Product image is for illustrative purposes only. Actual medication, packaging, and labeling may vary depending on the dispensing pharmacy.
BIEST Cream
BIEST is a compounded estrogen cream that combines estriol and estradiol, prescribed to help manage menopause symptoms such as hot flashes and dryness. Compounded hormones are not FDA-approved, so your provider reviews your history and the risks before prescribing. Supplied as a 30 g container.
- Several delivery forms
- Thyroid support where indicated
- Ongoing monitoring
Save 10% on Your First Prescription Order
New prescription customers save 10% with code MEDURA10. Enter your code during checkout after your assessment.
Answer to see the price
Which one of the following best describes your preferences today?
Your Treatment. Everything Included.
Know what's included in your treatment, from your initial virtual consultation to prescription delivery.
- Your Prescription MedicationYour prescribed medication is priced as listed on its treatment page, with no additional medication markup at checkout. Injectable treatments also include essential supplies at no extra cost: alcohol prep pads, gauze pads, syringes, drawing and injection needles, plus clear administration instructions.
- Initial Virtual ConsultationYour required initial virtual consultation is included in the treatment price. Refills during its validity period are not charged that fee again.
- Licensed Provider ReviewA licensed provider reviews your information to decide if treatment is appropriate. An assessment does not guarantee a prescription.
- Unlimited Doctor AccessIncludes unlimited doctor access in-between subscriptions.
- Free Expedited Prescription ShippingIncluded with eligible prescription orders, shipped in discreet, unbranded packaging.
- Temperature-Controlled PackagingCold-pack packaging is included when your medication requires it.
- One Transparent Price. Everything Included.The price displayed isn't just for your medication. It also covers the required initial consultation with a licensed doctor, eligible expedited shipping, supplies, and temperature-controlled packaging when needed. While each of these services carries its own cost, we've bundled them into one reasonable, upfront price.
How it works
Submit your free assessment
Step 1: Complete your medical assessment for review by a licensed medical provider. If appropriate, the provider will determine whether the treatment is right for you.
Get your plan and your order at home
Step 2: If approved, your provider selects a formulation, strength, and schedule and explains how to use it. Your order ships in plain, unbranded packaging.
Receive 24/7 Support and Ongoing Care
Step 3: Access your patient portal to communicate with your care team, ask questions, and get support throughout your treatment journey.
BIEST Cream
How BIEST supports hormone balance
BIEST (20:80) is a compounded cream combining two estrogens, estriol and estradiol, in a 20:80 ratio. It is offered at 2.5 mg/mL in a 30 g presentation and is applied topically. Hormonal changes affect every woman differently. Your provider reviews your symptoms, history, and goals before recommending whether hormone therapy fits and in what form.
Several delivery forms
Creams, capsules, patches, and a vaginal insert are available through our pharmacy network. Not every option is right for every patient.
Thyroid support where indicated
T3 and T3/T4 capsules are available when your provider determines they are appropriate for you.
Ongoing monitoring
Your provider follows up to check how you are responding and adjusts your plan as needed over time.
Provider-guided from start to finish
A licensed provider reviews your health history, checks for contraindications, sets an appropriate starting plan, and monitors your progress over time.
How to use it
Clear instructions for your prescribed formulation arrive with your first order.
Real Medical Professionals. Personalized Care. Transparent Pricing.
Your health deserves more than a one-size-fits-all approach.
Medura connects you with licensed medical professionals who take the time to review your health history, evaluate your individual needs, and determine which treatments may be right for you.
We believe quality healthcare should come with professional oversight, personalized attention, and honest, transparent medication pricing.
No unnecessary medication markups. No confusing treatment pricing. Just a more straightforward approach to getting the care you deserve.
Licensed Medical Professionals
Your treatment is evaluated by qualified, licensed providers.
Personalized Medical Evaluations
Recommendations are based on your individual health needs.
Provider-Approved Prescriptions
Medication is prescribed only when clinically appropriate.
Transparent Medication Pricing
Know the medication price before moving forward.
Connect with a licensed medical professional and discover whether treatment is right for you. Prescriptions require a medical evaluation and provider approval.
Quality and ingredient standards
Made in the U.S.A.
Some treatments are compounded by licensed U.S. pharmacies in facilities registered with the FDA. Registration does not mean a compounded medication is an FDA-approved finished medication.
USP <797>
Sterile compounding standards.
Documented handling.
Every batch released to spec.
ISO Class 7
Cleanroom-grade air.
Filtered environments.
Tighter contamination control.
Clean ingredients, careful delivery
- No heavy metals
- No added dyes
- Licensed U.S. pharmacies
- Provider-prescribed
- Cold-chain protection
- Plain, unbranded packaging
- Serves all 50 states
- HSA and FSA eligible
Medication guide
What to know about BIEST Cream
General education to help you prepare for a conversation with a licensed provider. It is not a prescription or personal medical advice.
- Generic name
- Estriol and estradiol (20:80), "BIEST"
- Drug class
- Estrogens (compounded bioidentical combination)
- Form
- Cream applied to the skin
- Regulatory status
- Compounded, not FDA-approved
BIEST is a compounded combination of estriol and estradiol. It is not FDA-approved, and estriol is not an ingredient in any FDA-approved product in the US. A 2020 National Academies review found insufficient evidence that compounded bioidentical hormones are safer or more effective than FDA-approved hormone therapy, and recommended restricting their use.
Compounded medications are not FDA-approved. FDA does not review them for safety, effectiveness or quality before they are dispensed. A compounded preparation can differ from approved products in strength, ingredients, dosage form and how it is absorbed, so it should not be assumed to work the same way as an approved medication. Compounding is meant for patients whose needs cannot be met by an FDA-approved drug.
Overview
BIEST cream is a compounded estrogen used by some providers to relieve menopause symptoms.
Who may be evaluated for it
- Women with bothersome menopause symptoms such as hot flashes, night sweats, sleep disruption or vaginal dryness.
- Generally best studied in women under 60 or within 10 years of their last period, per The Menopause Society’s 2022 position statement.
Who may not be a good fit
- Anyone with unexplained vaginal bleeding.
- Women with a current or past breast cancer or other estrogen-sensitive cancer.
- Women with a past blood clot, stroke or heart attack, or a known clotting disorder.
- Women with active liver disease.
- Women who are or may be pregnant.
How it works
Estradiol and estriol both act on estrogen receptors. Estriol is a weaker estrogen. Applied to skin, they are absorbed into the bloodstream, but the amount absorbed from a compounded cream varies between people and batches.
The term "bioidentical" means the hormones have the same chemical structure as those the body makes; FDA-approved estradiol products are also bioidentical.
Potential benefits and realistic timelines
What the evidence supports
- Estradiol, its main component, is effective for hot flashes in FDA-approved forms.
Not established
- That BIEST is safer than FDA-approved estrogen.
- Consistent dosing and absorption of compounded creams.
- That estriol protects the breast or uterus.
- 2 to 4 weeksHot flashes often begin to ease.
- About 3 monthsFull effect is usually seen; providers commonly reassess dose and side effects.
- OngoingNeed and dose are reviewed at least yearly. Symptoms may return after stopping.
Results vary from person to person. Your provider decides whether and how long to continue.
How it’s used
- Apply the amount your provider prescribes to clean, dry skin as directed, typically at the same time daily.
- Wash hands afterward and avoid skin contact with children or pets until dry.
- Women with a uterus still need a progestogen.
If you miss a dose
Apply when you remember the same day; otherwise skip. Do not apply extra.
Storage and handling
Room temperature in a closed container, out of reach of children and pets.
Your prescription label and provider instructions always take priority over this general information. Do not change your dose or stop without talking to your provider.
Side effects and safety
More common, usually manageable
- Skin irritation at the application site
- Breast tenderness
- Spotting
- Headache
Less common but serious
- Blood clots in the legs or lungs, and stroke (higher with oral estrogen than with skin patches).
- Endometrial (uterine lining) cancer if estrogen is taken without a progestogen by a woman who has a uterus.
- A small increase in breast cancer risk with long-term estrogen plus progestin.
- Gallbladder disease.
Get medical help right away
- Sudden chest pain, shortness of breath or coughing up blood.
- Pain, swelling or warmth in one leg.
- Sudden severe headache, vision loss, weakness or trouble speaking.
- Unexpected vaginal bleeding after menopause.
- A new breast lump.
Call 911 or go to the nearest emergency room for chest pain, trouble breathing, swelling of the face or throat, fainting, or signs of a stroke (sudden weakness, numbness, trouble speaking or seeing).
Pregnancy, breastfeeding and fertility
Not for use during pregnancy or breastfeeding. Estradiol is not a contraceptive.
Interactions and combinations
Known interactions
- Seizure medicines (carbamazepine, phenytoin), rifampin and St. John’s wort can lower estrogen levels.
- Some antifungals (ketoconazole), clarithromycin and grapefruit juice can raise estrogen levels.
- Smoking increases the risk of clots and stroke.
Related treatments and options
Listed for education, not as a recommendation to combine. Any combination needs your provider’s approval.
- Progesterone IRSupported by evidence
Needed to protect the uterus in women who have one.
Do not combine estrogen products unless directed.
Monitoring and follow-up
- A review of your symptoms, personal and family history of breast cancer, clots, heart disease and stroke, and your blood pressure.
- Up-to-date mammogram and cervical screening as recommended for your age.
- A follow-up visit within about 3 months of starting, then at least yearly to reassess dose and whether to continue.
- Any unexpected vaginal bleeding is evaluated promptly.
- Routine hormone blood levels are generally not recommended to guide menopause therapy, per The Menopause Society.
Lab tests and follow-up visits are not included in the medication price unless your plan says so. Your provider will tell you what is needed.
Alternatives to discuss
- Estradiol Patch
FDA-approved transdermal estradiol with consistent dosing.
- Estradiol Capsules
Oral estradiol.
- BIEST (20:80) / Progesterone IR
Compounded capsule with progesterone included.
Lab tested medications for quality and potency.
Every medication ships from a licensed U.S. pharmacy in our network, delivered straight to your door.
Third party quality control testing
Compounded in U.S. pharmacies
Dosage, Schedule & Supply
- Dosage
- BIEST (20:80), 2.5 mg/mL concentration.
- Schedule
- Determined by your prescribing provider.
- Supply
- 30 g.
- Estimated Supply Duration
- Varies based on the amount applied and how often it is used.
Supply duration is an estimate based on the prescribed treatment plan. Actual duration may vary depending on dosage, frequency of use, and medication expiration.
Treatment information is for educational purposes. Your licensed healthcare provider will determine the appropriate dosage and schedule. Always follow your prescription instructions.
Frequently Asked Questions
Is "bioidentical" safer?
Not proven. FDA-approved estradiol is also bioidentical. The National Academies found no good evidence that compounded bioidentical hormones are safer or more effective.
Do I still need progesterone?
If you have a uterus, yes. Estriol has not been shown to protect the uterine lining.
Why would a provider use BIEST?
Sometimes for patient preference or when an approved product is not suitable. Discuss whether an FDA-approved option could meet your needs.
Do I need a prescription?
Yes. After your free consultation, a licensed provider reviews your intake, symptoms, and health history to decide what’s appropriate for you.
Is every formulation appropriate for me?
No. Your provider selects a formulation based on your individual symptoms, history, and goals, not every option listed is appropriate for every patient.
Is this available in my state?
Availability varies by formulation and state. Your provider will confirm what can be prescribed and shipped to you during your consultation.
Can I use my HSA or FSA?
Yes. Medura accepts HSA and FSA cards at checkout, and we can provide documentation for reimbursement if you need it.
What happens after I request treatment through Medura?
You complete an online assessment about your health history, current medications and goals. A licensed provider reviews it and decides whether a prescription is appropriate. Completing the assessment does not guarantee a prescription. If one is written, a licensed pharmacy prepares and ships it, and your provider can adjust or stop treatment as needed. If lab work is needed, your provider will tell you; it may be ordered and billed separately.
What to expect and possible side effects
- 1
Start with a consultation
A licensed provider reviews your intake, symptoms, and health history to determine whether hormone therapy is appropriate and which formulation may fit.
- 2
A plan matched to you
If approved, your provider selects a formulation, strength, and schedule, and explains how to use it.
- 3
Ongoing monitoring
Your provider follows up to check how you are responding and adjusts your plan as needed over time.
Questions to ask your provider
- 1.Am I a good candidate based on my age, time since menopause and health history?
- 2.Do I need a progestogen because I have a uterus?
- 3.Which form (pill, patch, cream, vaginal) has the lowest risk for me?
- 4.How will we decide my dose and when to reassess?
- 5.What screenings do I need while on hormone therapy?
References
- The Clinical Utility of Compounded Bioidentical Hormone Therapy (National Academies, 2020)(opens in a new tab)
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society(opens in a new tab)
- FDA-approved labeling updates for menopausal hormone therapy boxed warnings (FDA, Feb 12, 2026)
- Menopause (MedlinePlus)(opens in a new tab)
- Compounding and the FDA: Questions and Answers (FDA)(opens in a new tab)
Sources last checked October 17, 2026. This page is for general education and does not replace advice from a licensed provider. Treatment requires a clinical evaluation, and a prescription is written only if a provider decides it is appropriate. Individual results vary.
Related Products & Treatments
Explore other options that may support your goals.
BIEST/Progesterone CapsuleBIEST combined with progesterone in one capsule. Helps relieve menopause symptoms such as hot flashes and night sweats, with progesterone for balance.View details for BIEST/Progesterone Capsule
Estradiol CapsuleSingle-ingredient estradiol in oral capsules. Helps relieve menopause symptoms such as hot flashes and night sweats.View details for Estradiol Capsule
Progesterone CapsuleSingle-ingredient progesterone capsules. Helps support sleep and hormone balance, and protects the uterine lining for those taking estrogen.View details for Progesterone Capsule
DHEA CreamA compounded DHEA cream at 50–100 mg/mL in a 30 g presentation. Helps support low DHEA levels, and may ease vaginal dryness and low libido.View details for DHEA Cream
Estradiol PatchA transdermal estradiol patch at 0.025–0.1 mg/day, 8-pack. Helps relieve menopause symptoms such as hot flashes and night sweats.View details for Estradiol Patch
Estradiol Vaginal InsertA 10 mcg estradiol vaginal insert. Helps relieve vaginal dryness and discomfort during menopause.View details for Estradiol Vaginal Insert
Liothyronine T3 SR CapsuleA dye-free, sustained-release liothyronine (T3) capsule at 5–26 mcg. Helps with symptoms of low thyroid function such as fatigue, feeling cold and weight gain.View details for Liothyronine T3 SR Capsule
T3/T4 CapsuleA combination thyroid capsule containing T3 and T4. Helps with symptoms of low thyroid function such as fatigue, feeling cold and weight gain.View details for T3/T4 Capsule
Not Sure Where to Start?
We're here to make things simple. Book a free 15-minute Google Meet consultation with our team to get help navigating Medura, understanding the assessment process, pricing, and next steps.
Book a Free 15-Minute ConsultationThis is a customer support session on Google Meet, not a medical consultation. You will not receive medical care, medical advice, or treatment recommendations, and you will not be speaking with a licensed physician. All medical evaluations and treatment decisions are handled separately by licensed healthcare providers.
Health and wellness, nationwide.
From everyday wellness essentials to personalized medical treatments, Medura makes it easier to take control of your health, wherever you are in the U.S.
Explore personalized treatment guidanceNot sure where to start?
Answer 10 quick questions to explore Medura products and treatment options that may align with your health goals.
Educational only. Not medical advice.