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 50:50 Cream
Topical cream blending estriol and estradiol (50:50) for moderate to significant menopausal symptoms. Apply daily to skin. Balanced ratio, potent action.
- Bioidentical 50:50 estriol and estradiol
- Topical, adjustable dosing
- More potent than 20:80 blend
- 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
- 7 options · 4 clicks, 0.75 mg
What is BIEST 50:50 cream?
(50% estriol, 50% estradiol)
BIEST 50:50 balances estriol and estradiol equally, offering more symptom relief than the 20:80 blend for patients with moderate to severe hot flashes or night sweats. Apply topically for gradual, steady absorption.
What's in it
- BIEST (50:50)Estrogen: eases menopause symptoms
50:50
a balanced estriol-estradiol blend for moderate symptoms
Apply 0.5-1.5 grams daily to clean skin. Your physician titrates based on symptom control and lab work.
Is it right for you?
Who it's for
Women who need a stronger estrogen effect through the skin.
What sets it apart
Half estradiol, half estriol: more estradiol than the 20:80 blend, so it is stronger at the same amount.
Worth knowing before you start
Compounded Bi-Est is not FDA-approved. FDA-approved estradiol patches and gels exist.
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, 0.75 mg)
- How often
- Once a day
- Each shipment
- 1 tube
- Pharmacy label
- Apply 1 mL (4 clicks, 0.75 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
- 0.75 mg/mL
- 2.75 mg/mL
- 2 mg/mL
- 1.25 mg/mL
- 1.5 mg/mL
- 3 mg/mL
- 1 mg/mL
The science of bioidentical estrogen
A 50:50 blend offers more estradiol activity while retaining estriol's gentler tissue profile. Transdermal delivery reduces first-pass hepatic metabolism.
BIEST conlleva the same safety profile as all estrogen therapy: clot, stroke, and gallbladder risk. Your physician monitors your blood pressure and reviews risk factors at every visit.
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 50:50 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 (50:50) Cream?
Applied to the skin, once a day. The starting prescription is 1 mL (4 clicks, 0.75 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 (50:50) Cream come in?
The pharmacy carries 7: 0.75 mg/mL, 2.75 mg/mL, 2 mg/mL, 1.25 mg/mL, 1.5 mg/mL, 3 mg/mL, 1 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.
Should I start with 20:80 or 50:50?
Your physician sets the starting ratio based on symptom severity. Starting with 20:80 allows tolerability assessment; if symptoms persist, your physician may increase to 50:50. Some patients start directly at 50:50 if symptoms are significant.
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.
Gonadorelin
A copy of the brain's own GnRH signal that keeps the testes producing testosterone and sperm, used alongside testosterone therapy and in fertility care. Prescribed and dosed by a licensed physician.
Injection
from $159/mo
7-Keto DHEA Capsules
7-Keto DHEA, a metabolite of DHEA that does not convert to testosterone or estrogen. Supports energy and metabolism without hormonal side effects.
Capsule
from $79/mo
Anastrozole - Men
A low-dose aromatase inhibitor for men on testosterone therapy whose blood work shows high estradiol, easing breast tenderness and water retention. Slow-release capsule, prescribed and dosed by a licensed physician.
Capsule
from $54/mo
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 50:50 Creamfrom $109/mo