What is the Drug Dotti Used for?

October 6, 2025 •

4 min read

Approximately 85% of menopausal women experience at least one symptom, with many turning to hormone replacement therapy, and one such treatment is the drug Dotti. Dotti is a twice-weekly transdermal patch containing estradiol, a bio-identical estrogen, used to manage moderate to severe menopausal symptoms and prevent postmenopausal osteoporosis.

Quick Summary

The Dotti patch is an estrogen replacement therapy used to treat moderate to severe menopausal symptoms like hot flashes and vaginal dryness, and to prevent postmenopausal osteoporosis.

Key Points

Estrogen Replacement: Dotti is a transdermal patch that delivers estradiol, a bio-identical estrogen, through the skin to address low hormone levels.
Menopausal Symptom Relief: It is primarily used to treat moderate to severe menopausal symptoms, such as hot flashes, night sweats, and vulvar/vaginal atrophy (dryness, itching, burning).
Osteoporosis Prevention: Dotti is also prescribed to prevent postmenopausal osteoporosis in women at high risk of fracture.
Stable Hormone Delivery: The transdermal application bypasses the liver, resulting in more consistent hormone levels in the body compared to oral estrogen therapies.
Notable Risks: Significant risks include increased likelihood of blood clots, stroke, and certain cancers, which require careful consideration and physician supervision.
Twice-Weekly Use: The patch is applied twice a week on the lower abdomen or buttocks, and the application site should be rotated.

Understanding the Dotti Transdermal Patch

Dotti is a prescription medication in the form of a transdermal patch, which means it delivers medication through the skin and directly into the bloodstream. The active ingredient is estradiol, a form of estrogen that is chemically identical to the hormone produced naturally by a woman's body. By providing a steady and controlled dose of estradiol, the Dotti patch helps to alleviate symptoms that arise from the decrease in natural estrogen production during menopause.

Unlike oral medications, the transdermal delivery of Dotti bypasses the digestive system and first-pass metabolism by the liver, which can lead to more stable hormone levels and potentially fewer side effects. Dotti is a generic version of the brand-name patch Vivelle-Dot, making it a more affordable option for many patients.

Primary Indications for Dotti

Physicians prescribe Dotti for several key health concerns related to low estrogen levels in women. The main indications for this therapy are outlined below.

Treatment of Menopausal Symptoms

One of the most common reasons for using Dotti is to treat the moderate to severe symptoms associated with menopause. These include:

Vasomotor Symptoms: Primarily hot flashes and night sweats, which are caused by fluctuating hormone levels. The consistent delivery of estradiol helps stabilize body temperature regulation.
Vulvar and Vaginal Atrophy: Symptoms like vaginal dryness, itching, and burning are directly related to a decline in estrogen. Dotti can help restore the health of vaginal tissues and improve comfort, including during sexual intercourse.

Prevention of Postmenopausal Osteoporosis

After menopause, the decrease in estrogen can accelerate bone density loss, increasing the risk of osteoporosis and fractures. Dotti is indicated for the prevention of postmenopausal osteoporosis, especially in women who are at significant risk of fracture and when other non-estrogen medications are not suitable. Estrogen therapy is known to help maintain bone mineral density.

Treatment of Hypoestrogenism

For women who experience low estrogen levels due to reasons other than natural menopause, Dotti can be prescribed as a treatment for hypoestrogenism. This can be a result of:

Surgical removal of the ovaries (castration)
Primary ovarian failure
Hypogonadism (a condition where sex glands produce little or no hormones)

Administration and Dosage

Dotti is a simple-to-use patch that is applied to the skin twice a week. The specific dosage is determined by a healthcare provider based on the individual's condition and needs.

Application Instructions:

Apply the patch to a clean, dry area of the lower abdomen or buttocks.
Do not apply to the breasts or to oily, broken, or irritated skin.
Avoid applying the patch on the waistline where tight clothing may rub it off.
Rotate the application site with each new patch to prevent skin irritation.
If a patch falls off, reapply it or a new one and continue with the original schedule.

Common Side Effects and Risks

While Dotti can be an effective treatment, like all medications, it carries potential side effects and risks. Some of the most common side effects include:

Headache
Breast tenderness or pain
Application site reactions, such as redness or irritation
Nausea or stomach cramps
Bloating or fluid retention
Mood changes, including depression

Serious Warnings and Precautions

For some women, hormone replacement therapy carries serious risks, especially with prolonged use. The following are a few of the potential concerns, which is why a thorough discussion with a doctor is essential:

Cardiovascular Disorders: Increased risk of stroke, heart attack (myocardial infarction), deep vein thrombosis (DVT), and pulmonary embolism (PE).
Certain Cancers: Estrogen-only therapy can increase the risk of endometrial cancer, particularly in women with an intact uterus who do not take a progestin alongside it. Estrogen-plus-progestin therapy has also been linked to an increased risk of breast cancer.
Dementia: Increased risk of developing probable dementia in women over 65 years old.
Gallbladder Disease: An increased risk of gallbladder disease requiring surgery.

Dotti vs. Other Estradiol Patches

Several other estradiol patches are available, and they differ in their formulation and application schedule. A healthcare provider can help determine the best option for your needs.


Feature	Dotti (Generic for Vivelle-Dot)	Climara	Minivelle
Application Frequency	Twice weekly (every 3–4 days)	Once weekly	Twice weekly (every 3–4 days)
Patch Size	Small, dot-like	Larger, rectangular	Small, dot-like
Adhesive Technology	Dot matrix, integrated adhesive	Reservoir (older technology)	Dot matrix (newer technology)
Key Differences	Generic version of Vivelle-Dot. Small and discreet.	Once-weekly application may improve adherence for some.	Very small and discreet, often preferred for sensitive skin.

Contraindications and Considerations

As hormone replacement therapy, Dotti is not suitable for all women. Contraindications include:

Current or previous breast cancer
Known or suspected estrogen-dependent tumors
Undiagnosed abnormal vaginal bleeding
Active or history of blood clots (DVT, PE)
Active liver disease or hepatic impairment
Hypersensitivity to any component of Dotti

Furthermore, women with a uterus must typically use a progestin in conjunction with Dotti to reduce the risk of endometrial cancer. It's crucial for patients to have regular check-ups with their doctor, including breast exams and mammograms, while on hormone therapy.

Conclusion

Dotti is a widely used transdermal estradiol patch that effectively treats various estrogen deficiency-related conditions in women, especially menopausal symptoms and postmenopausal osteoporosis. Its twice-weekly application and reliable transdermal delivery offer a convenient way to achieve stable hormone levels. However, its use is not without risks, including a boxed warning for cardiovascular events and certain cancers. A comprehensive discussion with a healthcare provider is essential to weigh the potential benefits against the individual's specific health profile and risk factors, ensuring it is a safe and appropriate treatment option. For more detailed prescribing information, consult the NIH DailyMed.

Frequently Asked Questions

The active ingredient in Dotti is estradiol, a form of estrogen that is chemically identical to the hormone produced naturally in a woman's body.

The Dotti patch is typically applied twice weekly, meaning it is replaced every 3 to 4 days. It is recommended to change the patch on the same two days each week to maintain a consistent schedule.

If you have a uterus, you will likely need to take an additional medication called a progestin while using Dotti. This is because estrogen-only therapy can increase the risk of endometrial cancer.

If a patch falls off, you can try to reapply it. If it does not stick well, apply a new patch to a different area. In either case, continue with your original treatment schedule to ensure consistent dosage.

Yes, the estradiol in the Dotti patch is considered bio-identical because it is chemically identical to the hormone naturally produced by a woman's body.

Serious side effects, while rare, can include an increased risk of blood clots, stroke, heart attack, and certain cancers. Patients should be aware of these risks and discuss them with their doctor.

Dotti is a generic version of the brand-name patch Vivelle-Dot, containing the same active ingredient and sharing the same twice-weekly application schedule and dosing. The main difference for most users is the cost, as the generic version is often more affordable.