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
BioidenticalVaginal atrophyLocalized
Estradiol Vaginal Cream
RxPrescription onlyUsed vaginally · Once a day · 0.015–0.5 mg · Bioidentical · Vaginal atrophy · Localized
Starting at $79/mo
Bioidentical estradiol cream for vaginal atrophy and dryness. Applied directly into the vagina. Local relief without systemic absorption.
Choose your plan
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Bioidentical estradiol
- Applied directly to affected tissue
- Minimal systemic absorption, local effect
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 vaginal cream?
(bioidentical estradiol, vaginal)
Estradiol vaginal cream delivers bioidentical estradiol directly to the vaginal tissue to restore moisture, elasticity, and comfort. At standard doses, minimal estradiol enters the bloodstream, making this option suitable even for patients avoiding systemic hormone therapy. Apply with the supplied applicator.
- How it is taken
- Used vaginally
- How often
- Once a day
- Dose range
- 0.015–0.5 mg
- Form
- Bioidentical · Vaginal atrophy · Localized
Localized
bioidentical estradiol, vaginal application with minimal systemic absorption
Apply 0.5-1 gram daily for 2 weeks, then 2-3 times weekly for maintenance. Your physician adjusts based on symptom relief.
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
vaginal estrogen.
Low-dose vaginal estrogen is a well-studied treatment for dryness, burning and pain of the vagina and urinary tract after menopause. Its evidence is stronger than for most other estrogen forms.
- GuidelineEffective for GSM
The Menopause Society's 2020 statement lists low-dose vaginal estrogen as an effective prescription option for genitourinary syndrome of menopause. At low doses, blood estrogen stays within the postmenopausal range, although product labels carry the same boxed warning as systemic hormone therapy.
The Menopause Society, Menopause 2020;27(9):976-992 - Trial reviewSymptoms and lining
The Cochrane review of local estrogen (creams, pessaries, tablets and rings) for vaginal atrophy was updated in 2016: the woman's own rating of vaginal symptoms is the main outcome, and endometrial thickness is tracked as the safety outcome, with low-quality evidence on the lining.
Lethaby et al., Cochrane Database Syst Rev 2016 (CD001500.pub3) - Softgel trialPain with intercourse improved
The REJOICE trial randomized 764 postmenopausal women with vulvar and vaginal atrophy to a vaginal estradiol softgel at 4, 10 or 25 micrograms, or to placebo, for 12 weeks. Dyspareunia improved with the 10 and 25 microgram doses and with the 4 microgram dose at a smaller margin.
Constantine et al., Menopause 2017 (REJOICE)
What the studies found
- Less pain with intercourse at the 10 and 25 microgram doses of a vaginal estradiol softgel, against placebo at 12 weeks (REJOICE, Menopause 2017)
- Better vaginal cell maturation and pH at 12 weeks with the softgel, against placebo (REJOICE, Menopause 2017)
- Better sexual function scores with the 10 and 25 microgram doses (REJOICE, Menopause 2017)
- Symptom relief with low systemic exposure: estradiol blood levels stayed close to placebo in the softgel trial (REJOICE, Menopause 2017)
The trials covered FDA-approved vaginal estrogen products at their studied doses, not compounded vaginal creams or inserts. Results are averages across women, not predictions for one person. The compounded preparations here were not studied as such.
What this does not say
- Vaginal estrogen treats local symptoms; it is not a whole-body menopause treatment.
- Endometrial safety beyond a few years is not well documented.
- The Cochrane review does not compare compounded forms with approved products.
The research
behind it.
Vaginal atrophy from low estrogen causes thinning, dryness, burning, and pain with sex. Topical vaginal estradiol restores tissue health and lubrication effectively.
At therapeutic vaginal doses, systemic estradiol levels remain low. However, higher doses can produce measurable blood levels. Your physician may check estradiol levels if you use high doses or have hormone-sensitive conditions.
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 Vaginal Cream?
Used vaginally, once a day, at bedtime. The starting prescription is 1 mL (0.015 mg) each time. Your physician sets your own dose and it is printed on your label.
What strengths does Estradiol Vaginal Cream come in?
The pharmacy carries 7: 0.015 mg/mL, 0.1 mg/mL, 0.15 mg/mL, 0.2 mg/mL, 0.5 mg/mL, 1 mg/mL, 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.
Will this affect my systemic hormone levels?
Vaginal estradiol at standard therapeutic doses produces minimal systemic absorption. However, your physician may check blood levels if you use high doses or have a history of hormone-sensitive cancer. Always inform your physician of this therapy.
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.
How long do I take estradiol?
That is a decision you and your physician make at every visit. Some women use it for a few years; others longer. Your physician discusses the ongoing balance of benefits and risks with you regularly.
Estradiol vaginal 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
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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.