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 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
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