Does BiEst cream work?
BiEst combines estriol and estradiol. Evidence that estrogen can treat menopausal symptoms does not establish that a particular compounded BiEst ratio is safer or more effective than an approved estradiol product.
What do the ratios tell you?
An 80/20 or 50/50 ratio describes the proportions of the two estrogens, not the total dose or the amount absorbed. It cannot tell you whether one cream will work better for you. Ask for the complete strength, dose and application instructions.
How does it compare with approved options?
ACOG finds a lack of high-quality evidence for the safety and efficacy of custom-compounded menopausal hormones and recommends approved formulations when appropriate options exist. A specific formulation need is a different question from claiming a custom blend is inherently better.
Read: ACOG: Compounded bioidentical menopausal hormone therapy.
What should the treatment plan cover?
Discuss which symptoms are being treated, why the formulation is being considered and how response will be followed. If you have a uterus and use systemic estrogen, endometrial protection needs to be addressed; do not assume that every cream includes adequate progesterone.
Read: Climara prescribing information; Progesterone capsule prescribing information.
Sources
- ACOG: Compounded bioidentical menopausal hormone therapy
Clinical Consensus, 2023. Evidence limits and selection of approved versus compounded formulations.
- Climara prescribing information
DailyMed. Systemic estradiol indications and safety.
- Progesterone capsule prescribing information
DailyMed. Endometrial protection in the specified estrogen regimen; precautions and adverse effects.
- FDA: Compounding questions and answers
The distinction between compounded medications and FDA-approved drug products.
