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
BioidenticalGentleMenopausal
Estriol Cream
RxPrescription onlyApplied to the skin · Once a day · 4 clicks, 2 mg · Bioidentical · Gentle · Menopausal
Starting at $79/mo
Bioidentical estriol, the weakest estrogen, as a topical cream for mild to moderate symptoms. Apply daily to skin. Gentlest estrogen option.
Choose your plan
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Bioidentical estriol
- Topical, gentle absorption
- Weaker action, fewer systemic effects
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 estriol cream?
(bioidentical estriol, topical)
Estriol is the weakest of the three main estrogens and the dominant form during pregnancy. Estriol cream delivers this gentle hormone topically for patients seeking the mildest estrogen option. Estriol is less likely to stimulate breast tissue and carries a theoretically gentler risk profile, though all estrogens carry the same core safety concerns. Use as monotherapy for mild symptoms or as part of a combination like BIEST.
- How it is taken
- Applied to the skin
- How often
- Once a day
- Dose range
- 4 clicks, 2 mg
- Form
- Bioidentical · Gentle · Menopausal
Weakest
the gentlest of the three natural estrogens
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 symptoms, history, and why you prefer a gentler estrogen.
Weeks 1-2
Some symptoms may ease slowly. Estriol's weaker action means gentler relief but may take longer.
Month 1-2
Your physician checks your progress and may increase dose or recommend adding estradiol if symptom control is inadequate.
Month 3
Review your symptom improvement and any side effects. Adjust plan as needed.
Beyond
Estriol therapy is reviewed regularly. Your physician helps you decide if adding stronger estrogens would help.
What you may notice,
and when.
Gradual hot flash relief
slower than higher-strength estrogens
Mood and sleep support
gentler effects as estriol slowly works
Tissue-gentle approach
weaker estrogen, theoretically gentler on breast tissue
Lower systemic load
gentler overall hormone exposure
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
Estriol is bioidentical but still carries estrogen's core safety risks. Common effects include breast tenderness, nausea, headache, and bloating. Estriol increases risk of blood clots, stroke, gallbladder disease, and, with a uterus, requires progesterone for endometrial protection. Not prescribed with breast cancer, blood clots, unexplained vaginal bleeding, liver disease, or pregnancy. 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
estriol.
Estriol is a weak estrogen. Its evidence is mainly from vaginal use, and one placebo-controlled trial of a low-strength vaginal gel has been registered and reported only in summary.
- Vaginal trial167 women, vs placebo
A triple-masked, phase 3 trial randomized women with vaginal atrophy 2 to 1 to 0.005% estriol vaginal gel or identical placebo, for 12 weeks. The primary endpoint was cytology (reversion of vaginal atrophy). Results appear only as a sponsor conference report and a company document, not a peer-reviewed paper.
ClinicalTrials.gov NCT04574999 - Dose rangeThree strengths tested
NCT02967510 compared three ultra-low strengths of estriol vaginal gel (0.005%, 0.002% and 0.0008%) with placebo. The registry lists the design; no results were found.
ClinicalTrials.gov NCT02967510 - Systemic useLimited safety data
The National Academies review found limited, mixed-quality evidence that estriol may help certain menopausal symptoms and insufficient evidence about its safety.
National Academies, 2020
What the studies found
- Improved vaginal cell maturation (cytology) against placebo at 12 weeks in a sponsor-run trial of 0.005% estriol gel (NCT04574999)
- Relief of vaginal dryness reported in the same sponsor document; not peer-reviewed (NCT04574999)
- Estriol may help some menopausal symptoms; the evidence is limited and mixed in quality (National Academies, 2020)
The trials used a licensed-type 0.005% estriol vaginal gel, not the compounded estriol cream sold here. Compounded estriol has not been tested in its own trial.
What this does not say
- The trial evidence is for the vaginal gel, not for compounded creams or for oral estriol.
- Most of the trial evidence is sponsor-linked or not yet published in full.
- Safety beyond 12 weeks is not established by the trials above.
The research
behind it.
Estriol has lower receptor affinity and receptor recycling compared to estradiol, making it theoretically gentler. It is used widely in Europe and Asia but less common in the US.
Estriol still carries estrogen's core risks: clots, stroke, gallbladder disease, and breast tissue stimulation. Your physician assesses your risk factors before prescribing. As with all estrogen therapy, if you have a uterus, progesterone is essential.
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 Estriol Cream?
Applied to the skin, once a day. The starting prescription is 1 mL (4 clicks, 2 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 Estriol Cream come in?
The pharmacy carries 5: 2 mg/mL, 4 mg/mL, 3 mg/mL, 1 mg/mL, 0.5 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.
Is estriol really safer than estradiol?
Estriol is weaker and has lower receptor affinity, so some patients and clinicians prefer it for a gentler approach. However, the core safety risks (clots, stroke, gallbladder disease) are not eliminated. Your physician helps you weigh the gentleness against the need for symptom control.
Is estriol less effective than estradiol?
Estriol is weaker, so symptom relief may be slower or less dramatic. For mild symptoms, estriol alone may work well. For moderate to severe symptoms, your physician may recommend combining estriol with estradiol (like BIEST) for better control.
When would I choose estriol alone?
If your symptoms are mild and you prioritize a gentler hormone exposure, estriol offers that option. Some patients also choose it for personal or cultural reasons favoring weaker hormones.
Do I need progesterone with estriol?
Yes, if you have a uterus. Estriol is estrogen and thickens the endometrium. Progesterone is essential to prevent endometrial cancer, just as with any estrogen.
Estriol 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.Estriol: review of safety and efficacy in menopausal hormone therapy. Maturitas, 2009
- 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.