What is Biest?
Biest is a treatment used in bio-identical hormone replacement therapy (BHRT) for menopausal symptoms and anti-aging treatment. Biest is the combination of estradiol (E2) and estriol (E3). Estradiol is a fairly strong form of estrogen and estriol is a very gentle form of estrogen. Because Estriol is a gentle form of estrogen, it can balance the strong effects of estradiol.
Estradiol treatment by itself can cause breast tenderness, further exacerbate fibrocystic breast disease, weight gain in the stomach, increase risk for uterine cancers by increasing the endometrial proliferation/lining and moodiness.
Estriol treatment alone is too weak for most women’s menopausal symptoms. Which is why by treating with Biest, the estriol can reduce the powerful effects of estradiol but still achieve successful menopausal relief and anti-aging.
Biest treatment comes in many forms such as capsules, gels, creams, sublingual, troche, suppositories. Biest also can come in any ratio of estriol to estradiol that your physician feels is most necessary for your hormone treatment.
The most common form of Biest is an 80:20 ratio; with estriol encompassing 80% of the dose and estradiol 20%. The flexibility of Biest for treatment creates many individual options in treating menopause and anti-aging.
I have been on bi-est 80:20 applying once daily .25 ml – 1 click 7 days a week at bedtime. I have been taking this since 2001 and I am 61. I have no sweats…some weight gain – moodiness – depression. I apply one click to my right thigh all the time. Is there a better way to take this. Will it effect moodiness and depression? How about weight gain. I have been dieting for 18 months… it has been a long journey but lost 200 lbs.
Any help is appreciated.
Hello Susan,
First off, congratulations on losing 200 lbs. That is remarkable. You should be very proud of that accomplishment. As for your hormones, you didn’t mention the dose of your Biest and you made no mention of taking any progesterone. Our patients are usually never on the exact same dose for 16 years. There are always reasons or circumstances that warrant a dose adjustment. The physical symptoms such as hot flashes, night sweats or insomnia are very common reasons for BHRT. However, the mood issues are also just as common, but a bit harder to improve. I would go back to the prescribing Dr and discuss your Biest dose and / or adding in progesterone. Also, thyroid function can play significant impact on mood. Dieting for an extended period of time can also reduce thyroid function as well, so getting some updated thyroid numbers might be a good idea. My wife and I like to see the Free T3 level at 3.0 or higher. Let us know if you have any other questions.
Dr. Maki
Hi Dr. Maki
Since a hysterectomy in 1993, i have been taking hormones. In recent years biest and progesterone. Dr. recently took me off completely, but that did not work so was out back on Estradoil and Progesterone. I use to take Biest. Got rid of the hot flashes, but I find my hair is thinning and falling out. Of course, I am extremely concerned since that is my best feature and regardless dont want to lose my hair. I also was diagnosed with hypothyroidism around 1995 and take Armour 120. Bottom line, hair falling otut and a lot of body aches ad pains and mood swings. Any suggestions. Many thanks.
Hello Rose,
Thanks for reaching out. First off, I am wondering why your dr took you off the Biest and Progesterone in the first place. Stopping the hormones is certainly not going to help your hair. As for your thyroid, the 120 mg of Armour sounds fine, but do by chance know what your Free T3 level is? The reference range is 2.0 to 4.4, depending on the lab, so hopefully, yours is at least 3.0. If it hasn’t been tested, that is a place to start to see if you need a dose change. Also, hair loss / thinning can be due to chronic stress level. How high is your stress? How well do you sleep? Do you exercise excessively?
Dr. Maki
Was taking both boi. Estrogen and progesterone and my hair is still falling out bad.
All blood work came out fine.
Taking progesterone 250 mg. And biest 80/20 1.5 mil. Cream
Hello Janis,
Thanks for reaching out. Hair loss is a tough problem to solve. However, from what you posted, I am assuming your Biest dose is only 1.5 mg/gram. I don’t know anything specific about your medical history or current situation, but 1.5 mg/gram is a very low dose. My starting dose for women is usually 3.0 mg/gram and we work our way up from there. I would also look at your stress level and thyroid function. Stress, including poor sleep quality, can cause and exacerbate hair loss. Also, check with your doctor to see what your TSH and Free T3 levels are. Enhancing thyroid function, can help with hair growth. I hope this helps.
Dr. Maki
Hello, I have high testosterone and considering this supplement to help with balancing out my estrogen and testorone levels to improve fertility. I want to try something other than birth control. I suffer from the abnormal hair growth on my neck and face. Thanks
Hello Marie,
It sounds like you have Polycystic Ovarian Syndrome (PCOS), which does cause facial hair growth, infertility, and weight gain. The underlying cause of the PCOS is insulin, so work on reducing processed foods, minimize stress and get good quality sleep on a regular basis. I agree birth control is not a good solution for your situation.
Dr. Maki
Hello. I too am on 1.5 mil of BiEst because my doctor says that estrogen in any form causes cancer. She is tapering me off completely. I don’t want to stop but she won’t prescribe further once I’m off regardless of my symptoms. She does not want to be responsible in the event I develop cancer. Cancer does not run in my family, Neither does diabetes or other health issues. I am not fat, don’t smoke, don’t drink, exercise, eat a vegetarian diet rich in raw veggies and olive oil. I am having hot flashed so she gave me a pill for hot flashes. My vagina is failing so she sent me to a PT for pelvic exercises. She is terrified of estrogen. I don’t believe estradiol causes cancer. Study after study places the blame for the WHI estrogen study and the very bad outcome squarely on Premarin and Progestin. Where can I find a doctor who will give me the 3mg does of BiEst and not scare the hell out of me or make me suffer because she/he is fearful of the treatment? Do I just start phone calling? Seems pretty slip shod way to me. Thank you for whatever help you can provide.
Hello Donna,
I apologize for the delay in my response. From what you shared, I think you are still a candidate for BHRT. You simply might need to find a doctor that feels comfortable prescribing BHRT for you. I don’t agree that estrogen in any form causes cancer. Unfortunately, this is a common, conventional opinion regarding hormone therapy. As for your Biest, 1.5 mg is such a low dose, its like your not even taking anything. Again, this is a very common dosage amount because doctors are trying to copy the commercial forms of estrogen. Compounded, Bioidentical Hormones are very different from the commercial forms. The commercial forms tend to be quite a bit ‘stronger’ than BHRT. Let me know if you have more questions.
Dr. Maki
Dr. Maki,
I was doing search about hormone replacement and reading this blog with the wonderful information. I was researching because I seem to be intolerant to all forms of estradiol and I’m seeking some way to raise my estrogen. I’ve tried estradiol patch, estrace and recently biest and all give me flu like symptoms. I have gallbladder issues but GYN feels like the estrace and biest are such low amounts they shouldn’t affect my gallbladder. Chaste Berry bothers my stomach, black cohosh causes fatigue. Went on 15 mg of boron and it is helping slight bit because the depression is better and vulvar pain a little better. I have CFS and also past year seem to be more sensitive to all medications herbs Etc. When menopause begin I started having worsening depression, low sex drive which is gotten worse with time, vulvar pain/ painful intercourse and lack of muscle tone even with strenuous exercise. I’m having bladder leakage. I can tolerate natural progesterone- helps sleep, mood and eliminates most of my bladder leakage. I’ve always had high sex drive and wonderful sex life so this is very depressing. Estrogen progesterone test low- d h e a slightly high. GYN just said no need to test hormones anymore since I’ve been in menopause for a while but I’m wondering how in the world we can get my symptoms straight without testing.
Hello Peggy,
The commercial forms of Estradiol (E2) are very strong and can certainly cause many different side effects, depending on the woman. If the Biest you tried was a capsule I would understand not tolerating it, but I would be surprised if you had the same issue with a Biest cream. Transdermal creams typically are very well tolerated even for women with CFS.
Progesterone is definitely a good idea for some symptom relief. Progesterone capsules is usually better than a cream; however, if your liver is over burdened a cream might be a better option. Gallbladder issues are always liver issues. You address the liver and the gallbladder improves. This possibly indicates that your liver detoxification pathways might be overly congested, which is common with CFS.
As for testing, a good deal of BHRT is very subjective and based on how the patient ‘feels,’ however, blood work is necessary when your on BHRT so adjustments can be made. Plus, other things like insulin, thyroid and imflammation markers like CRP-hs can be monitored to get a better idea of the overall situation. I hope this helps. Let me know if you have more questions.
Dr. Maki
Thank you so much for the information. I will address treating my liver if I can find something to treat it as my diet is already very good. I’ve become sensitive to so many herbs supplements Etc but believe I might have sibo which is adding to things. I’ve always have hormonal issues since I was a young woman and couldn’t take birth control and had pmdd for all my life until I went on progesterone cream. I would have terrible psychiatric problems mood irritability and also horrible migraines with my PMS . But often get so sick I was in the bed for a few days .When menopause started it also calmed me down a lot helped some of the psychiatric issues. I recently read a research article about pmdd and the possibility of it being a genetic mutation causing problems with the estrogen receptors. This may account for my sensitivity to the estradiol. My doctor recently gave me estriol and it worked the best with the least side effects but I still had some flu-like symptoms fatigue but no stomach problems .gallbladder issues with the estriol. I even tried doing just a small amount of it and it still seem to bother me, it’s very weird. I’m sure you’re very busy so thank you again for taking the time to talk to me and give me some information as I am struggling to resolve these issues – any help is greatly appreciated!!!
After I posted this I was looking for other estriol creams and noticed on another search that you sell E3 estriol. The estriol from the pharmacy was 1.25 mg / 1 gram and the last dose that I tried I probably took about a half a gram and still had a few symptoms. Would your estriol be different formulation then the pharmacy compounding? Also do you sell any other products that may raise my estrogen levels without the estriol? I’m also going to try the black cohosh again and perhaps try a liquid or a lower dose to see if that minimizes the fatigue I get with it. It’s also supposed to be beneficial for the liver. The past 6 months I have become sensitive to supplements and foods that have never bothered me before 🙁🙁🙁
Hello Dr Maki
Was menopaused @ 33, now 57 & on BHRT since 2012. Present dose is Biest 1.5mg/Dhea 20mg as a troche + 400mg micronised progesterone capsules.
I wonder if 400mg isn’t too high & am thinking to move to creams. My prescribing Doc isn’t working anymore & looking for help. I stopped it too suddenly & had some bleed. TSH 1.03 & F4 12.1. Libido very low & mood/sleep varies.
How long is it safe to stay on it ?
I thank you for your post which is very helpful.
Hello Dominique,
From what you listed, your Biest dose seems too low and I am not a fan of troches. Also, I agree that your progesterone dose is too high, bu I do like the capsule form. If was up to me, I would swtich to a Biest cream and increase the dosage from 1.5 mg to probably 5 mg/gram. I would want to see blood work for your DHEA. As for the progesterone, I would decrease down to probably 100 mg.
Your TSH looks good, but I am curious what your Free T3 level is. The conventional recommended is that women in general should stay on Hormone Therapy for no longer then 7 year; however, my wife and I do not agree with this recommendation. The 7 year timeline is for conventional hormone therapy, not BHRT. Hope this helps. Let me know if you have more questions.
Dr. Maki
Hi- Thank you for actually giving information that helps !
Trying to readjust my troche amount timing for better sleep.
Used to take it all at evening time as the prog asssts my sleepiness but it also has biest,dhea and T. Better to take everything but Prog in morning?`
Estrogen and progesterone will certainly help your sleep, but the dose of estrogen has to be high enough. My wife and I typically prescribe estrogen twice per day (morning and evening) because the half-life of estrogen is only 12 hours. If you take your hormones only in the morning, the estrogen will have worn off by bedtime and will not improve sleep.
My doctor just put me on Bi-Est/Progesterone/Testosterone 0.9/50/.5 troche and I just got diagnosed with bacterial vaginosis by my obgyn who prescribed Flagyl, can I take these medications together? I cannot find anything online to check for a drug interaction but I do want to take both and something happen, can somebody please help me?
Hello Crystal,
I don’t agree with your dose. I think your estrogen level is too low. However, I also don’t know much about your case either. I am not a fan of Flagyl at all. It is too strong in general, especially for BV. It is fine to take Flagyl with your hormones. The only thing to stay away from while on Flagyl is alcohol. My wife just wrote a blog post that has some useful information for your situation.
http://progressyourhealth.com/what-causes-fishy-odor/
Dr. Maki
Hello
I am 56 yrs old
Three yrs ago , I had hysterectomy & sling put on .
Ever seems been going threw
So much vagina pain . Vagina dryness at atrophy. I’ve been on estrogen estrace cream for almost three yrs. long story short, I had sling remove last yr , cause so much scar tissue.
I still have scar tissue problem. Got new dr . Put me on compound bi- est prog 2/150 mg sr caps . He said for me to continue using estrace cream. Is that ok . Plus he is sending me to tissue specialist
Hello Virginia,
Thanks for reaching out. My wife and I see situations like your quite often. Glad your new doctor switched you to Biest. However, we typically like to use a Biest transdermal cream instead of a capsule. Plus, the 2 mg dose seems to be too low for your situation. The progesterone capsule is good. Also, we are not fans of the Estrace either. Using an Estriol (E3) vaginal cream is a much better option. I hope this helps. Let me if you have more questions.
Dr. Maki
Hello, I’m 50 years old and 3 years into Menopause. My previous Dr had me in 0.1mg of Climara and 2.5mg of Provera. I had some bleeding when I skipped a few days of the Probera. I had an Ultrasound done and it showed that I have slight thickening of the uterine lining. I stopped taking the Hormones that my previous Dr has me on. I changed Dr.’s and she put me on BHT. 20% Estradiol 80% Estriol cream and 200mg of Progesterone. My fear is that this will make the Uterus lining grow thicker. Any suggestions. Thank you in advance.
Hello Lori,
Thanks for reaching out. Glad you switched Drs and your hormones. The Biest and Progesterone is a much better option then what you were on previously. Now I don’t know much about you and your situation and I don’t know your Biest dose, so take that into consideration regarding my response. The dose of the Biest (estrogen) will impact the thickening of the uterine lining. This is why you never give a woman “unopposed” estrogen. It should always be balanced with progesterone. Conventional, some Drs say progesterone is not necessary if a woman has had a hysterectomy, but we disagree. A woman still has a brain and breast tissue. It is ok to take progesterone by itself, we do that all the time, but not estrogen by itself. The progesterone prevents the thickening of the lining; however, progesterone creams even at 200 mg is not often strong enough to protect the lining of the uterus. This is why in most cases we use oral (capsule) progesterone and not a progesterone cream. So generally speaking, if a cream is a Biest/Pro combo, I would switch it to a 100 mg, maybe 200 mg progesterone capsule and a straight Biest cream.
I’ve been on biest (50/50) 1.5ml (apply 0.5ml 2x/day) and progesterone (100ml 2x/day)
4 about 6 weeks. The progesterone I feel is working and absolutely helping with the insomnia. Here’s my problem…. I have been extremely moody.. by that I mean I go from being 0 to pissed off royally in the snap of a finger. Which is so out of the norm for me. I’m also having issues with night sweats again. But daytime hot flashes are subsiding. How do I know what the right dosage for me is? And how do I know when there is too much? Can I experiment with possibly adding one more click during the day and seeing if that helps? I’ve reached out to my functional physician but can never get a response. I don’t have a follow-up appointment for another 3 months
Hello Mary,
Reference my response to Lori regarding progesterone and the uterus. Progesterone creams are usually not “strong” enough. A progesterone capsule 100 to 200 mg, will definitely help with sleep quality and also help to reduce the rage and irritability that you are experiencing. A progesterone cream may not provide that benefit. As for hot flashes, that is dependent on the Biest dose. If you are still having hot flashes, then the dose needs to increase. I probably would have started you on an 80 / 20 ratio, not a 50 / 50 ratio of your biest and had you gradually increase your dose. You are having night sweats, so adding more at night might be helpful. More estrogen will also help with the moodiness as well.
Hello! I’ve been on the estrogen patch 0.375 2 × a week and 100 mg of progesterone at bedtime. My Dr. Changed me to the biest 50/50 in the am. And still the 100 mg progesterone
At bedtime. Due to anxiety and not sleeping well. Any suggestions? Thank you.
Hello Debbie,
Thanks for reaching out. We are not a fan of the patch, so it is good you were switched to Biest. I am assuming your Biest is a cream. We typically like to dose twice daily, morning and evening. The 50/50 is the ratio of Estradiol (E2) to Estriol (E3), so your cream is 50% E2 and 50% E3. How many milligrams is your cream? I typically start at about 3 mg/gram and the ratio is 80/20, which is 80% E3 and 20% E2. Also, is your progesterone a cream or capsule? The 100 mg dose is good, but a capsule form works best for mood and sleep issues. Hope this helps.
Dr. Maki
I am on 80/20 biest troche
With 150 progesterone pill
I tried topical biest but did not work for my menopose
Symptomes
Troche is the one who help me a lot
So why you don t like that
Thank you
Marylîn
Hello Marylin,
There is nothing wrong with using a troche, especially if a transdermal cream was not helpful. Glad you found something to help your symptoms.
Dr. Maki
Dr. Maki,
I need some advice. I’m 40 and had a complete hysterectomy with bilateral oophorectomy putting me in surgical menopause. I’m seeing a doctor that is prescribing me BHRT, but he doesn’t have a lot of experience. I’m needing advice on best routes and what you think about my doses. Here’s my regimen
Progesterone compounded orally: 200mg QD at bedtime
Biest (50/50) 3mg with testosterone 3 mg apply to my thighs daily in The morning
My last set of labs:
Progesterone 2.3
Testosterone total: 86
Free testosterone: 1.5
Estrogen total: 77
Estradiol: 33
My sleep is awful, trouble falling asleep and staying asleep, I’m hot all night. I have face flushing multiple times a day, anxiety, joint stiffness and pain, irritation, zero libido even with the testosterone. Adding the testosterone definitely helped my fatigue. I’m a mess and at a loss. Everything I read seems contradictory. We adjust things every month about. Going from 100mg to 200mg of progesterone made a huge difference after one dose but now a month later I feel like it’s not as good.
Should I go to a progesterone cream? Should any of the creams be applied to the labia? Any advice would be great.
Thank you
Hello Jamie,
Overall, your regimen is not too bad; however, you are still having symptoms so something needs to be adjusted. Your Biest dose more then likely needs to be increased due to your temperature issues and poor sleep. I typically don’t start women with a 50/50 ratio, but that is fine considering you are 40 years old. From your labs, your testosterone is a bit high, which is usually ok as long there are no other issues. Did your Dr check your thyroid? In cases like yours (age and surgery), I will sometimes switch over to rhythmic dosing because the monthly dose of the Estrogen is higher. The link below can give you more information, the only trouble is most doctors don’t know anything about rhythmic dosing.
http://www.thewileyprotocol.com/
Dr. Maki
I know it sounds crazy as noone seems seems to experience this anywhere, but I have adverse reactions to progesterone. I’ve tried Progestin pills, generic and name brand, micronized progesterone pills and now transdermal creme… Same outcome each time. I have 0 hormones. Any other progesterone options?
Hello Jaque,
I can see having a hard time with progestins, but it is a bit unusual not to tolerate any form of progesterone. It sounds like you have tried all of the different dosage forms. Your Dr could consult with the compounding pharmacy to see if there is another option.
Dr. Maki
Hello, my doctor prescribed Estradiol .5 mg drops 1-2 drops theee times per day. I asked for it in sublingual drops or tabs which I prefer. In your opinion is it better to have bi-est? I am 51, have not menstruated for 18 months have no thyroid issues or any health issues other than my frequent hot flashes, especially at night interrupting my sleep, my lack of energy, brain fog, and my abdomen has widened to the point that none of my clothes fit me. I am 5’5” and most of my life weighed 110-115 but for the last 7 months have weighed 130 which I wouldn’t mind if the entire 15 lbs was not in my waist area. After I eat I bloat, I don’t know if that is related. My doctor thinks I should take progesterone only 2 weeks per month but from what I’ve read it seems better to take it every day. She prescribed 100 mg. and again I asked for sublingual drops or tabs. Please advise.
Warmest regards
Hello Suzanne,
Estradiol is strong, and it can lead to weight gain. The bloating after eating sounds more like Leaky Gut then it being related to estradiol. If you are still having hot flashes, the dose needs to be increased. I am not a fan of oral estrogen. I prefer to use a transdermal Biest cream. For static dosing, taking progesterone all month is a good idea.
Dr. Maki
Hi,
I am 45 yrs old and started experiencing vaginal dryness/painful sex 6 yrs ago. My gyno started treating me last Dec with BHRT capsules after I first tried Bio-T and had a horrible systemic reaction. I started with 1mg estradiol (not sure if it was Biest) with 200 mg of Prog. and really had no results. Now I’m on 1.5 Biest/200 mg progesterone for the last 17 days and I’m still not having much improvement. Is it too soon to tell? Can my doctor safely increase the dosage more? Is the cream better? Hope that’s enough info, any help is appreciated! Thanks!
Hello Julie,
Your only 45, are you still getting a period? Did you have a hysterectomy? Oral capsules of biest will not work for vaginal dryness. You need to use an Estriol (E3) cream that you apply vaginally. A typically dose is around 2 mg / gram.
Dr. Maki
Thank you for your response. No, I don’t get my period and didn’t have a hysterectomy, but I did have an hydro-ablation due to excessive bleeding for weeks each month. That was just 1 1/2 yrs ago, so my symptoms had started well before that. I have made an appointment with another doctor and intend to switch to a cream.
Hi Dr.,
I have been fighting hairloss for over 4 yrs. I’m 48 now. until one month ago i could not get bhrt in bio form, all 3 ob/gyn’s i saw would only give me bcp. which worsened my hair. my last estradiol was less than 10. my progesterone consistently .30 over past 4 yrs. one month ago, my dr finally put me on divigel 0.1% topically. she didnt even prescribe progesterone. i got progester-all on line & use it. im getting labs checked again this wk.
i believe i should be on this bi-est 80/20 cream + a bio progesterone pill. are these only available by prescription? or can i buy direct?
am i correct in my thinking for tx? i also take 25 levo & 5 cytomel for thyroid.
any response would be greatly appreciated 😊
Jen
Hello Jen,
First off, I would get your thyroid re-evaluated. Have your Dr check your Free T3 and Reverse T3 levels. Ideally, your Free T3 should be above 3.0. Yes, a transdermal Biest cream and a progesterone capsule could be a good option. The Biest dose needs to be high enough. Your 48, did you have a hysterectomy? Or just early menopause?
Hi,
Years ago I had a full hysterectomy and got very low in hormones with increased symptoms. About 6 weeks ago I started taking HRT and now taking 30 mg bi-est cream, 1mg estriol suppository, and 25mg progesterone capsules. I started on 100 mg of both bi-est and prog and whittled down to what I am taking now. I had to stop the estriol sup because I was reacting to it with groin redness, itching and inflammation of my internal varicose veins with pain in my feet and legs. I realize my Biest also has the estriol in it in greater amounts than the estrogen and am still having symptoms. I know I desperately need hrt but can’t take bio-identical wild yam or soy due to it bothering my bladder with IC. I have a lot of auto immune going on as well. I am sleeping better and only mild sweats at night and still no libido yet so many other symptoms are better such as my sleep. Got any ideas? I think the estriol is the culprit. I have gone back on my estrace cream now without the estriol sup.
Hello Diane,
Thanks for reaching out, but I think you may have miss stated your Biest dose. A dose of either 100 mg or 30 mg is way too high. I would double check your dose on your prescription, or you can call the compounding pharmacy and they can tell you to exact dose. As for Estriol, is usually very well tolerated, but it is certainly dose-dependent.
Dr Maki