Prescription
Prescription RequiredCompoundedBi-Est (50/50) Cream
This compounded cream contains equal parts estradiol and estriol, two forms of estrogen. It is applied to the skin to help relieve symptoms of low estrogen such as hot flashes, night sweats, and vaginal dryness. Because this is a compounded medication, it is prepared by a licensed pharmacy for your individual needs and is not reviewed by the FDA for safety or effectiveness.
Requires a valid prescription from your provider. Not sure if it's right for you? Ask a pharmacist.
These statements have not been evaluated by the Food and Drug Administration. Compounded products are not FDA-approved and are not intended to diagnose, treat, cure, or prevent any disease. Individual results may vary. This information is for educational purposes only and is not medical advice — always consult your healthcare provider before starting any new treatment.
Clinical information
Medication information for patients and providers.
Use as directed by your healthcare provider. Apply the prescribed amount to the skin area recommended. Wash your hands after application. If you miss a dose, apply it as soon as you remember unless it is almost time for your next dose. Do not apply extra cream to make up for a missed dose.
Estradiol and estriol are hormones that replace the estrogen your body no longer makes in enough amounts. When rubbed on the skin, they pass through the skin layers and enter the bloodstream. They bind to estrogen receptors in many tissues, helping reduce hot flashes, improve vaginal moisture, and support bone health. Most people notice symptom relief within 2–4 weeks, with full benefit in about 2–3 months. The effects last about 24 hours, so daily use is usually advised.
Do not use if you are pregnant, think you might be pregnant, or are breastfeeding (estrogen can harm an unborn or nursing baby). Do not use if you have or have ever had breast cancer, uterine cancer, or any estrogen-dependent tumor. Do not use if you have unexplained vaginal bleeding. Do not use if you have a history of blood clots in the legs, lungs, or eyes, or if you have a clotting disorder. Avoid if you have active liver disease or abnormal liver tests. Do not use if you are allergic to estradiol, estriol, or any ingredient in this cream.
Estrogen may raise blood levels of theophylline, cyclosporine, and some antidepressants, increasing side effects. It can lower the effect of warfarin or other blood thinners, so your doctor may need to check your INR more often. Anti-seizure drugs like phenytoin, carbamazepine, and phenobarbital may lower estrogen levels, reducing effectiveness. Herbal products such as St. John’s wort may also decrease estrogen activity. Tell your healthcare provider about all prescription drugs, over-the-counter medicines, vitamins, and herbal supplements you use.
Very common (affects more than 1 in 10 people): mild skin redness or itching at the application site. Common (affects 1–10 in 100 people): breast tenderness, headache, nausea, bloating, mood changes. Uncommon (affects 1–10 in 1,000 people): fluid retention causing ankle swelling, increased blood pressure, mild weight gain. Rare but serious: new breast lumps, severe headaches, vision changes, chest pain, sudden leg pain or swelling (signs of a blood clot). Call your doctor right away if you have any serious symptoms. Most mild side effects improve within a few weeks of continued use.
Store at room temperature (68-77°F, 20-25°C). Keep the cream in its original container, tightly closed. Protect from direct sunlight, high heat, and moisture. Do not freeze. Keep out of reach of children and pets. Do not use after the beyond-use date printed on the label. Dispose of unused or expired cream through a pharmacy take-back program or place it in a sealed plastic bag mixed with coffee grounds before throwing it in the trash.
Frequently asked questions.
Apply the dose to clean, dry skin on the area your provider recommended, such as the inner forearm or thigh. Rub it in until it disappears and then wash your hands. Avoid bathing or swimming for at least one hour so the medicine can fully absorb.
Many people notice fewer hot flashes and better sleep within 2–4 weeks. Full benefits for bone and vaginal health can take up to 3 months. Keep using the cream every day as prescribed, even if changes are slow.
Tell your provider if you get migraines, especially with aura. Estrogen can sometimes make these headaches worse. Your provider will decide if the benefits outweigh the risks and may adjust your dose or suggest a different therapy.
Mild redness or itching often gets better as your skin adjusts. You can apply the cream to a different recommended area each day to lessen irritation. If the reaction is painful, spreads, or does not improve in a few days, stop using the cream and call your healthcare provider.
Yes. You should see your provider at least once a year, or more often if advised, for a breast exam, pelvic exam, and to review your dose. Report any unusual bleeding, breast changes, or new symptoms right away.
More in Hormone Replacement
View all →
Bring this to the bench.
Transfer an existing prescription, or have your prescriber send a new one.