What is Biest?
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.
https://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
Just curious why you prefer Biest 80/20 vs 50/50? I had previously been on Vivelle Dot then Divigel but chose to switch to Biest cream. I believe my body is wired for higher does of Estradiol due to previous synthetic version use. Your thoughts? I’m 48, sudden unexplained menopause at 45. With no HRT my Estrogen and Progesterone <5. I require high doses to even raise my levels slightly. Currently on Biest 50/50 1 mg and Progesterone cream 40mg qd. My last E3 was 38! Help
Correction:. E2 was 38.
Dear Jennifer,
Thank you so much for your question! This is a really good one and it is helpful to others reading. Biest, which is a combination of estriol and estradiol can come in many ratios depending on the particular individual. Biest 80:20 ratio is a combination dose of 80% estriol and 20% estradiol. For example, a 80:20 ratio of 5 mg Biest is a combination of 4 mg estriol and 1 mg estradiol. The amazing thing about compounding pharmacies and Biest is you can create any ratio you want. A Biest of 80:20 ratio is much gentler than a 50:50 ratio. That is because estriol is much more gentle and less potent than estradiol. In someone that has never been on hormones, a 80:20 ratio is best so that we can get results without over-estrogenizing them. But in your case Jennifer, I would absolutely put you on a 50:50 ratio after been on the vivelle dot.
The Vivelle dot is estradiol based and as I mentioned above, estradiol is quite potent. A 80:20 ratio of biest for you Jennifer, would not touch your symptoms after having been on a estradiol patch. Although, this is not medical advice… disclaimer, disclaimer…. 1mg of a 50:50 ratio biest is a really low dose for someone that was previously on a estradiol patch. And while everyone enters menopause as different ages, 45 years old is young. Meaning you need estrogen to preserve your bone density compared to one that entered menopause at 51 years old. Below is a blog that I wrote about Biest and estradiol. And coming soon, I have a more indepth blog on BHRT which has more info about the ratios of Biest.
https://progressyourhealth.com/biest-vs-estradiol/
DrD
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
Hello
My Natropath gave me a Rx for 0.25 of TD BI-EST (80:20) 0.25 mg and TD compound of progesterone 15mg tropically . My question is will this help with vaginal dryness. Other Rx was for estriol 0.5 vaginally however left me with symptoms of burning and Pelvic achiness .
Hello Deb,
In my opinion, 0.25 mg of Biest is a very low dose. My wife and I will start biest at 2 to 5 mg. As for the progesterone, for women who have their uterus, we tend to use progesterone capsules more often then progesterone cream. Oral progesterone has a better impact on sleep, anxiety and will inhibit the uterine lining from growing. As for the E3 cream, the compounding pharmacy might need to use a different base for the cream.
Dr. Maki
Hi Dr Maki,
I’m currently taking Biest/Pregnenolone/Progesterone 1/50/300MG Touche. Quarter in the morning and at night. Its a new adjusted formula which was meant to help with sleep, mood swings and fluid retention. I’m 48 full blown menopause. Been on the formula for around 2-3 week. Sleep and mood swings are a little better however bad fluid retention is still an issue, anxiety is a bit of a problem and I now have acne which I suffered from as a teenager. Told my doctor about all of this prior to adjusting the formula. Does the dosage sound right to you?
I’m in Perth Western Australia and finding a good BHRT doctor is extremely difficult.
Hello Denise,
My wife and I are not a fan of putting all three hormones in 1 cream in case the patient doesn’t respond well. In my opinion, I think your Biest dose is very low and the progesterone dose is too high. I would probably also take out the pregnenolone and provide a separate capsule of 10 to 30 mg. My wife and I usually never go above 30 mg of pregnenolone. For static dosing (same dose every day), we typically start with a progesterone sustained-release capsule, versus using a cream or a touche.
Dr. Maki
I came across your webpage after doing many google searches on biest cream. My functional medical doctor has given me bio identical hormones over the last few years. I have only used progesterone cream because I always feared using the biest. My progesterone cream was given in many doses from 100 mg to 50 mg to 25 mg etc, and my body struggled with any dose. It would worsen my already terrible insomnia, it caused my body to feel hot and heated, etc. So the doctor started to give me biest cream. She said the reason I wasn’t tolerating the progesterone cream is because my estrogen is rock bottom. She gave me biest 50:50 ratio estradiol to estriol – and she gave me 12.5 mg of porogesteone with the option to raise to 50-100 mg (but because I’m so reactive she has allowed me to play with the dosing. The biest is .5 mg of cream with the option to increase to 2.0 mg of biest if needed. Because I’m sensitive she is allowing me to be cautious. I am 49 years old. My period stopped abruptly 4 years ago, due to adreanl fatigue and I’m sure thyroid function. But I’ve tried many thyroid meds (NDt t3 etc….) nothing worked for me they made me worse. I am a very healthy clean eater and take care of my body, I am a yoga Instructor. Any thoughts ? I worry about weight gain, feeling crappy etc.
Hello Tanya,
Not sure why you are so reactive to progesterone cream, but I would agree that you probably need more estrogen. As for the biest, we typically start women, especially women who are sensitive on a 80/20 ratio. We would use a 50/50 ratio for women who are having terrible hot flashes.
For static dosing (same dose every day) of BHRT, we tend to use oral progesterone instead of cream. This is good for sleep, anxiety and will inhibit the uterine lining from thickening. For women that still have their uterus, cream progesterone is often not strong enough to inhibit the growth of the lining.
For rhythmic dosing, we use progesterone cream instead of capsules. With this type of dosing, we usually do lower the progesterone cream dose, as it can make women feel worse. Also, with rhythmic dosing, the progesterone is only used for 1/2 the monthly, which would be the “luteal” phase of a woman’s cycle.
Dr. Maki
Why did you delete my post ?
I thought of consulting with you, but seeing how you deleted my post.
Not feeling as confident.
I didn’t delete your post. I simply had not responded to it yet. Sorry for the confusion.
Dr. Maki
I am on 1mg 80/20 Biest in the morning and 75mg micronized Progresterone at night. It really seems to be helping, but I will be increasing my dose to 1.5mg of the Biest and likely 100mg of the Progesterone. My last labs showed Estriol in the tank (below the sensitivity of the test) at <100 pg/ml, but Estradiol has not increased to Luteal levels (64.2 pg/ml). Progesterone is 700 pg/ml. All levels are serum levels in the morning and I used the cream prior to the test. I'm just confused on what ratio range is a standard serum target for someone in menopause? I have very high SHBG (181 nmol/L) which increased after treatment, and my CBG is a little high (3.7ng/dL up from 3.4ng/dL). So I am a bit confused on what is going on. I fell great, but I am retaining some water. My E2 goes up from 20 to 64.2 but my E3 is still below the test sensitivity level. My serum P/E2 ratio looks to me like I should be estrogen dominant but I have no symptoms. Should I wait things out and see where they land in a about 4 weeks given my high SHBG and CBG?
Dear Amanda,
Thank you for reaching out. The levels of the hormones really do depend on the person and how they are feeling. If you have a uterus, then you do need a little higher dosage of progesterone to keep the lining of the uterus thin, reducing risk of uterine hyperplasia and cancer. So I do think the 100mg of oral progesterone micronized is great. Although, some women need higher doses of progesterone. I do like biest bc the estriol can help balance the strength of the estradiol. Testing for estriol by blood may not entirely be accurate, which is why testing for estradiol is the best.
The best way to test for blood is to have the blood tested 3-5 hours after application of the biest cream. If you do not apply it in the morning of the test, then the levels will look falsely low. Estrogen has a short half-life, so you want to test after applying to see how well you are absorbing the dose.
So depending on what the timing of your blood test might show why your estradiol levels are fluxing from 20 to 64.2. The sex hormone binding globulin (SHBG) usually will increase after initially starting hormones but will balance out over time. I usually find testosterone to raise SHBG if the dose is too high. But a patient’s SHBG continues to stay elevated I give them supplementation to reduce estrogen metabolites such as DIM, nettle root or even chrysin can help (remember I am not giving medical advice here…). The CBC I would monitor as that slight increase could be completely unrelated. Honestly, I would give it some more time and then retest to compare your levels and how you are feeling.
DrD
Sorry, it should state Estradiol is now increased to Luteal levels (64.2 pg/ml). Sorry.
Hi Dr. Maki, I am 56 5’2” 140 lbs. with Interstitial cystitis. recently my gynecologist retired, about the same time my blood test came back with estradiol at 33 and Estrone LC/MS/MS/ at 191
I’ve been taking Estradiol 1 mg tablet for at least the past 5 years, and progesterone 100mg along with it. My IC has been worse lately, so my doc ran some tests. When my GP saw my lab results he perscribed bi-est 2.5 mg/GM VB CR #153 then to the right the label says 60 Gm it also says compounded he told me to keep taking my progesterone pills 100 mg because my progesterone level is normal at 3.6 I’ve noticed I’m more mentally alert now and that is a very good thing, however I’m waking up every couple of hours in the night and now having hot flashes. I wanted to get your opinion on whether I should ask my doc to increase the dosage? Or decrease? I started taking this exactly a month ago, I’ve also noticed a little breast tenderness and itching on the left breast which I had earlier during menopausal changes. I would sure appreciate your opinion, I trust my doctor but he’s never treated me for HRT because I had the same Gynecologist for 25 years.
Thanks so much.
Rose
Dear Rose,
Thank you for your question! So you current prescription is a Biest 2.5mg per gram cream in a versa base. I am sure it is a 80:20 ratio of estriol to estradiol (which is the default ratio that most docs use). That means that it is a combination of estriol 2.0mg with .5mg of estradiol per gram. I am not sure how much you are taking? The bioidentical hormones do not have a long lifespan. Usually the Biest is applied twice a day, morning and evening. I am thinking because you were given a 60 gram container that you are applying one gram, twice a day. That would be, 2.5 mg Biest twice a day equaling to 5.0 mg total. If you have a uterus, do keep taking your oral progesterone 100mg at night. As progesterone keeps the uterine lining thin, reducing the risk of uterine cancer and spotting. You were taking estradiol 1 mg orally previously. Taking estradiol orally can be quite strong. Oral estradiol is not ideal to take long term. So I am glad you are taking Biest as a cream now. But taking estradiol orally can be quite strong and puts a burden on your liver. In this case, when switching someone to a Biest, you need to start with a higher dose. Otherwise they will have hot flashes and night sweats. It could be that you need a stronger dosage of Biest to get you by temporarily for your symptoms. It can take up to 3 month for the body to get used to the Biest cream over the estradiol oral tablet. I usually start with a higher dose of Biest and a 50:50 ratio of estriol to estradiol to help with the transition to the much gentler Biest cream. Rose, it might be that you need a little higher dose or a 50:50 ratio to help with your transition short term. Again, I have to say: this is not medical advice….etc…. Opinion only…. disclaimer….
DrD
Hi,
I’m taking progesterone 100mg capsule, and biest 50/50 cream which is 0.2mg/ml, and dosage is 1ml daily. Is this a good combination? I’m 58 and have tried going off BHRT before and had depression, anxiety, sleep disorders, weight gain of about 15-20lbs, vaginal thinning and dryness and complete lack of libido. I am feeling better since restarting 3 months ago. Libido is a little better but not quite back but I have lost 8lbs. What exactly helps with libido?
Dear Penny,
With hormones, it really depends on the person and I always stick to less-is-best. And your dosage of Biest is on the lower side. But if you feel good on this dose, then it is the dose for you. I am so glad you are feeling better after having been on this dosage for three months, as the symptoms you described can very much be hormone related. Female libido is really complicated and I wish there was a quick fix, but there is not. Estrogen (estradiol and estriol) is helpful for libido. But if there is vaginal dryness and lack of sensitivity, using a application of estriol-only cream to the vaginal tissues can be quite helpful (professional opinion, this is not medical advice…). Also, using testosterone can be helpful for sex drive. I have also seen oxytocin improve sex drive as well (again disclaimer…disclaimer). So these are some options that you can talk with your doc about incorporating. If you want to read more about estriol and vaginal dryness , read my blog: What is Estriol Used For? https://progressyourhealth.com/what-is-estriol-used-for/
DrD
I am struggling to find the right dosage and combination of BHRT. I believe that I am sensitive to Progesterone. I am 53 and started menopause at age 50. Hot flashes and weight gain are my two main symptoms (I was super thin my entire life and now I’m 35 pounds overweight). I have 2-5 flashes a night – not soaking but they wake me (otherwise I would sleep fine) and always one at 4 or 5am. During the day I have several – not unbearable but that is only while on BHRT (when I stopped taking everything it was brutal). I have been taking some form of BH for about 2 years now. I tried the patch – Estradiol started at .5 and increased to .75mg. My symptoms became tolerable and the flashes were going away to the point that I only got the one early in the morning and maybe minor 1 or 2 during the day. But then I would take progesterone (pill) – 100mg (and gradually tried to decrease). As soon as I took the progesterone, the flashes would increase in intensity and frequency. I switched to cream – currently taking a combined cream of 5mg estradiol/gm, 30mg/gm of progesterone, 6 mg of testosterone/gm — 1/4 gm applied once a day. I still have difficulty losing weight, and flashes are still multiple times a night and throughout the day. (however, when I stop – its 10 times worse). I’d like to switch to a biest and even a cyclical dosing. I’ve read the Wiley protocol but the dosing looks super high (at least to start). I plan to stop the testosterone (I don’t have my numbers handy but the testosterone wasn’t that bad) and may take DHEA instead. My estrogen levels were pretty much non-existent when I tested before starting BH. My progesterone levels were low but not horrific. I plan to test again after starting the new protocol (saliva hormones, urine metabolites, thyroid, etc…). Can you suggest a starting dose? Should I do the biest at 50:50? How low can I go with progesterone and still have it protect me? I do want to do the cyclical dosing and I have the wiley protocol calendar – I just need to get the starting doses and I can work it out from there (BTW – I’m an acupuncturist and naturopath – so I’m working on myself and having a doctor friend write up the script for me – I’m using myself as a guinea pig basically! So any “guidance” is greatly appreciated). Also, if I want to use estriol vaginally (in addition) – what dosage should I do for that? Do I need a script for that as well or can I order that online? Thanks.
Dear Karen,
thank you for taking the time to share your situation and questions. We really think that other women could benefit and relate to your concerns. In fact, we did a podcast on your specific questions and concerns.
Here is the link to the podcast: What Biest Ratio is Best For Menopause?
Thank you,
DrD
I’m 51 and had a hysterectomy @ 35. I started having hot flashes, weight gain and a complete loss of sex drive a few years ago. When I do have sex, I’m horribly dry and it’s pretty painful. My dr just put me on Intrarosa 6.5 mg vaginal inserts and BIEST 50/50 1 mg each day. I will start both treatments tomorrow but wanted your advice on these, please.
Dear Ronda, thank you so much for your question. In fact, I really think other women can relate to your hormone issues. So I wrote an article with your question so that other women that are having similar experience can benefit. Here is the link to the article
Again thank you for your question! DrD
I have been on Biest 80/20 1mg with 50mg progesterone per pump since I started menopause symptoms about 1.5 years ago. I started with one pump at night vaginally and I had results within days. As time went on I started to get hot flashes and so per my Dr.’s recommendation started 2x a time. Morning transdermally and evening vaginally. There are times I would feel estrogen overload so I would back off to 1 day. But for the most part 2 a day and it has worked great for me. However, for the last month I have been having hot flashes mostly at night, night sweats and slight insomnia (not as bad as pre biest). I am working with my Dr. on dosage change and know she definitely prefers lower dosages but we may increase the dose to 1.25. I am just wondering if it is the progesterone may need to be higher or possibly separately? And keep biest as is? In all other regards I feel great.
Hello CeeCee,
Thank you for your question. I really appreciate you taking the time to explain your situation. In fact, I think other women can relate to your comment/questions. Below is an article I wrote where I answered your questions. Again thank you for reaching out.
-DrD
How Does Bioidentical Progesterone Help?
Hi Dr
I have been taking bi-est and testosterone in cream form in separate dispensers for 6 years along with progesterone capsules. My doctor has recently moved her patients to a new compounding pharmacy and i have just collected my latest prescription but the bi-est and testosterone cream were combined into one dispenser. I have never heard of this before and thought it was important not to cross-contaminate the creams and apply them in different areas. My Doctor is on leave and I am a bit concenred what to do. Any advice please?
thank you for your comment and question. It is common to have biest and testosterone combined into one container. It can help with the easy application, and can be cost effective combining the biest and testosterone. Although, some people apply the biest twice a day and the testosterone once a day, so it would not be wise to combine in this case. Or having the hormones together can cause issues if either the testosterone or estradiol/estriol were too high or too low. Then you have to toss out the combo container and create a new one. For example, a patient is on a combo of biest and testosterone. She all of a sudden starts to get intense hot flashes, but has 3/4 of a container of hormone cream left. So not to waste it, she increases the dose. Hot flashes go away bc of the rise in biest and then gets cystic acne bc of the increase in testosterone. So combinations are good if someone has been pretty consistent with their doses and you know you won’t have to make frequent changes. But to answer your question, there is no problem putting the two together in the same container. Testosterone does have the tendency to grow hair where it is applied. So you would want to apply the combo cream to the back of the knee or inner thigh. Bc if you applied it to your forearms, you would grow hair there and perhaps get it on other people or pets. I hope that help answer your question and if you need any more clarification, please reach out anytime. take care, DrD
Hi! I’m a 48 year old who has struggled with pcos my whole life. I have taken 200 mg of oral progesterone for several years now. I also take 45 mg of armour thyroid and my TSH is 387 and my free T3 is 322. I have had symptoms of hair loss, dry eyes, vaginal dryness, very low sex drive and irritability. I just had a saliva test done which revealed very low estradiol and low dhea along with bordering low testosterone. The practitioner put me on sublingual drops with dosage of 80/20 Biest .8 and .8 testosterone , 25mg oral dhea and kept me on 200 mg oral progesterone. My question is…is this a safe way to administer biest/testosterone and do you agree with dosing amounts? Any advise would be appreciated. Thank you for your time.
Heidi
Hello Heidi,
Thanks for reaching out. Oral Bioidentical progesterone is good. We prefer to use oral progesterone (not Prometrium) vs cream in most cases. Are you still having a cycle? If your not, that would explain low estradiol level. I am assuming you are not still cycling. We would not use sublingual drops of Biest/Test, plus the .8 mg dose is very low. If you have a history of PCOS, testosterone and DHEA might not be necessary. A blood test would be good to double-check your hormones levels. Your TSH (3.87) is too high. We aim for a TSH of .7 to 1.3. 45 mg of Armour is a relatively low dose. Your free T3 (3.22) is ok, but could be higher.
Dr. Maki
Thank you for your quick response Dr. Maki. My oral progesterone is prometrium can you please tell me why you don’t recommend prometrium and what oral progesterone you do recommend? Also, I am actually still cycling so not sure why my estradiol is so low. Why do you not recommend the biest/ testosterone in sublingual format? If my tsh is at 3.87 and free t3 is at 3.22 and my armour is at 45mg what would you recommend I go up or down in my dosage?
Thank you for your input!
Heidi
I have rec3ntly started taking 50mg of progesterone and bi est cream 50.50 it’s been 3 weeks. Experiencing hotflash at night and seeing very little improvement in my sleep. Does it really matter where we apply the bi est cream, I was told inner highs, I feel I absorb it better in the inner arm, Also could the dosage be too low, I cannot tolerate more than 50mg of progesterone.These are compounded in pharmacy..
Hello Lisa,
Thanks for reaching out. We recently published a podcast based on your question. I hope this helps.
https://progressyourhealth.com/podcast/where-do-you-apply-biest-cream/
Dr. Maki