Divigel vs. Bijuva
See how Divigel and Bijuva compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Divigel is estrogen-only, so women who still have a uterus usually need a separate progestin, while Bijuva already combines estradiol and progesterone in one capsule.
Divigel is a topical gel with four dose strengths for flexible titration, while Bijuva is an oral capsule available in just two strengths.
Both treat moderate to severe menopausal hot flashes, but Bijuva's cash price is notably lower than Divigel's typical monthly list price.
Divigel vs. Bijuva Drug Summary
Divigel
Divigel is a topical estradiol gel used to treat moderate to severe hot flashes caused by menopause. It's applied once daily to the thigh and comes in four dose strengths, allowing gradual dose adjustment. It's also used off-label for vaginal dryness and gender-affirming hormone therapy.
Bijuva
Bijuva is an oral capsule combining bioidentical estradiol and progesterone, approved for moderate to severe hot flashes in women with a uterus. It's taken once daily with food, since a high-fat meal increases progesterone absorption. It comes in two dose strengths and is the only FDA-approved single-capsule combination of both hormones.
Divigel vs. Bijuva Side Effects
Divigel
Bijuva
Divigel vs. Bijuva Dosage
Divigel
Bijuva
| STAGE | DOSE | WHEN |
| Starting dose | 0.25 g once daily | At the start |
| Maximum dose | 1.0 g once daily | If needed |
| Dose changes | 3 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 0.5 mg/100 mg once daily | At the start |
| Maximum dose | 1 mg/100 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Divigel
| STAGE | DOSE | WHEN |
| Starting dose | 0.25 g once daily | At the start |
| Maximum dose | 1.0 g once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Bijuva
| STAGE | DOSE | WHEN |
| Starting dose | 0.5 mg/100 mg once daily | At the start |
| Maximum dose | 1 mg/100 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Divigel vs. Bijuva Indications
Divigel
Divigel is FDA-approved to treat moderate to severe hot flashes linked to menopause. It's also used off-label for vaginal dryness and atrophy, and as part of gender-affirming hormone therapy, though the FDA has not reviewed it for those purposes.
Moderate to severe menopausal hot flashes (FDA-approved)
Vaginal dryness or atrophy (off-label)
Gender-affirming hormone therapy (off-label)
Not approved for preventing heart disease or dementia
Bijuva
Bijuva is FDA-approved for moderate to severe hot flashes in menopausal women who still have a uterus. The built-in progesterone protects the uterine lining, so it's not intended for women without a uterus.
Moderate to severe menopausal hot flashes (FDA-approved)
Only approved for women with an intact uterus
Not approved for women without a uterus
Not approved for preventing heart disease, stroke, or dementia
Divigel vs. Bijuva Pros and Cons
Divigel
Divigel is an estrogen-only gel with four dose strengths, letting clinicians fine-tune how much estrogen a person absorbs. Because it contains no progestin, women who still have a uterus typically need a separate progesterone prescription to guard against endometrial cancer. As a topical product, it also carries a small risk of transferring estrogen to another person through skin contact.
Pros
Four dose strengths allow gradual, individualized titration
Long track record, FDA-approved since 1975
Topical route skips first-pass liver metabolism
Can be used off-label for gender-affirming care
Cons
Estrogen-only, so a separate progestin is usually needed with a uterus
Risk of secondary hormone exposure to children or pets via skin contact
Roughly $650 to $900 per month before insurance, more than Bijuva
Daily gel application can be messier than taking a pill
Bijuva
Bijuva pairs bioidentical estradiol with bioidentical progesterone in a single daily capsule, so women with a uterus get endometrial protection built in. Because it's swallowed, it passes through the liver, a route linked to a higher risk of blood clots and stroke than transdermal estrogen. It's only available in two dose strengths, giving less room for fine adjustment than a multi-strength gel.
Pros
Combines estrogen and progesterone in one capsule, no separate progestin needed
Oral capsule avoids the skin-contact exposure risk of gels
Roughly $257 to $351 per month cash price, notably less than Divigel
Bioidentical hormone formulation matched to the body's own estradiol and progesterone
Cons
Only two dose strengths, less flexibility than Divigel's four
Oral estrogen is linked to higher clot and stroke risk than transdermal forms
Must be taken with food, since a high-fat meal changes absorption
Newer to market (2018) with a shorter track record than Divigel
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