Injection
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.
Starting at $139/mo
MenopauseBioidentical hormoneHormone therapy
BIEST 0.05 mg
RxPrescription onlyDissolved under the tongue · Once a day · 0.05 mg · Menopause · Bioidentical hormone · Hormone therapy
Starting at $99/mo
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.
How many tablets per month?
MonthlyEvery 3 months
30 tabletsper month
You'll receive 30 tablets per month. $119 billed monthly. Cancel anytime.
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Bioidentical estriol + estradiol in a lower microdose
- Orally dissolving tablet, no injection
- Designed for sensitive patients or those seeking a gentler dose
Every plan includes
- Personalized, physician-guided plan
- 30 tablets per month, monthly and 3-month
- 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 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.
- How it is taken
- Dissolved under the tongue
- How often
- Once a day
- Dose range
- 0.05 mg
- Form
- Menopause · Bioidentical hormone · Hormone therapy
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.
How it works,
week by week.
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.
Weeks 1–2
Place one tablet under the tongue daily. Hot flashes and night sweats usually ease within the first two to four weeks.
Month 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.
Month 3
Check-in. Your physician reviews how you feel, any bleeding or side effects, and confirms your dose going forward.
Beyond
BIEST 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 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
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
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.
The research behind
Biest.
Biest is a compounded mix of estriol and estradiol, usually in an 80:20 or 50:50 ratio. It is not FDA-approved, and no outcome trial has tested it; the evidence is pharmacology and a few small studies.
- Outcome trialsNo outcome trials
No randomized trial has tested Biest against heart, bone or cancer outcomes, or against symptom relief. The 2020 National Academies review judged the evidence for compounded bioidentical hormones insufficient, and found most marketing claims unsupported by well-controlled studies.
National Academies, The Clinical Utility of Compounded Bioidentical Hormone Therapy, 2020 - Blood levelsLess estrogen than a patch
In a Mayo Clinic randomized trial of 40 postmenopausal women over 16 days, Bi-est cream at the lower doses gave much lower estradiol exposure than a standard estradiol patch with micronized progesterone. The study measured blood levels only, not symptoms or safety.
Bioidentical compounded hormones: a pharmacokinetic evaluation in a randomized clinical trial, Maturitas 2013 - Estriol partLimited, mixed evidence
The same National Academies review found limited, mixed-quality evidence that estriol may help some menopausal symptoms, and insufficient evidence about its long-term safety.
National Academies, 2020
What the studies found
- No human trial has shown a clinical benefit of Biest itself; the 2020 National Academies review found the evidence insufficient (NASEM, 2020)
- The estradiol component alone has trial evidence for hot flashes, but that evidence is for estradiol products, not for this mix (MacLennan, Cochrane 2004)
- A vaginal estriol gel had a placebo-controlled trial with symptom and cytology outcomes, but that was a single estriol product, not Biest (NCT04574999)
- Mechanistic only: the idea that a fixed estrogen ratio mimics the body's own is unproven in people
Compounded Biest is not the product studied in any trial. The idea that the body needs a particular estrogen ratio is not tested in outcome studies. The known risks of estrogen apply to Biest as well.
What this does not say
- No outcome trial exists for Biest; the blood-level study says nothing about symptoms or safety.
- Compounded doses are not standardized, so the amount in each capsule or cream can vary.
- The trials of estrogen cited elsewhere on this page used other products.
The research
behind it.
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.
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 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.
BIEST 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.
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
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.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
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.