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 0.1 mg
Orally dissolving tablet combining estriol and estradiol (20:80 ratio) for moderate to significant menopausal symptoms. One tablet daily under the tongue. A bioidentical estrogen at a stronger microdose.
- Bioidentical estriol + estradiol at a higher microdose
- Orally dissolving tablet, no injection
- For moderate to severe hot flashes and night sweats
- 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
- 0.1 mg
What is BIEST 0.1 mg?
(BY-est)
BIEST 0.1 mg is the same formulation as BIEST 0.05 mg—estriol and estradiol in a 20:80 bioidentical ratio—but at a double dose. This strength is chosen for patients with more bothersome symptoms or those who do not achieve full relief on 0.05 mg. Both doses dissolve under the tongue and are designed for patients who prefer a compounded bioidentical approach and wish to avoid injections. The safety considerations remain identical to all estrogen therapy.
What's in it
- BIEST (20:80)Estrogen: eases menopause symptoms
0.1 mg
the dose per tablet, double the 0.05 mg strength, for patients with moderate to significant menopausal symptoms
BIEST is a compounded formulation, not an FDA-approved brand product. Dosing is set by your physician based on your symptoms and response.
Is it right for you?
Who it's for
Women whose hot flashes were not controlled on the 0.05 mg tablet.
What sets it apart
The same 20:80 blend at double the dose.
Worth knowing before you start
Give a dose change four to six weeks before judging it.
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 (0.1 mg)
- How often
- Once a day
- Each shipment
- 30 tablets
- Pharmacy label
- Place one tablet (0.1 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
Dose titration is standard in estrogen therapy: starting low and adjusting based on symptom response helps find the minimum effective dose. BIEST 0.1 mg is chosen when 0.05 mg does not adequately control hot flashes, night sweats, or mood changes.
The risk profile of BIEST does not change with dose in a linear way—the risks of clotting, stroke, and gallbladder disease do increase somewhat with higher doses, which is why your physician checks your blood pressure and reviews your risk factors 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) 0.1 mg ODT?
Dissolved under the tongue, once a day. The starting prescription is one tablet (0.1 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.
Should I start at 0.05 or 0.1?
Your physician sets the starting dose based on how bothersome your symptoms are. Starting at 0.05 mg allows assessment of tolerability; if symptoms are not controlled, your physician may increase to 0.1 mg. Some patients start directly at 0.1 mg if symptoms are severe. Your physician decides.
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 0.1 mgfrom $89/mo