Cream · 3 mg/gm · estrogen through the skin

Biest Cream (Estriol/Estradiol 50:50)

Estrogen through the skin, not swallowed.

This cream carries estradiol and estriol in equal parts, absorbed through the skin rather than swallowed. Estriol is not an FDA-approved drug in the United States and is available only through compounding, and the National Academies reviewed compounded bioidentical hormone therapy in 2020 and found the claims commonly made for it unsupported. Systemic estrogen labeling carries a boxed warning, the FDA's strongest: it covers endometrial cancer, stroke, blood clots, breast cancer and probable dementia, and directs that estrogen be used at the lowest effective dose for the shortest time that meets your goals. Bioidentical describes the molecule, not its approval or its safety.

$209/3 months

Whole monthly price, shown before you answer anything

Questionnaire · Open

A provider reads every answer and decides whether Biest Cream (Estriol/Estradiol 50:50) is right for you. The $209/3 months price is confirmed to you before any charge.

01 · What it asks of you

The routine, before the reasons.

Applied once a day to the skin as your provider directs. Let it dry, wash your hands, and keep the treated skin covered around other people. Each order is a three-month supply.

Medicines: Estradiol and estriol, topical
Form: Cream · 3 mg/gm
Monthly price: $209/3 months
Prescription status: Compounded by a pharmacy, so it is not FDA-approved. The FDA does not review a compounded preparation before it is dispensed, and a combination does not inherit the approval of any ingredient in it.
Billing: Monthly, at one of the two prices on the comparison table

02 · What a provider looks at closely

Where this medicine touches the rest of you.

Every prescription medicine has a short list of things worth checking first. This is the list for this option, so nothing in the questionnaire arrives as a surprise.

Estradiol and estriol are both estrogens, so the class risks in the boxed warning are taken to apply. Estriol has no approved labeling of its own that quantifies them. Because a compounded cream's absorption is uncharacterised, dose is less predictable than with an approved product, which is why a provider reviews symptoms rather than assuming a number.

Safety information

What to know before you start

Compounded by a pharmacy, so it is not FDA-approved. The FDA does not review a compounded preparation before it is dispensed, and a combination does not inherit the approval of any ingredient in it.

Estradiol, applied to the skin

Estradiol in a cream absorbed through the skin rather than swallowed. It still reaches the bloodstream, so the systemic cautions apply.

Not for

Anyone with undiagnosed abnormal genital bleeding.
Anyone with a history of, or suspected, breast cancer, or another estrogen-dependent cancer.
Anyone with active or past blood clots, or a clotting disorder.
Anyone with active or recent stroke or heart attack, or liver disease.
Anyone who is pregnant, or who may be pregnant.

Handling

Hormone cream transfers by skin contact. Let the site dry, wash your hands, and keep the treated skin covered around children, other adults and pets.
A compounded cream's absorption has not been characterized the way an approved product's has, so how much reaches the bloodstream is less predictable.

Common effects

Skin irritation or redness where it is applied.
Breast tenderness, headache, irregular bleeding or spotting, and mood changes.

Serious effects

Blood clots in the legs or lungs, stroke, and heart attack.
Endometrial cancer, where estrogen is used without adequate progestogen and the uterus is present.
Breast cancer.

Get medical help if

Sudden shortness of breath, chest pain, or coughing blood.
Pain, swelling, warmth or redness in one leg.
Sudden weakness or numbness on one side, or trouble speaking.
New, heavy or continuing vaginal bleeding, or a new breast lump.

Tell your provider

Whether you still have a uterus.
Who else has skin contact with you, particularly children.
Every medicine and supplement you take.

Sources

Estradiol tablets prescribing information, Boxed Warning. US Food and Drug Administration. FDA-approved labeling
The Clinical Utility of Compounded Bioidentical Hormone Therapy, dosing and absorption. National Academies of Sciences, Engineering, and Medicine. NASEM consensus study report, 2020
The Clinical Utility of Compounded Bioidentical Hormone Therapy. National Academies of Sciences, Engineering, and Medicine. NASEM consensus study report, 2020

Estriol

A weaker estrogen, used in compounded 'Biest' creams alongside estradiol. Estriol is not an FDA-approved drug in the United States.

Not for

Anyone with undiagnosed abnormal genital bleeding.
Anyone with a history of, or suspected, breast cancer, or another estrogen-dependent cancer.
Anyone with active or past blood clots, or a clotting disorder.
Anyone who is pregnant, or who may be pregnant.

Handling

Hormone cream transfers by skin contact. Let the site dry, wash your hands, and keep it covered around others.

Common effects

Skin irritation where applied, breast tenderness, headache, spotting.

Serious effects

Estriol is an estrogen, so the class risks in the boxed warning are taken to apply to it. Because it is not FDA-approved, it has no approved labeling of its own that quantifies them.

Get medical help if

New, heavy or continuing vaginal bleeding, or a new breast lump.
Sudden shortness of breath, chest pain, leg pain or swelling.
Sudden weakness, numbness or trouble speaking.

Tell your provider

Whether you still have a uterus.
That a compounded product's dose and absorption are less predictable than an approved one's.

Sources

FDA statements on compounded bioidentical hormone replacement therapy and estriol. US Food and Drug Administration. FDA compounded BHRT communications
Estradiol tablets prescribing information, Boxed Warning. US Food and Drug Administration. FDA-approved labeling
The Clinical Utility of Compounded Bioidentical Hormone Therapy. National Academies of Sciences, Engineering, and Medicine. NASEM consensus study report, 2020

03 · Worth asking

Three questions to bring, specific to this option.

A provider can answer all three inside the questionnaire thread. Writing them down first makes the answer more useful.

01
What makes a cream the better choice for me than a tablet?
02
How would you know whether the dose is right, given the absorption is less predictable?
03
I have young children at home. What precautions do you want me taking?

04 · The next step

One questionnaire, read by a person.

Health history, current medicines, and what you have already tried. A provider reads all of it and decides whether this option fits, asks for more, or says it does not.

Start the Biest Cream (Estriol/Estradiol 50:50) Questionnaire

05 · The nearest alternative

If this one is not it.

If you still have a uterus, the combined cream carries progesterone alongside the same two estrogens in one application.

Open the Combined Cream

06 · Keep comparing

All of them, side by side.

Return to the Comparison Table Email a Question About This Option

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What to know before you start

Compounded by a pharmacy, so it is not FDA-approved. The FDA does not review a compounded preparation before it is dispensed, and a combination does not inherit the approval of any ingredient in it.

Estradiol, applied to the skin

Estradiol in a cream absorbed through the skin rather than swallowed. It still reaches the bloodstream, so the systemic cautions apply.

Not for

Anyone with undiagnosed abnormal genital bleeding.
Anyone with a history of, or suspected, breast cancer, or another estrogen-dependent cancer.
Anyone with active or past blood clots, or a clotting disorder.
Anyone with active or recent stroke or heart attack, or liver disease.
Anyone who is pregnant, or who may be pregnant.

Handling

Hormone cream transfers by skin contact. Let the site dry, wash your hands, and keep the treated skin covered around children, other adults and pets.
A compounded cream's absorption has not been characterized the way an approved product's has, so how much reaches the bloodstream is less predictable.

Common effects

Skin irritation or redness where it is applied.
Breast tenderness, headache, irregular bleeding or spotting, and mood changes.

Serious effects

Blood clots in the legs or lungs, stroke, and heart attack.
Endometrial cancer, where estrogen is used without adequate progestogen and the uterus is present.
Breast cancer.

Get medical help if

Sudden shortness of breath, chest pain, or coughing blood.
Pain, swelling, warmth or redness in one leg.
Sudden weakness or numbness on one side, or trouble speaking.
New, heavy or continuing vaginal bleeding, or a new breast lump.

Tell your provider

Whether you still have a uterus.
Who else has skin contact with you, particularly children.
Every medicine and supplement you take.

Sources

Estradiol tablets prescribing information, Boxed Warning. US Food and Drug Administration. FDA-approved labeling
The Clinical Utility of Compounded Bioidentical Hormone Therapy, dosing and absorption. National Academies of Sciences, Engineering, and Medicine. NASEM consensus study report, 2020
The Clinical Utility of Compounded Bioidentical Hormone Therapy. National Academies of Sciences, Engineering, and Medicine. NASEM consensus study report, 2020

Estriol

A weaker estrogen, used in compounded 'Biest' creams alongside estradiol. Estriol is not an FDA-approved drug in the United States.

Not for

Anyone with undiagnosed abnormal genital bleeding.
Anyone with a history of, or suspected, breast cancer, or another estrogen-dependent cancer.
Anyone with active or past blood clots, or a clotting disorder.
Anyone who is pregnant, or who may be pregnant.

Handling

Hormone cream transfers by skin contact. Let the site dry, wash your hands, and keep it covered around others.

Common effects

Skin irritation where applied, breast tenderness, headache, spotting.

Serious effects

Estriol is an estrogen, so the class risks in the boxed warning are taken to apply to it. Because it is not FDA-approved, it has no approved labeling of its own that quantifies them.

Get medical help if

New, heavy or continuing vaginal bleeding, or a new breast lump.
Sudden shortness of breath, chest pain, leg pain or swelling.
Sudden weakness, numbness or trouble speaking.

Tell your provider

Whether you still have a uterus.
That a compounded product's dose and absorption are less predictable than an approved one's.

Sources

FDA statements on compounded bioidentical hormone replacement therapy and estriol. US Food and Drug Administration. FDA compounded BHRT communications
Estradiol tablets prescribing information, Boxed Warning. US Food and Drug Administration. FDA-approved labeling
The Clinical Utility of Compounded Bioidentical Hormone Therapy. National Academies of Sciences, Engineering, and Medicine. NASEM consensus study report, 2020

Biest Cream (Estriol/Estradiol 50:50)

The routine, before the reasons.

Where this medicine touches the rest of you.

What to know before you start

Estradiol, applied to the skin

Estriol

Three questions to bring, specific to this option.

What makes a cream the better choice for me than a tablet?

How would you know whether the dose is right, given the absorption is less predictable?

I have young children at home. What precautions do you want me taking?

One questionnaire, read by a person.

If this one is not it.

All of them, side by side.

Biest Cream (Estriol/Estradiol 50:50)

The routine, before the reasons.

Where this medicine touches the rest of you.

What to know before you start

Estradiol, applied to the skin

Estriol

Three questions to bring, specific to this option.

What makes a cream the better choice for me than a tablet?

How would you know whether the dose is right, given the absorption is less predictable?

I have young children at home. What precautions do you want me taking?

One questionnaire, read by a person.

If this one is not it.

All of them, side by side.