Capsule
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.
30 capsules per month
Starting at $89/mo
MenopauseHormone therapy
Estradiol Cypionate
RxPrescription onlyInjected under the skin · Once a week · 2.5 mg · Menopause · Hormone therapy
Starting at $139/mo
Long-acting estradiol injection for hot flashes, night sweats, sleep and mood changes of menopause and perimenopause, and for gender-affirming hormone therapy. One injection every one to two weeks.
Choose your plan
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- The most effective treatment for hot flashes and night sweats
- Steady levels from one injection every 1–2 weeks
- Prescribed and dosed by a physician who reviews your history
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
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
What is estradiol cypionate?
(es-tra-DYE-ol SIP-ee-oh-nate)
Estradiol is the main estrogen your ovaries make before menopause. Estradiol cypionate is estradiol bound to a fatty acid so that, injected into muscle, it releases slowly over one to two weeks. It replaces the estrogen that falls at menopause, which is what drives hot flashes, night sweats, vaginal dryness, disrupted sleep and bone loss. It is also a standard option in feminizing gender-affirming hormone therapy. Your vial ships every month with your plan.
- How it is taken
- Injected under the skin
- How often
- Once a week
- Dose range
- 2.5 mg
- Form
- Menopause · Hormone therapy
~75%
reduction in hot-flash frequency with estrogen therapy versus placebo, in the Cochrane review of 24 randomized trials
Hormone therapy is most favorable when started before age 60 or within 10 years of menopause, in people without contraindications. Your physician reviews that with you.
How it works,
week by week.
Day 1
A US-licensed physician reviews your symptoms, history, risk factors and, when needed, labs, and sets your dose. Your first vial ships discreetly to your door.
Weeks 1–2
One intramuscular injection every one to two weeks. Hot flashes and night sweats usually ease within the first two to four weeks.
Month 1–2
Sleep and mood follow as levels steady. Your physician checks in and adjusts the dose or interval to your response.
Month 3
Check-in. Your physician reviews how you feel, any bleeding or side effects, and confirms your dose going forward.
Beyond
Hormone therapy is reviewed at least yearly: dose, benefits, risks and whether to continue. Your physician decides with you.
What you may notice,
and when.
Fewer hot flashes
the change estradiol is best known for
Uninterrupted sleep
as night sweats settle
Steadier mood
reported by many as levels stabilize
Bone protection
estrogen slows the bone loss of menopause
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.
Safety first:
what to know before you start.
Important safety information and common side effects
Estradiol is a prescription hormone with real benefits and real risks, which is why a physician reviews your history first. Common, usually temporary effects include breast tenderness, bloating, nausea, headache, spotting or breakthrough bleeding, and soreness at the injection site. Estrogen therapy increases the risk of blood clots, stroke and 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 the clot risk further. 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 you take.
The research behind
estradiol.
Estradiol is the main human estrogen. The large outcome trials used conjugated equine estrogen or oral estradiol, and the evidence on hot flashes is the strongest; evidence on heart and cancer outcomes depends on age and time since menopause.
- Stroke riskStroke up in WHI
The WHI estrogen-alone trial gave conjugated equine estrogen 0.625 mg a day (not estradiol) to 10,739 women aged 50 to 79 after hysterectomy, against placebo, for about 6.8 years. Stroke rose (hazard ratio 1.39) and hip fracture fell; the trial was stopped early.
Anderson et al., JAMA 2004 (WHI estrogen-alone trial) - Artery wallOnly when started early
The ELITE trial randomized 643 healthy women by years since menopause to oral estradiol 1 mg a day (with cyclic vaginal progesterone if they had a uterus) or placebo. Thickening of the carotid artery wall slowed only in women under 6 years past menopause (0.0044 vs 0.0078 mm a year); women 10 or more years past menopause showed no effect.
Hodis et al., NEJM 2016 (ELITE) - Hot flashesFewer and milder
The Cochrane review of placebo-controlled trials of oral estrogen, each lasting at least three months, found hot flushes and night sweats less frequent and less severe than with placebo. The trials were short, so long-term safety is not settled by this review.
MacLennan et al., Cochrane Database Syst Rev 2004 (CD002978)
What the studies found
- Fewer and milder hot flashes and night sweats than placebo, in trials of at least three months (MacLennan, Cochrane 2004)
- Slower thickening of the carotid artery wall when started within 6 years of menopause; no effect at 10 or more years (ELITE, NEJM 2016)
- Fewer hip fractures in women aged 50 to 79 after hysterectomy taking conjugated estrogen (WHI estrogen-alone, JAMA 2004)
- Prevention of bone loss and fracture is listed as a benefit of hormone therapy in the 2022 society statement (NAMS, Menopause 2022)
Trial results are for the studied products at the studied doses (conjugated equine estrogen in WHI, oral estradiol 1 mg in ELITE). They are averages, not predictions for one person. Compounded estradiol capsules, creams and cypionate were not studied in these trials; they are not the same product as the FDA-approved estradiol that the trials used.
What this does not say
- Oral estrogen raises the risk of venous clots more than transdermal estrogen does, according to a 2008 BMJ meta-analysis (Canonico et al.).
- The WHI and ELITE results depend on age and years since menopause; they do not apply the same way to every woman.
- The trials measured stroke, artery thickness and hot flashes; they do not show that compounded creams work or are safe in the same way.
The research
behind it.
The 2022 Menopause Society position statement confirms hormone therapy as the most effective treatment for hot flashes and night sweats, with a favorable balance of benefit and risk when started under 60 or within 10 years of menopause.
Long-term follow-up of the Women's Health Initiative found no increase in all-cause mortality over 18 years among women who used hormone therapy. Your physician goes through your personal risk factors before prescribing.
Hormone therapy beyond hot flashes:
what the research showsBones, the heart, vaginal health and sexual desire: the trials, with their numbers and their limits.Read the researchHormone therapy and breast cancer risk:
what the trials foundEstrogen alone and with progestin, why the two differ, and how physicians weigh it.Read the research
what the research showsBones, the heart, vaginal health and sexual desire: the trials, with their numbers and their limits.Read the researchHormone therapy and breast cancer risk:
what the trials foundEstrogen alone and with progestin, why the two differ, and how physicians weigh it.Read the research
Getting started
takes a few minutes.
- 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.
Frequently asked questions
Contact supportHow do I use Estradiol Cypionate?
Injected under the skin, once a week. The starting prescription is 25 units (2.5 mg) each time. Your physician sets your own dose and it is printed on your label.
How much arrives in each shipment?
1 vial at the starting strength, shipped to your door from a licensed US pharmacy.
Who is estradiol injection for?
Women with bothersome hot flashes, night sweats, sleep or mood changes of perimenopause or menopause who have no contraindications, and adults on feminizing gender-affirming hormone therapy. It is not for people with a history of breast cancer, blood clots, stroke or unexplained bleeding. Your physician reviews your history and decides.
How do I inject it?
Into the muscle of the thigh or buttock, every one to two weeks, at the interval your physician sets. It takes a minute; the kit includes everything and your physician shows you how.
Do I need progesterone too?
If you have a uterus, yes: estrogen alone thickens the uterine lining, and a progestogen protects it. Your physician includes it in your plan. After a hysterectomy, estrogen alone is standard.
Is hormone therapy safe?
For most healthy women under 60 or within 10 years of menopause, the benefits outweigh the risks, according to the Menopause Society. Risks rise with age, time since menopause, smoking and personal history. Your physician goes through yours before prescribing and reviews the plan at least yearly.
Estradiol educational content reviewed by our physician
Scott Nass, MD Doctor 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.
More options
in this area.
Dissolving tablet
BIEST (20:80) 0.05 mg ODT
A low-dose bioidentical estrogen (20% estriol, 80% estradiol) in a tablet that dissolves in the mouth, for hot flashes, night sweats and other menopause symptoms. Prescribed and dosed by a licensed physician.
30 tablets per month
Starting at $99/mo
Dissolving tablet
BIEST (20:80) 0.1 mg ODT
A stronger dose of bioidentical estrogen (20% estriol, 80% estradiol) in a dissolving tablet, for menopause symptoms not controlled by the lower dose. Prescribed and dosed by a licensed physician.
30 tablets per month
Starting at $99/mo
Cream
BIEST (20:80) Cream
Bioidentical estrogen cream (estriol and estradiol in 20:80 ratio) applied topically. Supports hormonal balance and menopausal symptoms. Prescribed and dosed by a licensed physician.
Starting at $79/mo
References
- 1.The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 2022
- 2.Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women's Health Initiative randomized trials. JAMA, 2017
- 3.Eligibility criteria for menopausal hormone therapy: a position statement from a consortium of scientific societies. Maturitas, 2022
- 4.Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes: Cochrane review. Cochrane Database Syst Rev, 2004
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.