Estradiol Cypionate
Long-acting estradiol injection for menopause and perimenopause symptoms and for gender-affirming hormone therapy, given every one to two weeks. Prescribed and dosed by a licensed physician.
Injection
from $139/mo
Applied to the skin · Once a day
BioidenticalMenopauseHormone therapy
BIEST 20:80 Cream
Topical cream blending estriol and estradiol (20:80) for menopausal symptoms. Apply daily to skin. Gentle absorption, adjustable dosing.
- Bioidentical estriol, estradiol blend
- Topical application, flexible dosing
- Quick absorption through skin
- Monthly$109/mo
- Free, discreet shipping
- Licensed U.S. pharmacy
- Board-certified physicians
Disclaimer: Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.
- How
- Applied to the skin
- How often
- Once a day
- Each shipment
- 1 tube
- Strengths
- 8 options · 4 clicks, 2.5 mg
What is BIEST 20:80 cream?
(20% estriol, 80% estradiol)
BIEST cream combines estriol (the weaker estrogen) and estradiol (the bioidentical form your ovaries made) in a 20:80 ratio, applied directly to skin. Absorption is gradual and local, making dose adjustment simple. Choose this form if you prefer topical application without pills or injections.
What's in it
- BIEST (20:80)Estrogen: eases menopause symptoms
20:80
the estriol to estradiol ratio for gentle absorption
Apply 0.5-1 gram daily to clean skin. Your physician adjusts based on symptom response and blood work.
Is it right for you?
Who it's for
Women who want mostly-estriol estrogen through the skin.
What sets it apart
Through the skin, estrogen avoids the liver, which is linked to a lower clot risk than pills.
Worth knowing before you start
Apply to the inner forearm or thigh and rotate. Never on the breasts.
Results you can feel
Fewer hot flashes
the most dramatic change from estrogen therapy
Better sleep and mood
as night sweats settle and hormones stabilize
Bone protection
estrogen slows bone loss at menopause
Steadier energy
many patients report clearer, more stable daily rhythms
How BIEST therapy works
Day 1
A US-licensed physician reviews your menopausal symptoms, history, and risk factors to set your dose.
1Weeks 1-2
Hot flashes and night sweats usually ease within the first two to four weeks.
2Month 1-2
Sleep and mood stabilize as hormone levels rise. Your physician checks in and adjusts dose if needed.
3Month 3
Check-in. Your physician reviews symptom relief, any side effects, and confirms your dose going forward.
4Beyond
BIEST therapy is reviewed yearly: dose, benefits, risks, and whether to continue.
5
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
How you use it
This is the starting dose the pharmacy prints on the label. Your physician sets yours and adjusts it with you.
- How
- Applied to the skin
- Where
- inner forearm or inner thigh
- Dose
- 1 mL (4 clicks, 2.5 mg)
- How often
- Once a day
- Each shipment
- 1 tube
- Pharmacy label
- Apply 1 mL (4 clicks, 2.5 mg) to the inner forearm or inner thigh once daily for 30 days. Rotate sites and wash hands after use.
A sample week
- M
- T
- W
- T
- F
- S
- S
Once a day
Strengths the pharmacy carries
- 2.5 mg/mL
- 1.25 mg/mL
- 2 mg/mL
- 0.4 mg/mL
- 0.2 mg/mL
- 1 mg/mL
- 0.625 mg/mL
- 3 mg/mL
The science of bioidentical estrogen
Transdermal estrogen bypasses first-pass liver metabolism, lowering gallbladder and clot risk slightly compared to oral forms. Estriol's weaker action appeals to patients seeking a gentler profile.
Like all estrogen therapy, BIEST cream carries risk of clots, stroke, and gallbladder disease. Risk rises with age, smoking, and time since menopause. Your physician reviews your risk factors before prescribing.
Learn moreImportant safety information and common side effects
BIEST is a prescription hormone combination with real benefits and real risks. Common effects include breast tenderness, bloating, nausea, headache, spotting, and injection-site reactions. Estrogen therapy increases risk of blood clots, stroke, gallbladder disease, and, with a uterus, requires progesterone to prevent endometrial cancer. Not prescribed with breast cancer, blood clots, unexplained vaginal bleeding, liver disease, or pregnancy. Smoking raises clot risk. Seek care for chest pain, shortness of breath, leg swelling, severe headache, or vision changes. Tell your physician about every medication.
Every plan includes
- Personalized, physician-guided plan
- Monthly plan
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
How it works
1.Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
2.Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
3.Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
BIEST cream educational content reviewed by our physician
Scott Nass, MDDoctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
Frequently asked questions
How do I use BIEST (20:80) Cream?
Applied to the skin, once a day. The starting prescription is 1 mL (4 clicks, 2.5 mg) each time. Your physician sets your own dose and it is printed on your label.
Where do I apply it?
Inner forearm or inner thigh.
What strengths does BIEST (20:80) Cream come in?
The pharmacy carries 8: 2.5 mg/mL, 1.25 mg/mL, 2 mg/mL, 0.4 mg/mL, 0.2 mg/mL, 1 mg/mL, 0.625 mg/mL, 3 mg/mL. Your physician chooses which one you get.
How much arrives in each shipment?
1 tube at the starting strength, shipped to your door from a licensed US pharmacy.
How much cream should I apply?
Your physician sets the starting dose, usually 0.5-1 gram daily. Use a metered applicator or measuring guide. Apply to clean, dry skin (inner arm, abdomen, or thigh work well). Adjust only under your physician's guidance.
Is BIEST really bioidentical?
Yes. Estriol and estradiol are both bioidentical, meaning their chemical structure matches what your body made. BIEST is a compounded formula mixing these two in a specific ratio.
Do I need progesterone with BIEST?
If you have a uterus, yes. Estrogen thickens the uterine lining, and progesterone protects it. After hysterectomy, estrogen alone is safe.
Is BIEST better than estradiol alone?
Not necessarily. Both work. BIEST appeals to patients seeking a lower dose, a gentler profile, or a compounded approach.
Hormones, balanced.
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The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Individual results vary.
Sources
- 1
The 2022 hormone therapy position statement of The North American Menopause Society.
Menopause, 2022 - 2
Estrogen and progestogen use in postmenopausal women: 2015 perspective.
Lancet, 2015
BIEST 20:80 Creamfrom $109/mo