Bi-Est/Progesterone is a compounded, prescription-only hormone preparation that combines three hormones the body makes naturally — estriol (E3) and estradiol (E2), the two estrogens in Bi-Est, together with progesterone — in a single product. It is prepared by a licensed pharmacy to the ratio and strengths your provider orders rather than mass-produced, and it is available in several forms, including a topical cream, an anhydrous topical gel, and a troche (a lozenge that dissolves in the mouth).
Providers may consider it as part of menopausal hormone therapy for a patient who needs both an estrogen and a progestogen — delivering both in one preparation instead of two separate products. Only a licensed provider can decide whether it is appropriate for an individual.
How does it work?
This preparation brings together the estrogen and progestogen components of hormone therapy in one formula:
- Estriol + estradiol (Bi-Est): two estrogens that supply estrogen to help address menopausal symptoms such as hot flashes, night sweats, and vaginal dryness (MedlinePlus, estradiol topical).
- Progesterone: when estrogen is given to someone who still has a uterus, a progestogen is added to protect the uterine lining and lower the risk of endometrial (uterine) cancer (MedlinePlus, progesterone).
The estrogen ratio is commonly compounded as 80/20 or 50/50 (the proportion of estriol to estradiol), with the progesterone strength set alongside it. Your provider chooses the ratio, strengths, form, and schedule.
What is it used for?
Providers may prescribe a combined estrogen-and-progestogen preparation such as Bi-Est/Progesterone as part of care for menopausal symptoms in a patient who has a uterus and therefore needs both hormones. The role of estrogen-plus-progestogen therapy is described in the Menopause Society 2022 Hormone Therapy Position Statement. Only a licensed provider can decide whether this formulation is right for an individual; Bayview Pharmacy does not provide consultations or determine appropriateness, and a valid prescription is required.
How does it compare to taking the hormones separately?
The same hormones can be prescribed as separate products or combined into one. The table below describes the options for education only.
| Option | Hormones | Form / route |
|---|---|---|
| Bi-Est/Progesterone (this formulation) | Estriol + estradiol + progesterone | One compounded cream, gel, or troche |
| Bi-Est + Progesterone separately | Same three hormones, two products | Estrogen and progesterone prepared as separate items |
| Bi-Est alone | Estriol + estradiol | Estrogen only (progestogen added separately if needed) |
Combining the hormones in one preparation is a matter of form and convenience and is not a statement that it is safer, more natural, better, stronger, or more effective than the same hormones taken separately. Compounded preparations are not FDA-approved. Your provider determines what is appropriate for you.
How is it used?
Bi-Est/Progesterone is used following the exact form, technique, schedule, and dose set by your prescriber, who establishes your starting dose and any adjustments. A cream or gel is applied to the skin as directed; a troche is allowed to dissolve as directed. Because it contains progesterone, which can cause drowsiness, your provider may direct that it be used at a particular time of day. If it was prescribed to include endometrial protection, take it exactly as directed and do not stop on your own. Never change your dose without talking to your provider. If you are unsure about how to use it or about your dosing, contact your prescriber, and a Bayview pharmacist is available if you have questions about your prescription.
Side effects & safety
As with any medication, side effects are possible. Because this preparation contains both estrogen and progesterone, reported effects can include breast tenderness, headache, nausea, bloating, mood changes, drowsiness or dizziness, and spotting or breakthrough bleeding. Report any of these to your provider.
Seek immediate medical care for signs of a serious problem such as chest pain, shortness of breath, a severe headache, sudden vision changes, weakness or numbness on one side of the body, or pain and swelling in a leg. Contact your provider promptly for unusual vaginal bleeding, a breast lump, or any reaction that concerns you.
Who should not use it?
This therapy is not appropriate for everyone. It is generally avoided in people with unexplained vaginal bleeding, a history of certain hormone-sensitive cancers (such as breast or uterine cancer), a history of blood clots, stroke, or heart attack, active liver disease, known or suspected pregnancy, or a known sensitivity to the ingredients. A combined estrogen-and-progesterone product is generally intended for patients who need both hormones; a provider decides whether a combined preparation or separate products are appropriate. Tell your provider about your full medical history and all medications you take.
How should it be stored?
Store exactly as directed on your label, away from heat, light, and moisture. Keep it out of the reach of children and others in the home, and avoid skin contact with topical forms by anyone the medication is not prescribed for. Do not use it after its expiration or beyond-use date.
Why is this compounded?
A single product combining estriol, estradiol, and progesterone is not available as a standard FDA-approved manufactured medication, so it is prepared by compounding. Compounding lets a licensed pharmacy combine all three hormones into one preparation and tailor the estrogen ratio, the strengths, and the dosage form to an individual prescription — for example, a cream, an anhydrous gel, or a troche. As a 503A compounding pharmacy, Bayview Pharmacy prepares each order in small batches under USP <795> standards using quality ingredients. Compounded preparations are not FDA-approved.
Clinical details for prescribers
Formulation. Single-preparation combined estrogen/progestogen therapy delivering estriol + estradiol (80/20 or 50/50 E3:E2) with micronized progesterone. Compounded as topical cream, anhydrous (VersaBase-type) gel, or troche; ratios and strengths per the strengths table on this page.
Clinical role. Provider-directed menopausal hormone therapy for patients with an intact uterus requiring progestogen opposition of estrogen. Combining agents in one vehicle is a delivery/adherence consideration and does not alter the underlying risk profile of estrogen-plus-progestogen therapy. Note that transdermal progesterone yields lower, more variable serum levels than oral micronized progesterone, so route matters when endometrial protection is the goal; individualize per the Menopause Society 2022 statement.
Counseling points:
- Confirm intact uterus / need for both hormones before selecting a combined product
- Review VTE, stroke, and hormone-sensitive-cancer contraindications
- Progesterone component can cause sedation; counsel on timing and driving
- Do not discontinue unsupervised; report unscheduled bleeding for evaluation
Component monographs: Bi-Est and Progesterone. Testosterone- and DHEA-containing multi-hormone preparations are also available.
This is a prescription-only compounded medication and is not FDA-approved. This information is educational and is not medical advice. Your provider determines whether it is appropriate and sets the ratio, formulation, and dose.
