and herbal supplements. Divigel® may also affect how other medications work. Tell your healthcare professional about all the medications you take. Also see the Full Prescribing Information for Divigel® .

Studies conducted using other approved topical estrogen gel products have shown that sunscreens could change the amount of estrogen that is absorbed through the skin into the body.

The effect of applying sunscreen and Divigel® to the same application site has not been clinically evaluated.

However, remember that Divigel®, unlike other topical estrogen therapies, is applied to a discreet area of the upper thigh. Using creams or lotions on other parts of the body should not change the absorption of Divigel® at the application site.

Divigel® should be stored at room temperature, between 68°F and 77°F.

To ensure that Divigel® is absorbed through the skin properly, do not wash your thigh for at least 1 hour after application.

If you apply Divigel® after a shower or bath as part of a daily routine, just make sure that your upper thigh is thoroughly dry before applying the gel.

Speak with your healthcare professional about all medications you are taking if you are considering surgery.

That’s because blood clots may be more likely to occur following some types of surgery. And estrogen may increase your chances of blood clots.

If possible, you should stop taking all estrogen-based medications, such as Divigel®, at least 4 to 6 weeks before you undergo a surgical procedure associated with an increased risk of blood clots or during periods of prolonged immobilization.

  • The estrogen hormone in Divigel® is called estradiol.
  • The estradiol in Divigel® is made from plants unlike some oral estrogen therapies that are derived from animal sources (horse urine).
  • Divigel® contains bioidentical estradiol that is chemically identical to the estrogen hormone women naturally make in their bodies before menopause.

The duration of menopause symptoms is different for each woman and can last for years.

Talk with your healthcare professional periodically about whether you still need treatment with Divigel®.

Concerned about how menopause will affect your lifestyle? Read on for more information to ease your worries.

Be sure to call your doctor if you still have questions or concerns.

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