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Bi-Est (Estriol/Estradiol) Cream


This cream contains a Bi-Est or Bi-Estrogen component, which consists of two estrogens – Estradiol and Estriol. There are three types of estrogen that are produced by the ovaries: Estrone (E1), Estradiol (E2), and Estriol (E3). Estradiol is the dominant estrogen in premenopausal women.  Estrone is the second dominant estrogen and is produced by the metabolism of estradiol. Estriol is the weakest of the three estrogens but it is considered the safest estrogen.

Progesterone is added to estrogen therapy to prevent the overgrowth of the cells that line the uterus, which can lead to uterine cancer.  Therefore, women who have not had a hysterectomy (removal of the uterus) will receive progesterone in addition to estrogen.

Low levels of estrogen can result in symptoms such as irregular menstrual periods, sleep disturbances, excessive sweating, and vaginal dryness. Over time, low levels of estrogen can lead to complications such as osteoporosis, depression and heart disease. If you have low estrogen levels and are experiencing symptoms, your doctor may choose to prescribe bioidentical hormone replacement therapy.


This is a compounded cream that consists of ‘bi or two estrogens as well as progesterone.  The two estrogens have a concentration of 80% estriol and 20% estradiol.


You may have been experiencing symptoms resulting from low levels of estrogen.  Hence your doctor may have decided to treat the symptoms using hormone replacement therapy (HRT).  Bioidentical hormones have chemical composition similar to the hormones produced by the body and offer therapeutic benefits.  Bioidentical hormones when taken orally get converted to a different hormone by the liver. In order to get the therapeutic benefit of the indented hormone the best form is the topical form of the hormone.  This cream has been specially compounded to meet your need as this formulation is not available on the market.


Your prescriber may have special instructions as to how they want you to use this product.  It is important that you follow the directions.

In some cases, the doctor may want you to apply the cream to a specific location for example on the inner part of your thigh or behind the knees.  If the cream is required to be applied vaginally use the applicator provided.

  1. Apply the cream at the same time each day
  2. Apply the cream to a dry part of the skin
  3. Rotate the site of application to avoid skin irritation and saturation issues
  4. Do not apply any other cream to the site of application
  5. Do not bathe or exercise right after applying the cream, as this may not allow the cream to be absorbed.
  6. Avoid direct skin contact with other people, children or pets while the cream is getting absorbed
  7. Wash your hands after application of the cream


Some of the side effects that you may experience are slight vaginal bleeding, nausea/vomiting, bloating, appetite changes, breast tenderness and swelling, fluid retention and in some cases anxiety and irritability.  The side effects may be temporary and in some cases can be resolved by adjusting the dose.


Take your next dose of the medication as soon as you remember unless it is close to your next dose.  In that case, skip the dose and resume your scheduled dose. Never double your dose!


Store it in a cool and dry place.  Avoid direct sunlight and make sure it is stored in a safe place away from children.


Estriol and estradiol are bioidentical hormones manufactured in a laboratory from a soy base.  They do not contain gluten-based products. These creams can be compounded using any cream base.  If you have sensitive skin, you can request your cream to be made with Eucerin or cetaphil as the base.


Studies have indicated that -high levels of endogenous estrogen has been linked with increased risk of breast cancer.  This cream is an effective therapy for women suffering from bothersome symptoms of estrogen deficiency. It should be used in the lowest effective dose for the shortest amount of time in consultation with your physician.

Warning: This product is not recommended for women who are pregnant or breastfeeding.

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