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
BioidenticalMenopauseTopical
Estradiol Cream
RxPrescription onlyApplied to the skin · Once a day · 1–4 clicks, 1.5 mg · Bioidentical · Menopause · Topical
Starting at $79/mo
Bioidentical estradiol cream for moderate to severe hot flashes and night sweats. Apply daily to skin. Steady absorption, flexible dosing.
Choose your plan
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Pure bioidentical estradiol
- Topical, adjustable dosing
- Avoids first-pass liver metabolism
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 cream?
(bioidentical estradiol, topical)
Estradiol cream delivers bioidentical estradiol, the same form your ovaries produced, directly through the skin. Transdermal delivery avoids first-pass liver metabolism, potentially lowering gallbladder and clot risk compared to oral forms. Apply daily for steady symptom relief.
- How it is taken
- Applied to the skin
- How often
- Once a day
- Dose range
- 1–4 clicks, 1.5 mg
- Form
- Bioidentical · Menopause · Topical
Bioidentical
pure estradiol, topically absorbed
Apply 0.5-1.5 grams daily to clean skin. Your physician adjusts based on symptom response and blood work.
How it works,
week by week.
Day 1
A US-licensed physician reviews your menopausal symptoms, history, and risk factors to determine the best form and dose for you.
Weeks 1-2
Hot flashes and night sweats usually begin to ease within 1-4 weeks, depending on the form and dose.
Month 1-2
Sleep quality improves, mood stabilizes. Your physician checks in and may adjust your dose or form based on symptom control.
Month 3
Check-in. Your physician reviews your progress, any side effects, and confirms your ongoing plan.
Beyond
Estradiol therapy is reassessed at least yearly. Your physician discusses continuing, adjusting, or stopping based on benefits and risks.
What you may notice,
and when.
Hot flash relief
the most dramatic change from estrogen therapy
Better sleep and mood
as symptoms settle and hormone levels 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
Estradiol is a prescription hormone with real benefits and real risks. Common effects include breast tenderness, nausea, headache, bloating, and spotting. Estrogen therapy increases risk of blood clots, stroke, gallbladder disease, and, with a uterus, requires progesterone for endometrial protection. Not prescribed with breast cancer history, blood clots, unexplained vaginal bleeding, liver disease, or pregnancy. Smoking significantly raises clot and stroke risk. Seek immediate care for chest pain, shortness of breath, leg swelling, severe headache, or vision changes. Tell your physician about every medication.
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 WHI trial found that transdermal estrogen carries lower clot risk than oral estrogen, likely because it bypasses first-pass liver metabolism and avoids increases in clotting factors.
Transdermal estradiol still carries risks of stroke, gallbladder disease, and, with a uterus, requires progesterone for endometrial protection. Your physician monitors your blood pressure and reviews risk factors at every 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 use Estradiol Cream?
Applied to the skin, once a day. The starting prescription is 0.25 mL (1 click, 2.5 mg) each time. Your physician sets your own dose and it is printed on your label.
Where do I apply it?
Inner forearm or inner thigh.
What strengths does Estradiol Cream come in?
The pharmacy carries 8: 10 mg/mL, 1.5 mg/mL, 3 mg/mL, 2 mg/mL, 2.5 mg/mL, 1 mg/mL, 4 mg/mL, 0.2 mg/mL. Your physician chooses which one you get.
How much arrives in each shipment?
1 tube at the starting strength, shipped to your door from a licensed US pharmacy.
How much cream should I apply?
Your physician sets the starting dose, usually 0.5-1 gram daily. Use a metered applicator. Apply to clean, dry skin on the inner arm, abdomen, or thigh. Adjust only under your physician's guidance based on symptom control.
Is estradiol really bioidentical?
Yes. Bioidentical means its chemical structure matches what your body made. FDA-approved estradiol (brand names like Estrace) and compounded estradiol are both bioidentical. The difference is regulatory oversight.
Should I take topical or oral estradiol?
Your physician helps you choose based on your symptoms, tolerance, and risk factors. Topical forms bypass first-pass liver metabolism and may carry lower clot risk. Oral forms are convenient but increase gallbladder and clot risk slightly more.
Do I need progesterone with estradiol?
If you have a uterus, yes. Estrogen thickens the uterine lining, and unopposed estrogen increases endometrial cancer risk significantly. Progesterone prevents this. After hysterectomy, estrogen alone is safe.
Estradiol cream 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) 0.05 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
References
- 1.Kronos Early Estrogen Prevention Study (KEEPS): cardiovascular and metabolic effects. Menopause, 2016
- 2.The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 2022
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.