Biest (Medication) Guide for Menopause: Side Effects & Dosing

Biest (Medication) Guide for Menopause: Side Effects, Dosing & More

Biest may be the preferred way to treat low estrogen in the setting of menopause. 

Learn more about why this combination medication is preferred to other formulations, how it works in your body, how it may be protective against breast cancer, how to dose it and more


Bio-Identical Hormone Replacement Therapy & Biest 

Bio-identical hormone replacement therapy is the use of hormones which look exactly like the hormones your body produces naturally. 

These hormones are then given to patients to relieve problems associated with hormone imbalance (such as low estrogen). 

Biest is a perfect example of a bio-identical hormone and it is often (or should be) used to treat cases of low estrogen and menopause. 

But what exactly is biest?

Biest is a combination of estrogens formulated into one compound. 

Thus the name "bi" (meaning two) and "est" (referring to estrogen)

list of bioidentical vs synthetic estrogens

The two estrogens included in this are estradiol and estriol. 

Estradiol is considered the most powerful and most potent estrogen in the female body while estriol is considered a much weaker estrogen (1).

Biest is most often used as part of HRT (hormone replacement therapy) for women who suffer from menopause and low estrogen. 

Because of its unique properties, it may be preferred when compared to synthetic estrogens such as those found in birth control pills (2).

Using Biest for Menopause & Low Estrogen

Does using biest have any benefits over more traditional medications such as estradiol?

The answer is probably and here's why. 

Biest includes a combination of the most powerful estrogen that your body produces naturally (estradiol) and a weaker, more protective estrogen (estriol)

In order to understand the benefit, you need to know just a few basics about HRT. 

The first has to do with the concern over using estrogens and estrogen therapy to treat low estrogen. 

In the early 2000's there was a study (the Women's Health Initiative) which showed that using estrogen, specifically in the setting of menopause, may lead to an increased risk of heart disease (heart attacks), breast cancer, stroke and venous thromboembolism (3) (blood clots). 

Up until this point up to 30-40% of women who were post-menopausal were using HRT (4) which was being actively prescribed by Doctors.  

The women undergoing treatment for HRT during this time were experiencing significant relief from their symptoms but were placed at an increased risk of the events listed above. 

This caused a massive shift in thinking among physicians and MANY women were pulled off of HRT in a hurry. 

percentage of women using HRT prior to 2002 and after

This study has had a lasting impact on many physicians who are unwilling to prescribe HRT due to this perceived risk (5).

The problem with the study is that it tested what are known as synthetic estrogens, such as Prempro, Premarin and progestin (pharmaceutical variants of actual hormones that females produce naturally). 

Even though these hormones are NOT the same as the hormones that your body produces naturally (these are referred to as bio-identical hormones), both bio-identical and synthetic hormones have been lumped into the same category in terms of these risks. 

The problem with this is that many studies show that the negative side effects seen in this study may have been primarily due to the fact that these hormones were synthetic and not bio-identical (6).

This is a long introduction to biest, but this is where biest takes center stage.  

Studies have shown that there is indeed a difference between how stimulatory certain estrogens are on tissues such as breast tissue and endometrial tissue. 

What this means is that there are weak estrogens and strong estrogens, and some estrogens may be balancing the effects of stronger estrogens (7).

Estriol is an example of one of these weaker estrogens and one that has the potential to combat the increased potency of estradiol (8) (especially when used alone). 

In fact, newer studies have shown that the use of bio-identical hormones does not show an increased risk of these negative side effects (cancer, stroke, etc.). 

Wouldn't it be nice if you could use the exact same hormones that your body produces naturally to completely eliminate the symptoms of menopause, without experiencing the increased risk of heart disease, breast cancer and so on?

Well, that's the logic behind the use of biest and other bio-identical hormones. 

It's important to realize that no hormone is perfect, however, so before you jump in and use biest you need to be evaluated by a physician to assess your own personal risk.  

Dosing Based on Symptoms & Blood Tests

Another important factor, as it relates to risk factors and side effects, is the dose of your medication. 

The best approach to take, when using hormones, is to use the absolute minimum amount of hormone necessary to completely resolve all of your symptoms and without causing the symptoms of excess hormone. 

This can be done by carefully monitoring your symptoms and by watching your serum levels of estradiol and progesterone (you can also assess your hormones via 24-hour urinary testing as well). 

Biest is usually formulated with 80% estriol and 20% estradiol

This ratio can be adjusted based on the needs of the individual. 

For instance:

Your Doctor may prescribe 70% estriol and 30% estradiol or even 90% estriol and 10% estradiol. 

The idea is to use no more estradiol than necessary to help reduce the symptoms of menopause and to balance that with a sufficient amount of estriol. 

The estradiol component of biest can be manipulated (either up or down) if you are struggling with persistent symptoms. 


Estradiol is the most potent estrogen in the body and the symptoms of menopause tend to be primarily caused by the reduction in estrogen (9) (estradiol) produced naturally by your ovaries. 

In order to achieve symptomatic relief, you NEED some estradiol, but you don't want to use too much

Women who are post-menopausal, and experiencing side effects such as hot flashes, weight gain, and depression, will often notice a near immediate reduction in their symptoms when starting biest (10).

Dosing can be started at a very low dose and increased until the side effects stop. 

While you are adjusting your dose make sure that you monitor for symptoms of excess including breast tenderness and menstrual bleeding (more on side effects below). 

Your Doctor can, and should, work with you as you start biest to help titrate and tweak your percentage to find an optimal level for you. 

This may take some trial and error, so be patient!

As a provider, and after treating hundreds of patients, I can tell you that no two women are exactly alike. 

The amount of hormone that they require will be different and unique to their body. 

But taking this approach has allowed me to help 98+% of women suffering from menopausal symptoms. 

Application (How to use Biest effectively) 

So, how do you use biest if you plan to take it?

Biest is usually formulated in either a cream or a gel by a compounding pharmacy. 

This may be different from other hormones you are used to taking because most medications are taken orally (meaning by mouth). 

Taking hormones transdermally (through the skin) or via injection (with a shot) is usually better when compared to orally due to the avoidance of the first pass metabolism by the liver (11).

When you take a medication by mouth, the medication must go through the intestinal tract where it is absorbed and then processed directly by the liver via the portal system. 

The liver will then break down a large percentage of the hormone into smaller pieces to help your body get rid of it.

This may lead to concentration of the hormone in the liver which can stimulate hepatic protein synthesis and may increase inflammatory markers and markers of coagulation and so on (12).

The use of oral estrogen also dramatically increases the creation of sex hormone binding globulin which can bind to and inactive testosterone (which is in low supply during menopause!). 

Once the hormone is broken down it is then sent to the heart where a portion of the original hormone absorbed is directed to your cells and tissues.  

This process should be compared to the natural process that your body goes through when it releases hormone through endocrine glands (hormone glands). 

Your body releases hormone directly into the bloodstream where your hormones go straight to target tissues FIRST as opposed to being broken down by the liver first

In almost all cases, it's best to mimic the natural flow of the body when using hormone replacement therapy. 

For this reason, the transdermal route may be preferred over oral medication. 

In addition, when using biest, you'll also want to make sure that you put it on the appropriate place on your body. 

The forearms are perfect "real estate" for hormone application because the skin is thin (13), there isn't very much fat there and your superficial veins will carry the hormone directly to your heart for pumping throughout the body. 

Other areas that biest can be used include the inner thighs, vaginal area, peri-anal area, and neck. 

If you are using other hormones, such as testosterone or progesterone, make sure that you do not apply more than one hormone to the same spot on your body at a time. 

Some hormones, such as progesterone, will need to be alternated each time you use them. 

Another quick tip:

Estrogen has an enhancing effect on the skin and can help reduce wrinkles/age spots (14).

Some patients will apply their biest to their forearms and then do a quick swipe of hormone on the back of their hands, neck and even face

You don't want to apply the hormone to these places directly, but a small residual amount may work wonders! 

Side Effects to Watch out for

Side effects from biest tend to come from either underdosing or from overdosing. 

It would be unusual to respond directly to the active hormones because your body has been producing them naturally for many years (remember they are bio-identical). 

With this in mind, you can imagine a scenario in which you might be reacting to the absolute dose vs the hormone itself

For instance: 

Using an insufficient dose will lead to the persistence of symptoms such as hot flashes, weight gain, and depression. 

This does NOT mean that the medication is causing these symptoms, instead, it may mean you need to increase your dose. 

Symptoms that you are not using enough biest may include:

  • Persistent hot flashes
  • Persistent weight gain
  • Persistent mood issues or depression
  • Persistent vaginal dryness and decreased libido
  • Persistent night sweats or insomnia

On the other hand, it's also entirely possible that you are using TOO MUCH hormone and may be experiencing side effects associated with excessive dosing. 

This would be an indication to cut down on your dose because excessive dosing may lead to overstimulation of estrogen receptors and may increase your risk (if continued long-term) of breast cancer and so on

You can find a list of excessive dosing below: 

  • Breast tenderness
  • Menstrual bleeding
  • Abdominal cramping
  • Water retention or bloating
  • Nipple tenderness
  • Breast fullness or enlargement (with or without tenderness)
  • Pelvic cramps (with or without bleeding)
  • Continued hot flashes at very high doses (hot flashes may subside and then persist if dosing is extremely high)

When using biest ensure that you do NOT experience the side effects listed above. 

If you do, then reducing your dose (or stopping for 2-3 days) should be sufficient to bring you back to normal. 

If there is any confusion about your dose make sure to discuss it with your physician or re-order blood tests. 

How to get Biest from your Doctor

In order to get biest, you will need a prescription from a physician (MD or DO). 

Most conventional doctors, such as family practice doctors or endocrinologists, may not be familiar with using biest or other bio-identical hormones. 

The reason for this has to do with the fact that hormone replacement is not taught in medical school. 

So, in order for a physician to be knowledgeable on the subject, they usually have to take extra classes or courses to help bring them up to speed. 

The logic and theory behind bio-identical hormone use are also vastly different from the conventional hormone replacement therapy model that standard physicians use

Conventional doctors don't have a problem giving out massive doses of insulin, birth control or steroids, but they seem to have a problem when it comes to bio-identical hormones. 

Much of this simply has to do with the fact that they are not educated on the topic. 

It's my experience that most physicians when they see how effective these hormones can be, and when they are confronted with the studies that show they are effective (15), they tend to be willing to give them a try. 

But having this discussion is generally not worth your time or effort when you can find a physician who specializes in hormone replacement therapy relatively easily. 

If you are interested make sure you look for a doctor that specializes in Integrative medicine, Anti-aging medicine or functional medicine. 

Most women find that their symptoms are taken more seriously and they are "listened to" by integrative Doctors compared to conventional physicians (this is actually seen in studies (16)). 

Final Thoughts

Biest is a combination medication used to treat low estrogen which can also be very effective in menopause. 

This formulation of estrogens contains both estradiol and estriol and may be superior when compared to just estradiol alone. 

Estriol may help to reduce the powerful impact that estradiol has on breast and endometrial tissues by acting as a minor anti-estrogen. 

If you are considering using HRT for menopause then biest may be the preferred option because it is bio-identical and contains a more complete hormone profile when compared to generic pharmaceutical medications

As always, ensure that you titrate your dose based on your body and on your symptoms. 

Doing this should reduce your risk of negative side effects. 

Now I want to hear from you:

Have you used biest previously? Are you using it now? 

Has it helped reduce your symptoms?

Why or why not?

Leave your comments below! 

References (Click to Expand)

stop menopause symptoms with biest

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

P.S. Need more help? Check out my free thyroid downloads and resources.

76 thoughts on “Biest (Medication) Guide for Menopause: Side Effects, Dosing & More”

  1. Hi,

    I have been using Bi-EST 80/20 for two years along with progesterone cream (10 MG at night only). I have undergone many salivary tests to try and get the levels right but it seems to be a vicious cycle for me. During this two year period, my hot flashes and night sweats have not gone away. They have lessened, but there are times when they are out of control, especially during the night while trying to sleep. I never feel cool at night and this has greatly affected my quality of life.
    The highest dosage I have been prescribed is 0.2MG CR, 2 clicks twice daily. Keep in mind that I am 118 pounds, 5’4 1/2 inches and am 50 years old.

    The Most noticeable side effects of the HRT for me are bloating and blurred vision.

    I haven’t slept well since I started menopause. The hot flashes and night sweats are the main cause, but menopause has changed me— I also have increased anxiety and depression, even while on the HRT (that seeks to be a vicious cycle). I would appreciate your advice.

    Thank you,

    • Hi Stacey,

      I generally don’t recommend dosing based off of salivary testing. The best way to determine if you need the right dose is a urine test which can help you to understand how your body is metabolizing estrogens to determine if your estrogen quotient is sufficient. To get this information you need a urinary test (usually a 24-hour urine test).

    • Hi Stacey, Although this is a while after you posted, I am experiencing exactly the same thing. A bit of background: I used progesterone cream for 2-3 years prior to using bi-est. I used the cream at high doses for a while. Felt great for a while but it wasn’t until my estrogen dropped that the anxiety – chest jitters and inability to focus at work, general sense of “losing it” – kicked in. Then I tried adrenal herbs. I cannot strike a balance. Now I don’t feel good unless I use a double dose of bi-est. Wondering if I used too much progesterone from 45-48? It can store in fat. Hoping you read this and can respond…how are you doing and if good…what did you do to get to being good again? So frustrated. Feel like I’ve lost myself.

    • I just read all you’ve gone thru during menopause. We have a lot in common with size, age, and symptoms. I just recently added oxytocin to ease the anxiety and depression. At this date and time, I’m also at the 2 year point of perimenopause and 3 months without a period.
      I’m sending this reply in hopes you may have found some help that you’d be willing to share.
      Appreciate your time,

      • How did you add oxytocin? Is that something one can get a Compounding Pharmacy? !!! From everything I’ve heard / read…it sounds like it could REALLY improve one’s quality of life, by increasing all those feel-good things, love, bonding, pleasure, etc. Seems like any Rx would be highly addictive. Is it?

  2. I am 56, postmenopausal using Biest 50/50 to reduce hot flashes and for anti-aging. Current dose is E2- 0.1 mg and E3- 0.1 mg, progesterone 36 mcg/ G using 10 clicks daily M- Sat.
    I’ve had my levels tested using a slightly lower dose and it hardly made a difference in my testing results although my hot flashes did significantly improve. I’ve been reading about dosing and it appears this is an extremely low dose. Can you elaborate on what the optimal Estrogen/progesterone levels to aim for are and your thoughts on dosage? (Thyroid function has been improved using compounded T3/T4 with levels acceptable to my DO)

    Thank you.

    • Hi Cheri,

      When I use progesterone and estrogen I try to reduce the symptoms of menopause while avoiding the symptoms of excess estrogen/progesterone and minimally impacting estrogen/progesterone serum labs. I don’t have specific ranges as they vary based on the individual.

  3. I have been using Biest since 2011. I went into early menopause after a car accident in 2009. My symptoms were severe. I could not carry on a competent conversation, I lost my train of thought very easily. I had severe hot flashes, overwhelming night sweats, and trouble sleeping. All of these symptoms caused me to lose hope with life. I was demoted at work, my family was falling apart, and I was angry all of the time. Once my DO prescribed my compounded bio-identical hormones, and I began taking them daily. I lost weight. My memory came back, and I was able to sleep again. I still have the occasional night sweats, but they are bearable. I would also like to mention, that I take 125MG of Progesterone as well. Both of my hormones are taken in lozenges forms. I have my life back! I recommend this treatment to any woman who is struggling with severe menopausal symptoms. Thank you.

  4. Hi I just started Biest at the lowest dose, half a ml of .50

    I’m 49 and my periods are still monthly but range from 21-40 days.

    When I use this I feel a bit weird. Hard to describe but a little anxiety in my chest area, or a feeling of “coolness” or “menthol” like feeling.

    I’m wondering do you give this to women still menstruating? I got it for my anxiety, fatigue, depression and other perimenopausal symptoms. Thanks.

  5. I’ve been using for 2 days. The doctor said 4 pumps, but I’m only doing 2. Have cramps about 2 hours after. Exactly like my period used to be. I’m 66, postmenopausal.

  6. Hi, I’ve been taking Biest (C-Biest 80/20) orally for the last 4 years and prior to that Prempro. I have a couple questions. I’ve been diagnosed recently with Hypothyroidism and have Thyroid nodules and a cyst on the left side of my neck. Can Biest cause Thyroid problems? Also if I nap in the daytime I wake with a throbbing headache which I’m positive is caused by Biest. I never experienced this till I went on HRT. A doc friend told me it interferes with the Pituitary gland…any thoughts?

    • Hi Carol,

      All hormones (including biest) interfere with your pituitary hormones because of feedback loops (this includes birth control pills, etc.). This isn’t the problem, though, as symptoms arise from your dose, not the fact that it can reduce pituitary function. If you are experiencing negative side effects then it’s most likely dose related.

  7. Hi,
    I always read your blog, thanks for sharing the information. I am 42, due to endometriosis surgery my ovaries are stopped working and periods are stopped. I went to a doctor, she tested my hormones and she prescribed bio identical hormone. She was saying my estrogen levels are very low. She gave BIEST (50:50)0.288mg+ prog 4.6% per GM. Am I I using lower dose or high dosage? Is it ok use this dosage or not? Last one month I been using this, I see my breast size increased, 3 pounds weight gain. Sometimes middle of night feel hot flashes. Suggest any other ideas? I am using WP thyroid medicine too.

  8. I’ve been using biest cream 80/20 for years and just started using it vaginally but my breasts have enlarged and are very tender… should I cease using it vaginally and go back to putting it on my skin or will the breast tenderness subside.

  9. I took bio-identical progesterone in a pill form made from wild yam extract while I was perimenopausal and it was a lifesaver. About a year ago I began menopause and the progesterone seemed to make my hot flashes, palpitations, and anxiety worse so I discontinued it and noticed some improvements for a while. This relief was short lived and I started a biest cream for my symptoms which seems to help… however I am wondering if I need to take some bioidentical progesterone with it? When I tried both together it seemed to increase the hot flashes and anxiety again.. I thought women needed both hormones for balance and that estrogen alone without progesterone would not be safe. Is that correct? Should I just try to adjust the dose of each to find the right balance?

    • Hi Ann,

      Yes, most women do well on a combination of both progesterone and estrogen but it’s not true for all women. Some women can do well on one without the other and vice versa. It depends on a number of factors.

      • When using the Biest cream is it best to apply morning and night or just once per day? I am still trying to adjust my dose to figure out what amount relieves my symptoms and am having difficulty getting to that point. It seems that on some days, the dose applied in the morning has perhaps not lasted very long and I have tried to apply an extra dose midday to get relief. Is this not advised ? Is it better to increase the dose taken earlier rather than add an extra dose midday. Should a dose be lasting at least 12 hours, or less?

      • Isn’t there an elevated risk of uterine cancer if you take estrogen without progesterone? I have been on BIEST for about 9 months now. And I too have had real problems with side effects the progesterone. First I changed from pill to a cream and then reduced the dose further. Now I seem to be okay, but I’m always anxious to make sure to be trying to tolerate more progesterone because of this perceived risk of uterine cancer (about which my doctor seemed to worry). I’m 53 and on 1 mg BIEST, 1 mg testosterone, and 50mg progesterone (all topical).

        • Hi Jess,

          The risk often stated between unopposed estrogen and uterine cancer stems primarily from the use of synthetic estrogens (not bio-identical versions). Obviously, it is possible to get the same risk if you overuse biest, but the risk is far less at baseline with the difference in estrogens. I can’t recall the study off the top of my head but there is one that looked at the risk of cancer using various types of estrogen with or without progesterone. The takeaway was that as long as you are using bioidentical versions of estrogen at the lowest possible dose, the risk was essentially 0. Individual risk will vary from person to person but this just highlights the importance of dose and quality of the hormone whenever you are trying to discuss possible negative side effects. You can often use microdoses of biest to get the desired side effects which is the method I tend to prefer.

  10. Dear Dr. Childs,
    My wife is 69 years old, and approximately 20-25 years ago my wife had a bi-lateral masectomy, radical on her left side where the lump was, and simple on her right side. A few years later, an ultrasound showed “something” on one of her ovaries, and in light of her recent cancer, opted for a complete hysterectomy, both ovaries and uterus. The “something” proved to be non-cancerous.

    Because of the HABITS study, doctors and OB-Gyns have told her they will not prescribe any HRT for her, but after enduring misery for 20 years of surgical menopause–hot flashes, night sweats, insomnia, terrible mood swings, these symptoms appear to be getting worse, and she’s at the end of her rope.

    Because she has no breast tissue, nor any of her female reproductive organs, why is there fear of prescribing HRT for her? What is there to get cancer in?

    She has tried the usual non-hormonal recommendations, to no avail.

    Is there any hope of finding a doctor who would consider prescribing biest or similar bioidenticals for her, or alternately, could any of the OTC bi-est or bi-est transdermal creams, with perhaps a supplement of progesterone OTC transdermal cream be an option for her?

    Thank You very much,
    Sincerey, Rick S, Atlanta, GA

    • Hi Rick,

      Yes, there is certainly hope. I would make sure you look for a doctor who specializes in bio-identical hormone therapy, anti-aging medicine, or functional medicine.

  11. I am just starting therepy with Biest cream (80/20) and Progesterone cream. Please tell me what the average starting dose of each is for menopause. Thanks.

  12. Thanks for this post. I had sudden cessation of my hormone production due to neurotoxin about 3 years ago. I’ve been on HRT for 1.5 years.

    I was started on 0.1 mg Estrogen patch twice weekly. I’m seeing another doctor now that wants to switch me to Biest. I was beginning to have weight gain, breast pain, bleeding, and cramping. I’m starting on 5mg/ML Biest at 1ML per day.

    What should I expect?

    We began using one patch per week vs 2, and are now switching to Biest.

    Also, I was previously also on Progesterone at 50mg/ML apply 1 ML per day. We have decreased that dose to .20ML per day now and the breast tenderness and bleeding seem to be resolving. My new Dr is a bigger fan of Biest and cream, not the patch.

    Thanks for your thoughts on these changes.

  13. I am currently using OTC bi-est and OTC progesterone cream (Iona’s 10%) and tomorrow I go to my doctor for blood labs to see how I am doing. I should note that she gave me a compounded cream months ago (I was away at the time and it was estriol/estradiol/progesterone/testosterone small amount) and could NOT handle the testosterone (made me mad/angry). I kind of would like to use the OTC stuff as it is cheaper (unless I need way more on something/complete hysterectomy/post menopausal. 1/2 thyroid which I am trying to optimize.

  14. Hi there,
    I am in my thirties and have been on HRT for 7 years now. I have hypothalamic amenorrhea – I do not get my period unless I am on the pill/withdrawal bleeds. However, I developed liver adenomas – one from OCP (removed 2008) & another 2 when I was pregnant. Without supplementation, my hormones – especially estrogen, FSH and LH are rock bottom and because of the risks of osteoporosis, etc I must use estrogen and progesterone but oral is not ideal because of having to pass through the liver.
    So I have been using estrodot 100mcg patches and progesterone cream. I am now trying to swap to biest – currently using the 80/20 but my gyn is worried the dose of estradiol is too low. Can you recommend what type of biest dosage I should be aiming for to approximate the estrodot patches I was using previously? That dose of estrogen raised my levels to a good amount. When my estrogen is low (& it decreases to 19? Without HRT) I feel terrible. Because of my age, my gyn would like to have my levels as high as possible as safely as possible and feels biest is likely the best way but doesn’t have the experience to prescribe. Could you possibly recommend a dose? And how I could order this, please? I am currently using 1ml of 80/20 morning and 2ml 80/20 at night and 20mg progesterone at night. I don’t have any other symptoms that I know of – no breast tenderness etc but then I have also never experienced PMS so it’s difficult to know.
    Thank you so much.

  15. I was using biest (2.5 mg) for quite a few years during menopause. It helped me significantly compared to if I didn’t have it. I still experienced a couple of years of hot flashing but it was kept to a minimum as long as I ate very healthy foods (mostly organics, no fast foods or refined foods) and supplemented with fish oil (Nordic Naturals or OrthoMolecular) and had 2 T of ground flax seed in my diet most every day. When I missed either of those items, I found my hot flashes were more frequent and greater in intensity. At around 8 years of treatment, the hot flashes finally subsided and I actually felt chilly again like normal people do. My functional medicine doc recently had me stop the biest and now I am on estradiol (1 mg) because I had developed some small uterine cysts, non-cancerous, which may have been related to the biest. So, I’ve had a reduction now and still feeling very good and no side effects.

    • Weird, I would have thought Biest was less of a risky preposition compared to estradiol but I would have added some natural progesterone to it.
      PS; Not a medical professional, just reporting what I have been learning

  16. Hello, I’m Tina I am 34 years old and my doctor prescribed Biest 50/50 daily because of my sex drive has gone way down. My question is where is the best place to apply the cream.

    • Hi Tina,

      Generally, I wouldn’t consider estrogen to be the “fix” for low libido (though it can potentially). Depending on your formulation, you should be able to apply it anywhere on the skin. I typically prefer the forearms or inner thighs as these are prime real estate for absorption and getting medications quickly into your veins (the veins are superficial in these places, especially the forearms). Some women find success with transvaginal application of the creams, but I wouldn’t go this route unless your medication was specifically formulated for this area.

  17. I was just prescribed Biest as a vaginal suppository. Haven’t started yet but was wondering how others were faring using this method.

    • Hi there — TY for a great article. I have used bi-est 70/30 now for 6 months – started at 80/20. This article is so wel written and I really appreciate it — again thank you!!! I had made zero hormones for a good long time due to a rad hysto in 2007 — it has been a rocky road but a year in I feel human again and have my life back thankfully. It DOES take time and patience indeed but it is well worth the wait — I went through MANY doctors who all told me NO and I was miserable as all get out. No longer — education is key and this article is in every way s spot on!!! Many physicians are not taught — true — it would take my finding the amazing functional medicine hormone specialists wh were not afraid to help me to help me and they have. I take my bi-est via holistic organic oils with a progesterone 100 mg gel cap. I am very happy. Again – great article all the way around. Very appreciative — I have shared it to my group.

  18. Hi, I have been on Biest 80/20 for years after having a total hysterectomy. I took a break for a while I tried estradiol and testosterone pellets as well as compounded progesterone. I immediately gained 10 lbs. A year later I am still struggling with the same 10 lbs. and a lot of it is water retention and bloating. 6 months ago I started BiEst again. I cannot tolerate doses over .75 mg, I went from 1 mg. back down to .5, seemed to stabilize a little, then back to .75… My breasts have grown, are heavy and hurting, even though any diet is near perfect and I work out daily, I struggle with extreme water retention, bloating and weight around my hips and tummy. I do not have hot flashes. Unfortunately after consulting so many doctors including functional, naturopath, endocrinology, hormone specialists, nobody can help. After reading your article I am convinced that I need to use less BiEst and that it is causing my issues. No matter what my lab levels are, after years of this I can tell when I’m imbalanced. I am scared, but I’m thinking about stopping for 2-3 days as you mentioned in the above article. And then starting at .25-.5 for a month to see if this helps… Can you give me some input?

  19. Hello I am taking compounded biest 80:20 6mg/ml (two lines per day) and Progesterone 400mg/ml (two lines per day). I have been taking these creams for 6 yeas. I am postmenopausal and we do have a history of breast cancer in my family. I am a little concerned as my Estrone went up from 140 to 312. Where should the Estrone be in a postmenopausal woman with estrogen replacement therapy? Thank you.

  20. Hello. I am so happy to have found this website. I am in pre menopause and I am 47. The hormonal imbalance has interfered with my life so much that I was suicidal. I have been on Prempro, Combipatch, and now Biest 50/50 1mg with Progesterone 10mg. First month was great but the second month has been awful. Hot flashes, insomnia, chills, mood swings. It seems the dose isn’t high enough. I had knee surgery on 12/6 and placed on steroids a few weeks later because of swelling. I don’t know if certain medications can reduce the positive effects of the Biest? I also started Herblife shakes. I can’t take combo patch because I developed an allergy from the glue and that was working. I’m at my wits end here.

  21. Hi there!! Thank you so so much for an excellent explanation!!!!!!!!!!!! I have been taking Bi-est after a very long 17 years of being without ANY hormones at all due to two estro pos breast cancers and then a rad hysto ( 2003, 2005 & 2007) – to say that the quality of my life was so so awful is putting is very mildly. I finally did find the amazing functional medicine hormone specialists who saved me — in 2018 actually. There was not a doctor on the planet would touch me with a hormone no way no how nope nope nope!!!! I understand why this is but I really suffered terribly. I went onto 50/50 first – changed to 80/20 and then finally landed at 70/30 @30 mgs/ml. One year and one month in I am an entirely different person and so grateful. I recently have changed though again to 45mgs/ml as I still test low. However — my cancer numbers went down from 11 to 9 on one (ca 125) and from 9 to 2 ( special breast ca test). Wow! The way you have explained all of this is excellent!! Thank you so very much. Though I have been in the med field my whole life (and when diagnosed at 43 with my first breast cancer I was in school going for my physician’s assistant deal but obv stopped) — I had not a clue about any of this at all. Now at 62 I am feeling great and for me, I will not go off of my hormones no way! I feel human again. I have been studying all of this almost relentlessly these past six years and am just now really starting to understand. There is a lot to learn indeed!
    It can be very tricky to treat menopause and yes, a lot of patience is needed for sure when trying to find our right doses – when we are suffering so badly it is awful to wait I well know. It took me five months of serious trail and error to get it “right” but it was worth every minute. Seriously — 17 years of feeling ghastly was not fun at all. I trust my doctors implicitly and they do understand that menopause is a serious specialty and need be treated as such. None of us women should be suffering all of this in 2020 no!!!
    So, thank you so very much for writing out this incredible information for all of us! It is very much appreciated and it also is spot on! Thank you so much and thanks also to all who have left posts too!!! Carolyne Sherman Oaks CA.

    • Small addendum — I take my Bi-est transdermally via holistic oils that are compounded out for me and this method, at least for e has worked really well — Carolyne from above. 🙂

  22. I am curious what your thoughts are on using biest cream 50/50 and it causing me a histamine reaction. Sneezing, itchy eyes, scratchy throat, nasal drip, congestion.

    I was using 50/50 biest for about 2 mo ths without any change in my blood work. Taking a dose of 1 mg so functional med doc changed ratio to 80 estradiol to 20 estriol and this is when histamine reaction hit hard.

    I’ve since gone back to 50 5p biest but the reaction remains.

    Thoughts ? Have you dealt with this ? Benadryl takes symptoms away and cromolyn eye drops help the eyes etc. But I can not live in OTC items like this.

  23. I am on a compounded med called
    PROG 100/DHEA 10/MAGNL 250 MG

    I have also been prescribed BIEST 1MG (50/50)/TEST 2MG
    {because of low libido}

    Well the testosterone was not helping so now I’m trying Vyleesi. However, should I still be using the BIEST??? My dr was not clear, but by reading your article and the comments, I’m thinking I still need to be on both.

    What are your thoughts?

  24. I’m going through menopause. My testosterone total is 5 and my testosterone free is .5. My estradiol level is 32. My FSH is 64.3 and my LH is 34.3.

    Symptoms: hot flashes along with night sweats, terrible irritability, NO libido at all. I tried the Minivelle patch and helped until I was at that day before the day to change it. The compounded prog. I would take each night, but would still have some hot flashes, but my family said my mood was more stable. Just not sure about the BIEST that I described before. Any help or advice would be appreciated!

  25. I tried 50/50 Biest and migraines started again after day 3. It did help with hot flashes the first day. I stopped and resumed Progest. cream at night. My doctor just changed Biest compound to 80/20. He feels it will help with hot flashes,but will it cause migraines?

    • Hi Marie,

      The migraines are probably a sign the estrogen was too high compared to the progesterone. They still might come with the 80:20 but there’s a lower chance.

  26. Hi Dr. Childs,

    I’ve never heard to apply hormones separately before. I am on a combo cream of bi-est, progesterone, and testosterone. Is that a problem?

    Thanks much!

  27. Hello Dr. Childs,
    I was proscribed Prometrium and Estrogel, 17B-estrodial .06%. The full pump of Estrogel caused breast tenderness and I reduced the amount until that went away. I told the doctor that my main concern was hair loss which I had suffered for almost 20 years. During the year I was on these two I lost another 50%. When I finally read the contraindications myself I saw that hair loss can be a side effect of Estrogel. When I asked the doctor about this he said there were lots of other causes and that Estrogel was not the cause. I won’t go into that but I had been on the same supplement routine and the only thing that had changed was the Bioidenticals. I really don’t know what to do now. I also asked about testing my levels and he said that could only be done initially and no tests would measure levels accurately after starting to take the bio-identicals. He also did put me on a thyroid med of which I haven’t noticed any changes. Would biest be a better solution for me?

  28. I am 57 and had a total hysterectomy (no ovaries or uterus) 13 years ago. I was placed on estradiol 2mg immediately following my surgery. I have been fine and never suffered any symptoms until 2 years ago. I am having heat flashes, sweats, insomnia, brain fog, fatigue. My dr. switched me to prempro and I thought my head was going to explode….so I went back to estradiol every day. Has my estradiol stopped working? Could Biest be something that would help with the symptoms? Please let me know your thoughts as I would like to have my life back.

  29. I am 50 and had a hystorectomy at age 23. My doctor put me on Bi-est progesterone. I start taking it tonight. I get hot flashes, nausia, insomnia, brain fog, mood changes, racing heart, Thinning hair and dry skin, and fatigue. DO you think this will help with any of the symtoms i am having?

    • Hi Michelle, looks like you didn’t get an answer, but I suffer from the same symptoms. Did you find relief with the Bi-est and progesterone? I’m 39 in early menopause with an adopted two year old and my fatigue is so severe that it’s causing both of our qualities of life to suffer.

  30. I have been on BHRT for 10 yrs; about two yrs ago, I did a urine analysis and my doc finally listened to me about hot flashes and libido. She went from 2.75 80/20 E2 E3/day 1.75 T to 3.00 mg 50/50 E2 E3/day and 2.9 mg T/day. Recently my pharmacy included a plunger w my click dispenser and now I am inserting and applying the dose vaginally. After 2 months of this, I had breast tenderness, developed a 12 mm cyst that was diagnosed w mam and sonogram. Radiology Doc, said, “you don’t need a biopsy but it unusual for a woman ur age to develop a cyst.” I know it is the E2 E3 and vaginal application. I’m afraid my DO will want to knock be back to a low dose and I cannot handle the side effects; it is good enough to go back to 2.75 80/20. What would u do?

  31. Hello,

    I am starting the Prometrium 100mg per night (if I get a period take a 4-day break and start again) & Biest (80% E3: 20% E2): 1mg/0.2ml, 0.2ml to apply to the vagina daily as per my naturopath. I have tried only Prometrium 100mg before as per my previous naturopath and wasn’t happy at all as I had many side effects. Now, my new naturopath prescribed me both based on my Dutch test and other blood tests. But, I am still confused, when I can start each of them? Do I have to wait for my period? Do you think this dose combined will help me? Mihaela

  32. Hello Dr. Childs,

    Thank you for always putting out relevant information, just when I need it, it seems!
    My daughter(18 years old) has POI and has been on Vivelle-dot 0.1mg estradiol patches (the max strength). Yet, a recent DUTCH test showed her estrogen levels were low… Reading this article made me wonder if it’s possible that the absorption of the Vivelle-dot patch is lowered because it’s supposed to be placed on spots where there is a lot of fat (abdomen and buttocks), and my daughter is overweight. Are there any other possible factors that could prevent the absorption of the transdermal patch? I wonder if using bi-est would be better in this case, since it can be applied to other areas with possibly less fat for faster absorption? Thoughts and suggestions are highly appreciated!
    Thank you!!

  33. Hi,
    I’m 72 post menopausal and my dr wants to start me on low biest bcuz my estrogen imbalance is minimal according to saliva test.. Should I start this if I hve a very small uterus fibroid?

    • Hi Cynthia,

      I personally wouldn’t recommend that you base your dosing of estradiol off of salivary results. There are other methods that are better and more accurate.

  34. I had a Dutch test and my estrogen levels were below the minimum for menopausal levels (at the time, I was not menopausal yet). My doctor will not prescribe anything (also she does not understand the Dutch test). It is ridiculous.

    I have been using a little progesterone cream to deal with anxiety and sleep issues, and still even those levels were a bit low.

    In the meantime, my hot flashes have abated to almost nothing but my body has aged 15 years in 18 months. Skin, muscle loss, weak tendons, dental health… This is unacceptable.

    It is strange you mention BHRT just for “menopausal symptoms” – we want them also for disease prevention, including cardiovascular disease, brain function, bone health and vitality generally.

    I want Biest!!!

    • Hi Cis,

      The reason I mention them predominately for menopausal symptoms is because doctors will generally NOT prescribe hormones for disease prevention. They are more likely to prescribe them for reducing menopausal symptoms even though you get the added benefit of cardiovascular protection, bone health, general vitality, etc.

      You’ll probably have better luck just getting your serum estradiol and serum progesterone tested by your doctor. You can also check your FSH level to see if you are menopausal. These are tests your doctor is probably more familiar with so they will be more likely to act on the results.

      • My doctor had tested FSH – that is the only thing she understands. But, since my periods stopped suddenly 23 months ago (after a scare in the family) and I am now 56, I can safely say I am in menopause.

        Last time she tested my FSH was 6 years ago (day 5):
        FSH was 24 iu/L
        LH 10 iu/L
        estradiol 70 pmol/L
        Progesterone was 1.3 nmol/L (on day 5)
        SHBG: a high 103 nmol/L (down from 145 previously)
        She concluded I was in perimenopause (aged 50) and that was it. No comments or suggestions.

        I later went back complaining about fatigue and not feeling right: I was told to just “take some herbs, like most women do” (and this was a FEMALE doctor!).

        I started using a small amount of progesterone cream by myself because I felt like I was going mad.

        The main problem is – by implementing all the holistic practices possible including daily tai chi, walking, lots of veggies and seed cycling – I don’t have hot flushes anymore and I sleep decently.. but I do have fatigue, fuzzy brain, muscle loss, low immune function, dry skin, thin skin, often chilly, generally feel “suddenly old”.

        How to persuade her that this is the perfect time (the right “window”) to act?

        Even if I persuade my doctor to
        1) see me in these COVID times;
        2) she’d probably NOT give me bioidentical hormones. She likely mostly offers standard progestins and estradiol and I don’t think she has BiEst in her repertoire or natural progesterone cream.

  35. Hi there. Thanks for the informative article. I’m 56, went through menopause in my early-mid 40’s, and I’m a Hashi’s girl (20 years). Doc has just prescribed a Biest (80:20), Progesterone combination cream so this is all new to me. I’d just like to check a couple of things, please:

    * recommended spot for application –
    Dr suggested 1ml-pump application under armpit daily, but compounding pharmacy says – due to deodorant application – better to apply in places where there is FAT (thigh, butt, abdomen) and keep moving site (like you would a patch). You have recommended applying to forearms where skin is THIN. Is pharmacist incorrect?

    * thyroid medication and LDN-
    I’m taking NDT (1 grain on waking) and Low Dose Naltrexone (0.9ml) before bed. Is there a better time than another to apply the Biest cream, or it doesn’t matter?
    Thanks heaps.

  36. I am considering bi-est, because although I really never had much in the way of menopause symptoms, I have recently learned that I have osteopenia. My vitamin D levels are normal, and I do get calcium in my diet. My doctor did not suggest anything but adding calcium. Then thinking about being 15 years out from starting menopause, I realized perhaps that is the issue. I am reading that bio identical estrogen with strontium can improve bone density by 2% per year. I want to know if this is typical results. I am only 65, and will likely live to 95 because I am healthy, and have longevity in my family. I don’t want to be in pain for 30 years. Will this improve my bone density 2%/year?

    • Hi Debra,

      It’s impossible to predict that sort of thing but I can tell you that pretty much everyone I’ve ever treated has seen improvement in bone density with biest. Strontium is also another potential option as well.

  37. My dr just prescribed estrogen(biest), dont you have to BALANCE these hormones with a progesterone? Both of mine are basically zero.
    Is progesterone concerning if one had a salivary gland in the past?
    Does BHRT increase the risk of breast cancer?
    Symptoms are wt gain, bone health and major hair loss.

    Good to know biest helps with bone density or strontium.

    THANKS, Barb .
    Do you do private phone consults?

    • Hi Barb,

      Yes, generally speaking, you want to balance the combination of both estrogens and progesterone. I am not seeing patients at this time but if that ever changes I will send out an email to my list!

  38. Hi – thanks really interesting information and a great thread to follow.
    Am 59, menopause 7 years previously. Been on HRT about 3 months due to borderline osteoporosis, terrible sleep/anxiety. First an awful patch with synthetic progesterone. Now micronised progesterone 100mg daily and estradiol gel 1 mg daily. Comments about the strength of estradiol vs estriol interesting since, even at the low dose I’ve started with, the side effects are unpleasant – permanently sore enlarged breasts with painful nipples, fatigue, thinner/drier hair and 3kg weight gain. On the plus side better sleep and better facial skin tone. Not sure whether to continue and hope things settle down since I should be titrating the dose upwards to a “therapeutic dose” for the osteoporosis, quit and stick with supplements/weight bearing for the bone density or else try a different formulation. Any comments most welcome.

  39. Thank you for your interesting posts. I was on hrt until age 71 – Bi-est 1.75mg/ml (70:30) in Emu Cream, 1ml daily applied to thighs. I am now 79 and in the last few years, some prior symptoms seem to have gradually returned, but milder. I have a follow-up appointment with the same specialist. I have done a lot of reading and research during covid and see bi-est recommended for life. What is your thoughts on returning to hrt at my age.

  40. Thank you for your posts and wealth of info! I am perplexed at the moment over my 9/15/22 blood draw. I am 10+ years on BHRT, I’m 8 year’s post menopausal (59 yo in April). Have been doing est/test pellets for the last 5 years and have decided for easier dosing to try biest and testosterone RDT’s. What’s got me perplexed is my DHEAs level. It’s consistently high. This last one was 224 but has been as high as 321 back in 2015. It’s been 5 months since my last pellet when this draw was done and still DHEAs is high. My adrenals are fine, I don’t feel stressed or anxious at all. My FSH – 59.7, Progesterone 1.5, Estroidiol 21, Estrone 33, Testosterone 94, free testosterone 6.6 – I forgot to mention I am taking compounded progesterone 100 mgs at bedtime. Thinking I should increase the progesterone to 200 mgs. The new script for BiEST will be 0.175 mgs 2x daily RDT, and 0.50 testosterone RDT twice daily, and the 100mg progesterone at bedtime. It seems my testosterone is way too high so I’m not sure I’ll continue with that until my next blood draw. My last TSH was 2.83 and I am on compounded Thyroid for hypothyroidism as well. I am 5’5″ and weigh 151 lbs. no other meds other than multi vitamins. What say you ? Thank you in advance for your professional opinion


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