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
Dissolved under the tongue · Once a day
MenopauseBioidentical hormoneHormone therapy
BIEST 0.05 mg
Orally dissolving tablet combining estriol and estradiol (20:80 ratio) for menopausal symptoms. One tablet daily under the tongue. A bioidentical estrogen option with a gentler profile.
- Bioidentical estriol + estradiol in a lower microdose
- Orally dissolving tablet, no injection
- Designed for sensitive patients or those seeking a gentler dose
- Monthly$119/mo
- Every 3 months$297 billed up front$99/mo
- Every 6 monthsBest value$534 billed up front$89/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
- Dissolved under the tongue
- How often
- Once a day
- Each shipment
- 30 tablets
- Strength
- 0.05 mg
What is BIEST 0.05 mg?
(BY-est)
BIEST is a compounded combination of estriol and estradiol in a 20:80 ratio—meaning 20% estriol, the weakest estrogen your body makes, and 80% estradiol, the bioidentical estrogen your ovaries produced before menopause. This formulation dissolves under the tongue (orally dissolving tablet, or ODT) and is designed for patients seeking a lower microdose or a gentler profile than estradiol alone. Estriol is thought to be less stimulating to breast tissue, though both estriol and estradiol carry the same safety considerations as any estrogen therapy.
What's in it
- BIEST (20:80)Estrogen: eases menopause symptoms
20:80
the ratio of estriol to estradiol in BIEST, designed to blend the gentler profile of estriol with the proven efficacy of bioidentical estradiol
BIEST is a compounded formulation, not an FDA-approved brand product. It is prescribed off-label at your physician's discretion for menopausal symptoms.
Is it right for you?
Who it's for
Women starting hormone therapy at the lowest dose.
What sets it apart
Bi-Est 20:80 is mostly estriol, the gentler estrogen. This is the smallest dissolving tablet.
Worth knowing before you start
With a uterus you also need progesterone. Ask before starting, not after.
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, risk factors and, when needed, labs, and sets your dose. Your first supply ships discreetly to your door.
1Weeks 1–2
Place one tablet under the tongue daily. Hot flashes and night sweats usually ease within the first two to four weeks.
2Month 1–2
Sleep and mood stabilize as levels rise. Your physician checks in and adjusts the dose or may switch to a higher or lower strength.
3Month 3
Check-in. Your physician reviews how you feel, any bleeding or side effects, and confirms your dose going forward.
4Beyond
BIEST therapy is reviewed at least yearly: dose, benefits, risks, and whether to continue. Your physician decides with you.
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
- Dissolved under the tongue
- Dose
- one tablet (0.05 mg)
- How often
- Once a day
- Each shipment
- 30 tablets
- Pharmacy label
- Place one tablet (0.05 mg) under the tongue once daily for 30 days.
A sample week
- M
- T
- W
- T
- F
- S
- S
Once a day
The science of bioidentical estrogen
Estriol is the weakest of the three main estrogens and the dominant one during pregnancy. Some clinicians favor a BIEST formulation for patients seeking a lower-dose or gentler option, though the evidence base for BIEST specifically is smaller than for estradiol monotherapy.
Like all estrogen therapy, BIEST carries the same risk profile as estradiol when it comes to clots, stroke, and gallbladder disease—risks that rise with age, smoking, and time since menopause. Your physician reviews your personal risk factors before prescribing and at each visit.
Learn moreImportant safety information and common side effects
BIEST is a prescription hormone combination with real benefits and real risks, which is why a physician reviews your history first. Common effects include breast tenderness, bloating, nausea, headache, spotting or breakthrough bleeding, and, on skin, redness or irritation. Estrogen therapy increases the risk of blood clots, stroke, gallbladder disease, and, when used with a uterus, must be paired with a progestogen to protect the uterine lining. It is not prescribed with a history of breast or estrogen-sensitive cancer, blood clots, stroke or heart attack, liver disease, unexplained vaginal bleeding, or during pregnancy. Smoking raises clot risk further. Estriol, even at 20% of BIEST, still carries estrogen's full safety profile—do not assume it is "safer." Seek care immediately for chest pain, shortness of breath, leg swelling, sudden severe headache, vision changes, or unexplained bleeding. Tell your physician about every medication and supplement you take.
Every plan includes
- Personalized, physician-guided plan
- Monthly, 3-month and 6-month plans
- 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 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 take BIEST (20:80) 0.05 mg ODT?
Dissolved under the tongue, once a day. The starting prescription is one tablet (0.05 mg) each time. Your physician sets your own dose and it is printed on your label.
How much arrives in each shipment?
30 tablets at the starting strength, shipped to your door from a licensed US pharmacy.
Is BIEST safer than estradiol?
BIEST and estradiol share the same safety profile because both contain bioidentical estradiol. The difference is the added estriol, which is weaker. Some clinicians and patients prefer this ratio for symptom control and tolerability; others use estradiol alone. Your physician helps you choose based on your symptoms and risk factors.
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 at a 20:80 ratio. Compounded bioidenticals are not FDA-approved brand products, but the molecules themselves are bioidentical.
Do I need progesterone with BIEST?
If you have a uterus, yes: any estrogen thickens the uterine lining, and a progestogen protects it. Your physician includes it in your plan. After a hysterectomy, estrogen alone is standard.
Is BIEST better than estradiol alone?
Not necessarily. Both work for menopause symptoms. BIEST appeals to patients seeking a lower dose, a gentler profile, or a compounded approach. Your physician helps you choose based on symptom severity and tolerability.
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
Compounded bioidentical hormone therapy: new recommendations from the 2020 National Academies of Sciences, Engineering, and Medicine.
Menopause, 2021 - 3
Compounded Bioidentical Hormone Therapy: The National Academies Weigh In.
JAMA Intern Med, 2021
BIEST 0.05 mgfrom $89/mo