Bioidentical Estrogens Explained

estrogensIn previous blog postings, I’ve discussed hormones that qualify as bioidentical and the power of progesterone.  Here I want to dig a little deeper into the bioidentical estrogens since they are an important, and often misunderstood, part of menopausal treatment.  Although there is only one bioidentical progestin, progesterone, there are actually 3 bioidentical estrogens.  They are estrone (E1), estradiol (E2) and estriol (E3).  They each have different levels of estrogenic activity and biological properties.

Let’s start with the middle one first – estradiol (E2).  This is the primary estrogen in the body and the most potent.   Estradiol accounts for somewhere between 10-40% of the total estrogens circulating in the body.  Estradiol is also the most widely available estrogen as a mass-produced pharmaceutical.  It comes in tablets, patches and creams.  Estradiol is very effective at treating many menopausal symptoms, especially hot flashes and vaginal dryness.  But  because estradiol is so potent, it needs to be dosed carefully.  Overdosing estradiol can lead to many unpleasant side effects like headaches, fluid retention, and break-through bleeding.  Overdosing also increases risks of endometrial and breast cancer and blood clots leading to heart attack or stroke.  Therefore it is extremely important to dose estradiol at the lowest effective dose and to make sure its activity is balanced out with the proper amount of progesterone.  One way to lower the dose of estradiol is to combine it with the less potent estrogen estriol.  I’ll discuss that more later.

Estrone (E1) is the other potent estrogen.  It accounts for 10-20% of the body’s circulating estrogens.  There are a couple of mass produced estrone containing products on the market but they are rarely used.  The main problem with estrone is that it doesn’t appear to be that effective at treating menopausal symptoms but still has many of the unwanted side effects of estradiol.  Most concerning is estrone’s ability to stimulate breast tissue growth which may lead to increased risk of breast cancer.

Finally, estriol (E3) is the weakest estrogen, meaning that it exerts a much milder estrogenic effect than estradiol or estrone.  Estriol accounts for 50-80% of circulating estrogens in the body.  Controversy has surrounded estriol in the past.  Its value was questioned by the FDA in their letters to compounding pharmacies in 2008 (see my post Answering the Critics: the FDA for more information about that).  There are no FDA approved estriol containing products, so the only place to get estriol is through a compounding pharmacy.  The interesting thing about estriol is that even though it is a weak estrogen, it appears to be effective in treating many menopausal symptoms.  Some studies have also shown that it has a higher affinity to the estrogen receptors on breast tissue that are protective against breast cancer.  I think it would be premature to say that estriol prevents breast cancer but the data we have at this point indicates that might be the case.  My experience with estriol is that it is an effective treatment with often lower side effects than the more potent estrogens.  Again, it is important to balance the effect of any of these estrogens with the appropriate dose of progesterone.

Finally, often bioidentical estrogens are prescribed in a combination – either Tri-est or Bi-est.  Tri-est is a combination of all 3 estrogens usually in a 10%/10%/80% (E1/E2/E3) ratio.  The rational behind this combination is that it mimics the normal ratio of these hormones in the body (although clearly there is variability from person to person).  Because of the safety concerns of estrone (E1) and its limited effectiveness, Tri-est had gone out of fashion.  What I see much more of now is Bi-est.  This is a combination of estradiol (E2) and Estriol (E3) in a 20%/80% (E2/E3) ratio.  This combination often relieves menopausal symptoms with a much lower exposure to the more potent estradiol.

One last note… obtaining hormone levels prior to starting any of these treatments and doing follow-up tests after starting them is an important part of finding the exact custom dose to effectively treat menopausal symptoms with the lowest risk of side effects.

I hope this information is helpful.  Please post any comments or questions.

Thank you and live well!


385 Responses to “Bioidentical Estrogens Explained”

  1. 1 Linda April 3, 2009 at 11:03 am

    I have been using progesterone for 4 years and am just now using a little estridiol. My c.p. can not get estriol anymore and I was wondering if I can get it from Cananda or Europe and is it safe to get it there? Thanks 🙂 By the way I hate the FDA and I hope they go under along with Wyeth.


    • 2 thecompounder April 4, 2009 at 3:12 pm

      Hi Linda,
      Estriol is still available in the United States, it’s just that many pharmacies are having a hard time getting a hold of it. I think if you call around, you should be able to find a compounding pharmacy that still carries it. If you still can’t find it, let me know and I’ll see if I can track some down for you.

      • 3 Carol Geldenhuys October 6, 2014 at 4:06 am

        Thank you so much for a fantastic website. I came off estraderm patches and onto the bioidentical cream. The patches were not great, but they were taking the edge of my symptoms. I started on two squirts of the Estriol cream and the progesterone tablets. I started feeling really bad. Tender breasts etc etc. The doctor told me to stop the progesterone tabs which helped with those symptoms. But the cream felt as is it was doing nothing for me, she did a blood test and found I had no oestrogen in my body, so upped my cream to 5 squirts per day. I still feel zero improvement. I do it on the inner of my arm. What could be causing the cream not to penetrate my skin?

      • 4 thecompounder November 12, 2014 at 4:04 pm

        Thanks for writing into the blog. While Peter can’t respond to patient-specific questions in this online format, I’ve noted a general question you’ve raised here that he could write about in a future post, which is what could account for taking estriol cream but having no estrogen show up in a follow-up blood test.
        If you need a good resource for finding a compounding pharmacist you could consult with in addition to your doctor, we recommend the Pharmacy Compounding Accreditation Board,, which allows you to search for compounding pharmacies by state that have met the strictest national standards for quality.
        Thanks for writing. All my best,
        Krista Shaffer, Outreach Director at Koshland Pharm

    • 5 Paula Renner March 17, 2016 at 4:31 pm

      I started estriol and they changed pharmacies. Now they sent C-Biest is this the same? Does it work the same? Then they gave me progesterone at 200 mg . My new script is 100 mg. very afraid to use it. Spent 550.00 cash for this ,and the Dr won’t return phone calls. Any info you can give would be appreciated.

  2. 6 Kellie April 22, 2009 at 10:47 am

    Check out Women’s International Pharmacy. I work for an Integrative Medicine MD and a Naturopath .. most of our female patients using BHRT use this pharmacy.

    Hope this helps !

  3. 7 Allie June 1, 2009 at 1:58 pm

    Hi there
    I started on bio-identical progesterone on March 10. For 2 weeks I had no sleep at all and I felt absolutely FABULOUS! Yes, you read that right. FABULOUS. Clear head, energy galore. It was having the opposite effect on me. What goes up must come down right? Dr. said he hadn’t seen it before but to stick with it and yes it did. I started to sleep. I have had insomnia for years. Now I am getting on some nights, 8 hours of interrupted sleep. What a miracle. I had some mental clarity during the past 3 months but now I am feeling foggy and forgetful again. Almost as if my mind is spinning. My breasts increased in size and I gained some weight. UGH. But I’ll live with that to sleep.
    Now the blood work shows I have very low estrogen and testosterone also. My period is all over the place. Hot flashes and night sweats have gotten better on progesterone along with heart palpatations.

    I am starting on 1 ML daily of Bi-est along with my current dose of 1 ML of progesterone.

    I am worried about weight gain but from what I am reading it is not likely as I am taking progesterone also.

    I had pretty bad water retention and bloating with progesterone and my breasts, well they just got larger and I’m not happy with that. They are big enough.

    Any advice or info. on this matter of weight gain would be appreciated as I am a little leary of starting the Bi-est.

    • 8 thecompounder June 2, 2009 at 5:52 am

      Your reaction to progesterone is definitely unique, but it’s not the first time I’ve heard it. What it says to me is that you are especially sensitive to these hormones. If you are going to start bi-est and testosterone, I would recommend starting at a very low dose and titrating up as you tolerate them. One of the beauties of using a topical cream is that it is very easy to titrate the dose. Just start with 1/4 ml and then increase by 1/4 ml as tolerated up to the 1 ml target dose. Of course, please keep the prescribing doctor in the loop on any changes you might make to his or her prescription directions.

      Monitoring your symptoms will be important throughout this timeframe, as well. I often recommend keeping a daily journal where you write down your symptoms and rate them on a scale of 1 to 10. I would also recommend following-up with a saliva test in 3 to 6 months to make sure your hormones levels are in an appropriate range. It is possible that your progesterone levels might be on the high side. However, since the goal of bioidentical hormone replacement is always hormone balance, getting the appropriate dose of bi-est and testosterone may mitigate some of the adverse effects you are experiencing from the progesterone.

      Good luck and hang in there. Finding the right approach to balancing hormones is a process and can take some time.

      • 9 Allie June 2, 2009 at 8:40 am

        Thank you for your quick response. I really appreciate it. I started this morning on a very low dose as you recommended. It makes sense to me since the progesterone reaction was so severe.
        I felt pretty awful this morning. For the first time ever I took my thyroid pill (Eltroxin) at night 2 nights ago. I never, ever, ever take my thyroid pill at night. That’s how dopey I’ve been feeling. So I had to wait another full day to take it and I was feeling awful. Severe insomnia until 4 am last night until I decided to take my normal thyroid dose 3 hours early. I got to sleep soon after that but woke up feeling really weird. I took my first small dose of estrogen and a couple of hours later my head cleared.

        Could that be do to the estrogen so quickly???
        I teach Grade 2 and I was not in teaching form to say the least until about 10:30.

        Question: I take Eltroxin in the morning about 7. Can I take the estrogen near the same time? I would take it after I shower say between 8 and 8:30 am.

        Also I am to stop taking progesterone during my period. Do I stop the estrogen too during that time also.

        Thanks for your patience with my questions and time!

      • 10 thecompounder June 7, 2009 at 6:59 am

        If you are using topical estrogen, then it’s ok to use at the same time as the thyroid tablet. If they are both oral medications, I would wait 2-4 hours after you take the thyroid before taking the estrogen. It usually takes a few days for someone to notice the effects of the estrogen supplementation, although it’s not unheard of to feel effects after the first dose as you did.

        As far as what part of you cycle to take the progesterone and estrogen, I would talk to your doctor about that. There are many different regimens for taking these hormones, some have you taking the estrogen during your period, some don’t.

        Good luck with everything

      • 11 Allie June 11, 2009 at 3:57 am

        Another question please. Started estrogen a week and half ago along with progesterone 3 months ago. I am going up very slowly on my dose since my reaction to progesterone was so severe. (Reved me up for 2 weeks instead of calming me down) I am taking a 1/4 dose of Biest right now in the morning. With just progesterone my sleep was getting pretty fabulous. Now with the Biest I’m finding my sleep not as great and I actually had a night sweat which hasn’t happened for a couple of months. Sleep doesn’t seem as rested and it takes me longer to fall asleep than when just on progesterone. I need to raise my dose of Biest up to 1 ML at some point and I’m thinking if it is having this effect on me at only 1/4 of the dose should I even bother going up further? My mind though does seem to be clearer but my breasts are bigger and than isn’t a good thing because they are big enough.
        Any advice and/or direction is greatly appreciated!


      • 12 thecompounder June 15, 2009 at 7:58 pm

        Hi Allie, I would not increase the dose of the bi-est until you tolerate the dose you are at. If the adverse effects you are experiencing do not begin to diminish (or get worse), I would talk to your prescriber about cutting the dose down even more or possibly stopping the bi-est. Often, finding the right dose of hormone supplementation is a process that requires constant adjustment during the beginning stages of therapy. Good luck!

    • 13 Con April 5, 2012 at 9:41 am

      the biest cream will help you reduce you stomach fat but it takes time. I have noticed a huge difference but it took about 9 months for the transistion.

      I am also on natural progesterone cream.


  4. 14 Sandi July 8, 2009 at 7:58 am

    Last week I started using bi-est (.5 mg). Progesterone (200 mg)was also prescribed, but I haven’t started it yet. I was instructed to take the bi-est twice a day every day and the progesterone once a day from the first of the month until the 14th. Is it better to use progesterone every day? I’ve also experienced headaches and some lightheadedness. Are these symptoms common?


    • 15 thecompounder July 9, 2009 at 9:23 am

      There are lots of different way to do the bi-est/progesterone regimen. Certain doctors have their favored ways of using them and they have legitimate justifications for their views, but there is no difinitive study that supports one regimen over another.

      For progesterone, there are a couple of ways of taking it that I see the most. One is to use the progesterone every day. The other is to use the progesterone on days 14-28 of the cycle. This half-month regimen mimics the body’s lutial phase of the menstrual cycle. For some women it works well. If the progesterone is helping only on the days that a someone is taking it, I usually recommend trying taking it every day to see if it will help every day. There is no down side to that. it just is a departure from the way the ovaries produce progesterone. Your regimen is to use it from the 1st to the 14th, which is unusual. I would check with your doctor to see if they meant for you to use it in the second half of your cycle. Also, at the dosage you are mentioning, I assume that you are using oral progesterone. If you are using the topical form, 200mg is a very high dose.

      For the bi-est, it can be use once or twice daily. I usually recommend taking it in the morning if it is once daily because it can sometimes cause a little insomnia. The symptoms you mention are most likely due to the bi-est, although progesterone in rare instances (especially in high doses) can cause them too. I would recommend, with the support and approval of your doctor, in cutting back on the bi-est and slowly titrating it up to the dose you are at as you tolerate it.

      I hope that helps.

  5. 16 Elena July 8, 2009 at 2:58 pm

    Hi Peter,
    Just came across your blog. It’s nice to know that someone out there really cares and provides lots of info on bio hormones. I have few questions if you don’t mind. I’ve been diagnosed with pcos long time ago and was on BC pills until I found out about BHT. Well.. the thing is my estrogen was really low about 47 and testosterone is pretty high ( normal for PCOS i guess) i started taking biest 2.75 gel and progesterone 3% crm.It didn’t do me any good because my E was still low but I’m very sensitive to P so even taking 1/4 of gm of P puts me to sleep for 2 days and i have no energy at all… but it really brings Testosterone down which is a good thing for me.. on the other hand it brings my low E even lower.I was trying different tipes of E ( pills, cream) even whent as high as 3 mg estradiol/ 1mg estriol gel.. but i still don’t get enough even though my blood test shows E at 300. My Pharmacist said I should check blood for free Estrogen . I guess my question is whats happening to all that estrogen I’m taking and what should I do? I still have all the ” low estrogen” symptoms and I still don’t get my period, not even when I take Progesterone. It’s driving me crazy and non of the doctors I’ve been to know whats going on. Can you help?
    thank you,

    • 17 thecompounder July 9, 2009 at 10:10 am

      Thanks for your positive feedback on the blog.

      It’s difficult to make specific comments about your situation without knowing more of your medical history, but I do have a few comments. First, doing a blood test for free estradiol isn’t a bad idea although I suspect that the results will be similar to what you have been seeing. If you have not done saliva tests, I would recommend doing that as well since blood tests tend not to show hormone increases with hormone supplementation (especially topical dosage forms). If all of those tests continue to show low levels and you continue to experience symptoms of low estrogen, I would recommend trying obtaining your hormone cream from a different pharmacy and if that still doesn’t work, changing the dosage form. It is possible that the hormone is not penetrating the skin and you may need an oral dosage form (this is rare but possible). Also, keep in mind, your doctor will probably need to alter the strength of the medication if they switch from topical to oral dosages.

      I hope that helps. Let me know how it goes. Thanks.

      • 18 Elena July 15, 2009 at 7:27 pm

        Thank you, Peter
        Just to let you know I did try sublingual estrogen ( pills) and it did convert to testosterone( more testosterone) …Just don’t understand why 30mg of progesterone is way too much for me but 3 mg of estradiol is not even close to be enough.. It is pretty high dose for E don’t you think? Just wanted to know your opinion on that. Thanks again,

      • 19 thecompounder July 20, 2009 at 12:54 pm

        Three milligrams of topical estradiol is on the high-normal side of the dosage ranges that I see. That does not necessarily mean it is an inappropriate dose. As I’ve mentioned in many of my blog posts. Each woman has a unique dosage that is right for her. That dosage is determined by many factors including the number and intensity of symptoms, the amount of endogenous hormones being produced and one’s metabolic activity. The goal of therapy is always to achieve a balance of activities of each hormone as determined by blood/saliva levels and symptom reporting. In your case, it appears that the enzymatic activity that converts estradiol to testosterone (and vise versa) is quite high. This may just be your unique physiology. I recommend continuing to work with your doctor to find that appropriate balance. A saliva test is never a bad idea and often keeping a journal of symptoms (including type of symptom, severity and time of day) can help you achieve that goal. Good luck!

  6. 20 Wendy July 18, 2009 at 10:36 am

    I started on Bioidentical hormone cream in January, 2008. I don’t recall the doses I was started on, but I know my GYN started it on “lowest dose possible”. After the first month, I felt better than I have in years. I am 46, and started having significant perimenopause symptoms about 2 years prior to this – the symptoms were hot flashes, night sweats anxiety, heart palpatations (even had pvcs,and went through extensive testing when I had an abnormal EKG)), memory problems and low sexual desire. My last period was in September, 2008, so I am not quite technically past menopause yet.

    Over the last year and a half on BHRT, I had a few breakthrough symptoms, and my doctor made slight adjustments in my dosage.

    As of April 2009, I was on Bi-Est/Progest/Test 8/50/5(I apply the cream to my left inner arm) About a month AFTER that, I started noticing that many of my original symptoms were returning. I also noticed that a longstanding issues with IBS (diarreah predominant) was getting much worse, with almost constant cramping and lose, thin stools. I also have recurring (not constant) muscle sorness and spasms. A few weeks ago, I started having mild fevers.Last week it was really bad – one fever got up to 102. In an incredible stroke of bad luck, both my GYN and Primary Care physician were on vacation all last week. My compounding pharmacist also was getting ready to be out of the country for several weeks when I called her on July 12th. She recommended that I skip my dosage that night, then start the next morning at half my current dose. She said that my GYN had me on too high of a dose, and that we would need to “take me off of this and start over”. She said “we can do this the quick hard way, or the slower, easier way”. I chose the latter. Since then, I have done exactly as she told me to do. That first night – when I had no dose – was right after I had the 102 fever. I had terrible night sweats that night – worst I have ever had. The next two days – when I took half my ususal dose – I felt a bit anxious, but did not have any other symptoms. My digestive issues also lessened in severity.

    Over the course of this week, since I have reduced my dosage, I have had increasing anxiety, sleep problems and occasional night sweats.I also seem to be having some sort of blood sugar problems – feel very lightheaded and uncomforable if I don’t eat when hungery. I have not had any hot flashes. Last night I had another fever that lasted several hours that remained under 100 degrees. The fevers seem to come more often in the evening after dinnertime. This morning I woke up feeling like I had been hit by a truck – sore all over, depressed mood and tearfulness too.

    I am scheduled to see my physicians this week, and have bloodwork and a pelvic ultrasound scheduled (I haver a history of uterine fibroids and ovarian cysts – could those be aggravated by the BHRT,and could they have been causing my worsening digestive symptoms?). I’m glad to have found your blog, and appreciate any feedback you can offer.

    • 21 thecompounder July 20, 2009 at 12:45 pm

      Boy, that sounds like a very difficult experience. Cause and effect is always difficult to determine. Hormone imbalance could definitely exacerbate any of the symptoms you mention, but it is difficult to say if it is the cause of your symptoms. I’m glad you will be seeing your doctor soon. Hopefully they can get to the bottom of it.

      Please let me know if you find out any answers. I would be interested in what you discover. Thanks and good luck.

    • 22 me July 8, 2012 at 5:59 pm

      I started bio identical progesterone and my symptoms worsened including fever. Little did I know I am severely allergic to peanuts, which some compounds contain.. You might look in to that.

    • 23 tracy July 10, 2014 at 9:41 pm

      Hi, I know its an old thread, but…. I had similar symptoms and it was Cortisol. Low cortisol causes blood sugar to drop resulting in sweating and shaking and lowers blood pressure, it causes indigestion and diarrhea and plenty of other symptoms I never would have expected. I was diagnosed with adrenal failure eventually (after 4 doctors). All your hormones need to be in balance and cortisol too high or too low causes systemic troubles. My levels swung wildly before stopping completely. Blood tests are a waste of time – ask your doctor for a 24 hour saliva test.

      • 24 Sally August 4, 2014 at 6:26 pm

        Tracy can you describe what treatment you are receiving for adrenal fatigue, how long you have been on it and how you are feeling symptom wise?

  7. 25 Elena July 20, 2009 at 3:06 pm

    Thank you very much! One more question..estradiol usually prescribed with estriol, what would be an appropriate combination % wise for 3 mg of estradiol? It’s hard to find a doc who would be knowledgeable about BHRT ..Anyway you could recommend anyone in Nevada? Thanks again!

    • 26 thecompounder July 26, 2009 at 9:24 am

      The purpose of adding estriol to estradiol is that estriol is a much weaker estrogen but still competes for the same receptors as the more potent estradiol. This allows the amount of the estradiol to be decreased while still getting beneficial estrogenic effects. Some studies have shown protective effects of estriol on estrogen related cancers (like breast cancer). This makes since since it is minimizing the proliferative effects of the more powerful estrogens.

      Traditionally the ratio of estiol/estradiol has been 80%/20% because that was believed to be the natural physiologic ratio in the human body. Newer studies have shown the physiologic ratio to be closer to 50%/50%. In my practice, I usually still see the 80/20 ratio.

      I hope that helps.

      p.s. I unfortuantely don’t know any practitioners in Nevada.

      • 27 Elena August 21, 2009 at 1:37 pm

        Thank you ! Something interesting happened in the last two weeks. After reading Dr Erika’s books I decided to start taking L-carnitine and Co Q-10 supl. So.. before that I felt like any dose of Estrogen I was taking was going through me and not registering in my body ( I don’t know any other way to describe it) about a week after I started taking supplements Estrogen really kicked in! That was amazing!! That same cream that didn’t work before started working..As progesterone goes I don’t have that sensitivity anymore and can take a normal dose. Any thoughts on that? Thank you.

      • 28 thecompounder August 21, 2009 at 3:34 pm

        Interesting info. Thanks for posting.

      • 29 S September 15, 2015 at 7:50 pm

        I live in Las Vegas and I see Dr. Valorie Davidson for my Bi-est cream

      • 30 Karen April 24, 2016 at 5:43 pm

        Would you share the citations for the article(s) with the studies indicating that the physiologic ratios of estradiol and estriol are more like 50:50 than 80:20?

        Thank you,

      • 31 thecompounder April 25, 2016 at 3:59 pm

        Hi Karen,

        For the 80/20 Bi-est, one citation I have is: Wright, Jonathan. Altern Med Review 4(4): 266-270. (published in his book in 1986)
        For the 50/50 Bi-est, one citation I have is: Xu X, Duncan AM, Merz-Demlow BE, Phipps W, Kurzer MS, Menstrual Effects on Urinary Estrogen Metabolites. Clin Endocrin Metab. Nov 1999; 84(11)


    • 32 tina October 20, 2010 at 8:33 pm

      I just met this great doctor who specializes in hormonal therapy. His name is Ed Hoffman he is located off Sahara on the west side in Las Vegas NV. hope this helps… I have been on BHRT for a week and there has been quite the improvement in all of the symptoms (except weight thats too soon to tell)

  8. 33 SBurt July 24, 2009 at 1:49 pm

    Hope maybe you have an answer – I have been on bi-est cream 3.25 mg, dhea & testosterone cream 10 mg & 1.5 mg. and 1x day progesterone 20 mg and have gained 6 lbs. I am exercising, eating clean, lifting weights – all the things I normally do and yet have gained alot of weight – I am only 5’2″ so 6 lbs. is a lot. Am I on too much hormone? Freaking out!


    • 34 thecompounder July 26, 2009 at 8:57 am

      Without knowing your entire history, it is difficult to say that the dose you are on is too high. Often, rapid weight gain with hormone replacement therapy is associated with fluid retention. The estrogens are the most likely cuprit, although to a lesser extent, progesterone, and testosterone can contribute to this side effect. I would recommend talking to your prescriber about adjusting your dose. I always recommend using the lowest possible dose to effectively treat symptoms and improve quality of life, so it’s possible that a lower dose of one or more of your hormones could be just as effective as the dose you are on. Good luck and let me know how it works out.

  9. 35 judy August 23, 2009 at 1:00 pm

    The first two months on bio-identicals was great, slept thru the night no anxiety no depression, then all hell broke lose now six months later everything is worse than ever before, I wish I nver hear of bio-identicals and I am not having success with stopping


  10. 36 vickye September 22, 2009 at 4:28 pm

    I am 41 and had a hysterectomy over 10 years ago. I am on biest/prog/test. I have so many of the symptoms mentioned above, insomnia, weight gain, extreme increase in breast, terrible headaches. I am on the lowest doses of all three. Are these meds right for me?

    • 37 thecompounder September 24, 2009 at 4:36 pm

      I guess I don’t understand your question. Are you on biest/prog/test and now you are having those symptoms? If that’s the case, doing a saliva test and talking with you prescriber is a good idea.

  11. 38 Estelle October 12, 2009 at 8:41 pm

    Hi,I’m on Biest,prog,testost,dhea 2.5mg/80mg/o.5mg/20mg My breasts are very tender and I have terrible insomnia,crampy as well as feeling of malise. my hot flashes are gone and my skin seems better, been “tweeking” for awhile, is it really worth the journey with bioidenticals do people ever feel really good?

    • 39 thecompounder October 13, 2009 at 10:10 am

      Hi Estelle,

      All I can say is that symptoms matter. If you are not feeling well on your current regimen or if your hormones are making you feel worse, you need to look at waht you are on and make adjustments. A saliva test is helpful in the sense that it may point to what homrones are too high, too low, etc., but the symptom profile is just as important if not more important.

      People do feel good, and you should too. One other thing to look at is the cortisol levels and symptoms of chronic stress. If you have had chronic stress and your adrenal glands are not producing the appropriate amounts of cortisol, your body will not utilize the hormones you are taking very well.

      I would follow-up with your prescriber as soon as possible to begin addressing your concerns.

      I hope that helps. Take care.

  12. 40 Jane October 25, 2009 at 3:35 am

    I just started with bioidentical hormones, I find it very confusing to know what dosage I need or even if I am on a lose dosage or high. I found your website very helpful but also it seems I am not the only person out their very confused trying to find a hormone balance. There does not seem to be clear answers if symptoms are from the estrogen or progestrone. I don’t know if I should increase or decrease one or the other. Thanks again for your website it is the only one I found where women are explaining what they are experiencing.

    • 41 thecompounder October 29, 2009 at 10:31 am

      You are not the only one confused. It can be a confusing topic plus the drug companies that make synthetic hormones have gone out of their way to keep the difficult to understand. If people really were seeing this issue clearly and reading the research out there, they would never take a synthetic hormone again.

      It sometimes can be difficult to tell if symptoms are from estrogens or progesterone. Often times it is the ratio of the two that creates something called “estrogen dominance” where your estrogen is normal, but since the progesterone is low, you have symptoms of high estrogen (I wrote a blog post on estrogen dominacce – you can search for it in the search box). I would definitely recommend getting a saliva test. For you, that will give you very useful information about where your hormone level are in relation to normal levels and in relation to each other.

      I hope that helps.

  13. 42 Jane November 2, 2009 at 1:27 pm

    Hi Thank you for your reply. I am still trying to find the right ratio of estrogen to progesterone. Last week my dosage was 2/8 0.05 MG/ML of^DIEST and Progesterone 20MG/0.2ML and Testosterone 0.5MG/0.2ML I am in my fifth year of menopause. I was experiencing hot flashes , night sweats, and dryness. My symptoms are getting worse and I now have pelvic pain. I used to have a lot of trouble with fibroids but they subsided with menopause, I think they are back. My question is the dosage. Is this a high or low dosage. Thanks again,Jane

    • 43 thecompounder November 4, 2009 at 10:11 am

      Hi Jane,
      Your dosage seems middle of the road to me, but as I say often, the only way to know if your estrogens and progesterone are balanced is to do a saliva or blood spot test. A regular blood test won’t be useful to you since you’ve already started on treatment. What I often see is that women continue to make varying amounts estrogen through menopause while progesterone drops off. Do the test and I think the answers will become much clearer. Good luck!

  14. 44 Alicia November 23, 2009 at 5:20 pm

    I have been taking Biest and Progesterone (bio identical) for about six months now and while I have put on weight, very annoying…I have generally felt better. However, I recently had an estrogen metabolite test and found that my body makes large amounts of 4 hydroxtestronge and I am therefore in the “red zone”when it comes to my 2-hydroxyestrone/16hydroxyestrone ratio. My Dr. suggests a Bal Est formula of 50%/50% estradiol/estriol but from what I read on your website, this may not be a good idea. I am using the appropriate liver supplements to try to change my metabolism of estrogen. What do you suggest? Thank you!

    • 45 thecompounder November 24, 2009 at 12:04 pm

      Hi Alicia,
      I hope I haven’t given the impression that I am against a 50/50 estradiol/estriol formula. In fact, more recent studies show that the 50/50 ratio probably more closely mimmics our normal hormone ratios. It looks like you are on the right track with the liver support as well. Let me know how the new regimen works. Take care.

  15. 46 Alicia November 24, 2009 at 3:43 pm

    Thanks for your prompt answer. A question on DHEA-S. My levels are always very high (in the 300s) while my testosterone is quite low and I do not show the usual signs of excess DHEA. Would you attibute that to stressed adrenals or anything else? When I took pregnenolone it went even higher…I do take Levoxyl and in my recent peri menopause years, my thyroid was very difficult to regulate, I found out due to spiking estrogen levels….why don’t Drs make that connection when women go through hell with their thyroids during peri menopause? Thanks again!

    • 47 thecompounder November 30, 2009 at 3:20 pm

      Hi Alicia,
      For whatever reason, you are metabolizing DHEA to DHEA-S much more efficiently than to testosterone. It may be due to stress or it may just be your natural biochemistry. Certainly, dealing with chronic stress is a good idea for many reasons, including that it will allow your body to utilize the hormones you are taking (estradiol, estriol, thyroid) more efficiently. So, I would recommend that no matter what. And, if you are having symptoms of low testosterone (fatigue, low libido, muscle weakness, etc.), you may also benefit from supplementing with bioidentical testosterone. However, if your symptoms seem well managed, I would just have a watchful waiting approach with the DHEA-S levels and not worry about it for the time being. I hope that helps.

  16. 48 Alicia November 30, 2009 at 4:02 pm

    Thanks again. I wonder if you could voice your opinion on cycling the progesterone and Biest. I see that Dr. Hertoghe recommends progesterone for days 13-25 and estrogen from days 1-25. Do you think this may help with weight gain? Also, if my estrogen metabolism is not in the healthy range and I have a thyroid problem, should I avoid DIM and Indole 3 carbinol altogether and stick to the liver protocol (ie: milk thistle, NAC, alpha lipoic acid, TMG etc..). One more – do you have any experience with the gluathione patches that Suzanne Somers recommends in her latest book? They sound intriguing! thanks again…

    • 49 thecompounder December 3, 2009 at 4:14 pm

      It sounds like your regimen is a reasonable one. Cycling estrogens and progesterone like that more closely mimics the natural production of those hormones throughout the menstrual cycle.

  17. 50 beverly December 21, 2009 at 11:59 am

    I take Bio-Identical hormones. I am on oral 50/50 Bi-Estrogen 1MG once daily and oral Progesterone 100 MG. I use Testosterone cream at 1% and use 2 to 4 lines daily (10 MG syringe). I have gained 22 lbs in 2 years on this regimen. How can I lose the weight and keep from gaining on these hormones. Does it sound as though one or more drug may be too high? Any help you can give would be appreciated.

    • 51 thecompounder December 23, 2009 at 2:48 pm

      Hi Beverly,

      Understanding and monitoring your symptoms is an improtant part of making sure you are on the right hormone regimen. The other part is periodically obtaining hormone levels to make sure they are in the optimal ranges. I would recommend that you get a saliva test and test, at minimum, your estradiol, progesterone, and testosterone levels (you could also add an estriol level in there if you want). This will hopefully point out some areas where you might need to adjust some of your dosages to optimize your hormonal balance.

      I hope this helps.

      • 52 Elisa April 26, 2014 at 2:22 am

        I’ve read that oral estrogen can turn into a metabolite that causes weight gain, so maybe you’d be better off with a topical cream.I’ve had good luck with it for the past 8 yrs, of course with topical progesterone as well. Before that I had gained 40 lbs, but am now able to maintain my normal weight, which is a huge relief.

  18. 53 CSM in Vero FL March 14, 2010 at 1:40 pm

    Hello Peter!

    What a great blog with wonderful information for us!! I am learning so much here!!. Thank you for putting this information out to the public–it is NO WHERE else to be found.

    I am a nurse practitioner who is new to bHRT I am reading extensively about it trying to find out the best menopausal dose for myself to improve and protect MY bones —ONLY–not dosing for patients. I am slender; my dexa says “osteopenia” of the spine.

    As I am learning about bio-identicals—indications and dosing, I find there seem to be 3 types of practitioners.

    1. The traditional MD who prescribes only Pharmaceuticals for HRT—they may do blood work but think that sputum levels are a ‘waste of money’.

    2. The MD who draws labs work (blood) and orders estrogen and progesterone (bio-identical) but seems to have little idea or no notion about adjusting the dose –or advising the patient about sequential or continuous HRT. This describes my doctor. She also offers SotoPelle implantables.

    3. Dr. John Lee types who prescribe bio-identicals only if they are needed and order sputum levels to follow and adjust dosing. I am convinced this is the right way to go. There is no practicing doctor of this type in my community.

    I have just started bHRT this week.

    My serum estrogen level was 67—(a normal pre-meno level.) My MD ordered Biest Cream 50/50 4 mg. ½ cc daily topically and Progesterone Cream 100mg topically daily before knowing my estrogen level and forgot that I wanted to dose sequentially. These doses seem high to me after reading the info here and other books.

    I just started using the estrogen cream and last week have already noted a weight gain and other estrogen dominant symptoms—so stopped it and started using 20 mg of progesterone cream at hs—I plan to do this for 21 days.

    There is no MD in this area who prescribes the way I have become convinced that HRT needs to be dosed.

    Can you advise me on a course of action? Should I stop all HRT for a week and get saliva levels? Then, start at a low dose of estrogen and or progesterone per Dr. John Lee? Will the saliva results clue me in about what to do with my dosing?

    Alternatively, can you direct me to a site where I can learn about dosing using sputum levels to adjust my dose? Any wisdom you can send my way would certainly be appreciated.

    Thank you so much for taking the time to consider all of this.


    C. S. Martin

    • 54 thecompounder March 17, 2010 at 5:16 pm

      The blood levels can be useful as a baseline before you start using the hormones. However, once you start supplementing with hormones (especially topical ones), the increased amount of hormone acting on the cells in the body is not accurately reflected in the serum levels. This is where saliva testing is really useful. It looks at intracellular hormones (the ones having their physiologic activity on the body) and generally reflect the amount of hormone being taken.

      In my opinion 4mg of a Bi-est (50/50) is a very high dose of estrogen and 100mg of topical progesterone is on the high side as well. With my patients, I always recommend starting low, and gradually going up on the hormone doses. It is much easier to add more hormone than to take hormone out of the body. For any follow-up testing, I would definitely doing a saliva test.

      Check out ZRT’s website, they have lots of useful information about their tests as well as where to find practitioners who use them.

      I hope that helps.


  19. 55 CSM March 14, 2010 at 3:45 pm

    PS can you suggest a reliable saliva testing lab?



  20. 57 Shonna March 31, 2010 at 9:00 am

    I have been on biest for several years, I am 45 and had to have a surgical hyster when I was 30, tried other hrt and did not do well. I had been taking Troche 80/20 and .75 progesterone included. I didn’t feel great but stayed with it….since october i have had night sweats. not sleeping through the night~ so I saw DR and she upped the dosage with change to 60/40 and 100 progesterone. I had gained weight to no avail before the change and now have noticed in 2 weeks time i am getting bigger….what is your suggestion? also, i have breast soreness now…….please help!

    • 58 thecompounder April 5, 2010 at 4:49 pm

      It definitely sounds like your hormones are not balanced, so I would recommend doing a saliva test to see where your levels are at. I would definitely test estradiol and progesterone. If you have been under a lot of stress lately, it would be a good idea to do a 4 point cortisol test to see how your adrenal function is working. Diminished adrenal function can adversely affect your hormone balance as well as cause some of the symptoms you are mentioning. The test results will help indicate what type of imbalance you might have and how best to correct it. In my pharmacy, I use ZRT labs, and have been happy with them. To find a provider in your area that carries their tests, go to

      I hope that helps.


  21. 59 Kat April 7, 2010 at 9:15 pm

    Hello 🙂 I’m a 41 year old female and just started bioidenticals. My doctor gave me a prescription for Biest 20/80 estradiol, estriol. I’m a bit confused about the whole estriol thing in the fact that the research I’ve been doing suggests that estriol is only important during pregnancy and is made by the placenta.

    Does this mean that women who aren’t preganant normally don’t have estriol circulating in their system? I understand that it is a “safer” estrogen, but I am led to wonder if this is natural to make the majority of my prescription estriol instead of estradiol (even though it’s “safer”).

    I’m also wondering how I can get my doctor to switch my dosage to 50/50 since this website is not the only place I have read that women feel better on that dosage. I think generally doctor’s feel more confident prescribing a safer estrogen, but I would like to bring my estrogen levels to that of when I was in my 20’s, and I don’t know that this ratio is going to do that. I don’t think I was given enough estradiol.

    I guess I’m just confused about the estriol. It wasn’t even on my saliva test results. Is estriol normal when you aren’t pregnant?


    • 60 thecompounder April 14, 2010 at 6:39 pm

      Hi Kat,

      This is a very insightful question. Yes, we primarily make estriol during pregnancy, but there is also circulating estriol in the bloodstream at other times, mainly because it is a metabolite of estradiol. Early studies indicated that about 80% of circulating estrogens were estriol. This lead practitioners to dose Bi-est in an 80/20 radio of estriol/estradiol to match physiologic ratios. Later research showed that the amount of estriol was closer to 35% leading those in the field to reconsider the 80/20 radio in favor of a 50/50 ratio to more closely mimic the physiologic ratio.

      I see both in my practice. Since estriol is the weakest estrogen and may have beneficial long term effects especially on breast tissue, I don’t see a real problem using the 80/20 Bi-est, even though the 50/50 Bi-est is closer to our normal ratio. The body will also likely re-establish the amounts of the 3 estrogens after supplementation rather quickly (i.e. convert estradiol into estrone and estriol).

      If you are switching from an 80/20 bi-est to a 50/50 bi-est you must be careful to adjust the dose. The dose of an equivalent 50/50 bi-est is about 30% the dose of the 80/20 bi-est. This is because the equivalent dose is based off of the amount of estradiol in the medication since it is the strongest estrogen.

      You mention wanting to bring your estrogen levels to that of when you were in your 20’s and I just want to caution you as to not overdose on the estrogens. For many women, depending on their natural production of estrogens, even 0.5mg of estradiol can lead to superphysiologic levels. This can lead to a desensitization of the estrogens by the body.

      I see this all the time. A patient will tell me that they felt great on a high dose of estrogens for about a months and then they started feeling terrible, so the doctor increases the dose. This time they feel great for about 2 weeks and then feel terrible.

      Ultimately, feeling well is achieved not by having levels like a 20 year old by having a balance of the activites of the different hormones. The patient I mentioned above will only have a long standing benefit from the hormone replacement if the amount of estrogen is balanced out by the correct amount of progesterone (which often requires lowering the estrogen dose and increasing the progesterone dose along with addressing adrenal and thyroid function).

      The bottom line is that switching to the 50/50 bi-est is not a terrible idea keeping in mind that the dose should be decreased to be equivalent to your current 80/20 dose. Make sure you have enought progesterone to balance out the estrogens you are taking. And address any issues of chronic stress. This is a recipe for success. It takes some time and attention to get it right, but once you do, you will be rewarded.

      I hope that helps.


  22. 61 Alicia April 15, 2010 at 3:06 am

    Having read your comments on Biest and Balest (50/50) being different strengths, I wonder if you can comment on changing from Balest to Biest and whether one needs to take a larger dose in that case. I did not see significant gains with Balest (other than weight!) and am thinking of trying Biest. Also my testosterone levels (via blood testing as unfortunately my Dr. uses blood not saliva) have not gone up even though I have used the cream every day. Would that suggest a problem with my compounding pharmacy? Thanks for you response.

    • 62 thecompounder April 20, 2010 at 1:16 pm

      I am not too familiar with Balest so it is difficult for me to comment on that particular product. If you are converting from a Bi-est 80/20 to a Bi-est 50/50 you need to cut the dose to about 30% of the 80/20 dose to have an equivalent effect of the estradiol. This is an important point, and one that is often missed leading to overdosing of the estrogens.

      If you are using a topical testosterone, it is possible that the hormone is there but not showing up in the blood test. I would recommend doing a saliva test (I use ZRT and you can find one of their providers at This will often show a more accurate increase of hormone levels with topical administration than blood testing.

      I hope that helps. Take care.


  23. 63 Kat April 18, 2010 at 4:52 am

    Hi again. I’m 41 and have all my parts. Still menstruating. Thanks for your help and answering questions!

    Taking 0.2 ml biest (80/20) days 3-26, and 0.4 progesterone days 14-26.

    The first day I started taking the hormones I was hot all day. Now I’m hot at night. I wouldn’s say classical hot flash, but temp wise uncomfortably hot.

    Two days ago I told the doctor about this, and she told me to cut the dose of the biest down to 0.1 ml. I think it’s making me even hotter than before.

    Does that mean that I actually needed more biest and not less?


    • 64 thecompounder April 20, 2010 at 1:12 pm

      Hi Kat,
      With new doses of hormone creams, it usually takes a few weeks for the levels to reach a steady state. It is often impossible to tell if you need more or less of a hormone cream without trying different doses, or even better, retesting your hormone levels with a saliva test. It is definitely a process and can take a few months of working with the dosages to get it just right. Good luck!


  24. 65 Paula May 7, 2010 at 5:09 pm

    Hi, this website is very informative and I was wondering if I could ask you a question.
    I have PCOS and found that taking Diane-35 bcp was effective in treating all my symptoms, although I stopped because of the dangers associated with synthetic ethinyl estradiol.
    My question is, can I take biest instead and what dose would equal the same as what is contained in Diane-35 ? I believe the dose in Diane-35 is 0.035mg of ethinyl estradiol.

    • 66 thecompounder May 10, 2010 at 2:24 pm

      Hi Paula,

      It is impossible to do an exact dosage conversion from synthetic hormones (i.e. birth control pills) so bio-identical ones. And, we probably wouldn’t want to anyway, because equivalent doses would most likely be higher than normal physiologic levels, which we try to avoid. If you have been off the birth control pill some time, I would recommend starting as any patient would with a saliva test to see where your levels are and go from there.

      I hope that helps.


      • 67 Paula July 13, 2010 at 6:09 am

        Hi Peter,

        Thanks so much for your response :-}
        I was given Biest cream and Progesterone cream so I’m going to give them a try and see if it helps.

        My question is, if your testosterone and DHEA are higher and my other hormones (estradiol and progesterone) are lower, can taking the Biest and Progesterone help to decrease the other circulating hormones which are wreaking havoc ?

        Also, from what I know, if your estradiol is low, it can raise your insulin, or cause insulin resistance….which is another problem that I deal with and I notice that during certain times of the month my blood sugar is uncontrollable despite eating very healthy and exercising.

        Thank you again !

      • 68 thecompounder July 20, 2010 at 10:32 am

        Hi Paula,

        Finding the proper balance of estradiol and progesterone will help with insulin resistance. More importantly, adrenal function, as measured by cortisol levels, will have a definite impact on insulin release and insulin resistance.

        Regarding your other question, if my patients come in with moderately-high testosterone and DHEA levels without supplementation, I usually don’t worry about it unless they are having symptoms related to those hormones. Obviously, if the patient is on testosterone or DHEA supplementation, I would lower the dose or stop the supplementation. I would still, however, look at balancing estrogens and progesterone if the patient is having symptoms related to those hormones. Like I’ve said before, the best approach to supplementation is to look at both the hormone levels and the symptom profile. The goal of therapy should always be to relieve symptoms and improve the long-term health outlook.

        I hope that answers your questions. Take care.


  25. 69 Ashly July 12, 2010 at 7:02 pm

    I’m 24 years old and have recently had my hormones tested via saliva testing and serum testing. My estrogen level is low, sitting in the 30’s and has not moved over the course of a month (serum). My progesterone level has also stayed stable at 0.7 (serum). I have also been told I have ovarian cysts (golfball sized). I’m looking to start bio-identicals and I’m trying to figure out the best way to cycle them. I have not had a period now for two years.
    My doctor has given me her opinion which is 0.5mg bi-est 50/50 days 5-25 and 20mg progesterone days 15-25. my concern is that my estrogen levels are too low. i would like any opinion you have on my situation.

    • 70 thecompounder July 20, 2010 at 10:20 am

      Hi Ashley,
      It is difficult to make a specific recommendation regarding your treatment since I don’t know your entire history, but I never think its a bad idea to start low and gradually increase the dose. We use the phrase, “start low and go slow”. Its always easier to add in more hormones than try to get too much hormone out of your system.

      I hope that helps.


      • 71 Ashly July 20, 2010 at 10:54 am

        Do you typically see women my age with hormonal issues such as this? (low estradiol and progesterone levels?) Do you recommend starting both hormones during the same month or trying to increase estrogen levels before progesterone levels or vice versa? I’m struggling from extreme fatigue and have had gradual weight loss without trying over the last year. I have started on the 0.5mg bi est 50/50. I have not noticed any difference in the way I feel.

      • 72 thecompounder July 20, 2010 at 11:48 am

        Hi Ashley,

        Yes, I have seen women your age with hormone imbalance issues. For my pateints, I start them on both estrogen and progestrerone at the same time. I don’t see any benefit from starting one without the other since one hormone’s activity is optimized only when all the other hormones are optimized as well. Your reported symptoms of extreme fatigue and gradual weight loss can be due to any number of issues (not all of them hormone based). I would make sure your doctor is looking all all possibilities (including adrenal and thyroid function) as well as estrogen/progesterone balance.

        Good luck and take care.


  26. 73 Diane July 18, 2010 at 11:31 am

    I just started using Bi-Est (50-50 E2E3) Prog 1 ml each day. As in just started two days ago, I am much calmer, normnally feeling alittle OCD but these last two days I have sat down to read and fallen a sleep. Is this normal? And if so how long will this last, I work 9 to 10 hrs a day and can’t be falling a sleep at my desk.
    And will I gain weight on this? I weigh about 130 now and had back surgery about 7 years ago, I don’t want to gain weight and put anymore pressure on my back.

    Thanks – Diane

    • 74 thecompounder July 20, 2010 at 10:36 am

      Hi Diane,

      If your are gaining inordinate amounts of weight, that would definitely be something to look at with a follow-up saliva test. When my patients start on a new hormone regimen (especially if they haven’t been on hormones at all), I usually tell them to try their initial dose for a month and then re-evaluate their symptoms. Often times there needs to be some dose adjustment during the first few months since everyone’s optimal dose is unique to them.

      If you want a good symptom checklist, you can download one from my website at

      Thanks and good luck.


  27. 75 Ron'a Cushman July 20, 2010 at 6:00 am

    Hi Peter,

    Quick question regarding topical vs oral BHRT (P4 as well as E2/E3 combo). When taking oral medications so much of the drug is metabolized with the first pass that I’m not sure how much is available for use. Using topical preparations bypasses this. What are the benefits of prescribing oral Biest and P4 micronized SR capsules instead of topically applied cremes.


    • 76 thecompounder July 20, 2010 at 11:41 am

      Hi Ron’a,

      I think the crux of this most recent clinical trial (which is supported by previous trials) is that we should move away from oral estrogens for the most part. Progesterone is another story. At my pharmacy, I have many patients on sustained-release oral progesterone. I find the benefit of progesterone is that it helps patients whose primary complaint is difficlut sleeping. Yes, there is lots of metabolism with oral hormones, but one of the metabolites of progesterone is very sedating and helps patients sleep. One thing to keep in mind is that there needs to be a dose adjustment if you are switching from topical to oral dosing and vise versa.

      Take care.


  28. 77 Tracey August 20, 2010 at 6:10 pm

    My primary care doctor prescribed pregnenolone 30mg capsules and a combination cream with BIEST (80/20) and DHEA 5mg. For my low cortisol, DHEA, E1, E2 and testosterone levels. I got the prescription from a compounding pharmacy. I have been diagnosed with mild HYPERTHYROIDISM. My symptoms are anxiety, heart palpitations, weight loss, and headaches. I am afraid to start the medication for fear it will make my hyperthyroid situation worse causing more irregular heartbeats and anxiety.


  29. 78 Annie be August 25, 2010 at 3:00 pm

    Glad to find this site, thank you!
    Now I have questions if I may. I just started taking Troche, Bi-est/prog/dhea 3/200/50mg, a few days ago. What exactly do these numbers mean?
    From reading these post it would appear that I am on a rather high dose. Am I?
    Others wrote of 1/4 and 1 being high. Can you explain and perhaps lead me in a direction (such as web sites) so that I can be better educated and understanding how i can better care for my future well being?
    Thank you,
    hope you have an enjoyable day,

    • 79 thecompounder August 25, 2010 at 4:00 pm

      It’s difficult to say what exactly those numbers mean. Unfortunately, sometimes pharmacies truncate the name to fit it on their prescription label. I would check with the pharmacy that made the troches to get more clarification.


      • 80 Annie be August 26, 2010 at 2:21 pm

        Hi Peter,
        Spoke to the compounding pharmacies for clarification regarding above letter.
        It is 3mg. Bi-est (20%E2, Estradoil and 80% E3, Estriol) 200mg. Progesterone and 50mg. DHEA. I cut them in half which means I get 1 & 1/2 mg. Bi-est. 100mg. Progesterone and 25mg of DHEA a Day. Regarded my past question are these amounts high for daily dosing? What is considered average? And can you direct me to a web page(s) were I can better educate myself
        regarding Bio’s??
        Thanks Peter for your time and providing a wonderful service to others!

      • 81 thecompounder August 30, 2010 at 3:37 pm

        Hi Annie,
        See my blog post: New Study Confirms Preference of Topical Estrogens Over Oral Estrogens for a link to that most recent trial.

      • 82 thecompounder August 30, 2010 at 3:56 pm

        Hi Annie,

        It is difficult for me to comment on the correctness of your dose since I’m not familar with your history, labs, etc.

        That being said, there are 2 things to keep in mind when determining if a hormone regimen is appropriate for a particular person. First is symptom monitoring. Keeping track of your symptoms can be very helpful in making sure a dose is right. Monitor whether your symptoms are improving, whether there are any new symptoms, etc. Often I have my patients rate their symptoms on a scale from 0 to 10 and periodically check and see if the rating is changing over time. The primary goal of BHRT is to improve symptoms, so it makes sense to keep track of them. There are some good symptom checklists on my website at

        Second, it is important to monitor hormone levels periodically. Since you are on a sublingual dosage form, saliva testing is probably not he best option for you. The blood spot test from ZRT Labs is a good alternative. Since everyone produces and utilizes hormones differently, what may be the perfect dose for one person may be totally wrong for another. These tools help us determine the right dose for your unique physiology.

        I don’t know of any other websites that have good information about bioidentical hormones, but I can recommend a couple of good books: Awakening Athena by Kenna Stephenson, MD, and Are Your Hormones Making You Sick by Eldred Taylor, MD. You can find links to purchase those on my website as well at Also, this blog has a lot more information about bioidentical hormone replacement. A good place to start is the post Bioidentical Hormones Explained.

        I hope that helps.


  30. 83 Annie be August 25, 2010 at 3:06 pm

    Hello Again,
    Just read your last response to a posting.
    Why should we be moving away from oral Estrogen? I am taking oral, Troche. Please see my post about 5 min. ago.
    Thank you,

    • 84 thecompounder August 25, 2010 at 3:29 pm

      Hi Annie,
      Technically a troche is a sublingual dosage form. A majority of the hormone is absorbed through the mucosal layer underneath the tongue directly into the blood stream. This mitigates most of the first-pass metabolism of the hormone through the liver that is believed to be responsible for causing the increased risk.

      The concern with oral estrogens is that there appears to be an increased risk of blood clots with that dosage form which can lead to heart attacks and strokes.

      I hope that answers your question.


      • 85 Annie be August 26, 2010 at 12:01 pm

        Hello Peter,

        Thank you for your response.
        Can you please send me a link about this, is this research?
        Regarding the risk of blood colts from troche. What is felt to be the safest most effective form of Bio-identicals?
        And were may I read of this research as well?

        Thank you Peter!
        Annie =)

  31. 86 Kris September 27, 2010 at 11:45 am

    I am 69 and a year ago after saliva testing, started taking a compound of Bi-Est 0.5, Progesterone 200 and Melatonin 8 mg. capsules along with a testosterone cream and DHEA. I slept well, regained my mind and had tons of energy. Then in July I refilled a 90-day supply and immediately all of my symptoms returned along with major insomnia. Two months into the prescription I took it back to the pharmacy and was given troches instead. For a week and a half, everything was great again – went right to sleep, although I woke up at 4 a.m. every day. Then the symptoms returned again taking the same troches. I can be sleepy but as soon as the troches melt I am wide awake again and stay that way all night. My mind doesn’t race, just totally awake. Any ideas?

    • 87 thecompounder October 10, 2010 at 9:53 pm

      Whenever symptoms return suddenly with a prescription refill or when you get your prescription at a different pharmacy, it is worth looking further into that batch of capsules from the pharmacy – how was it made, what is the pruity of the chemicals used, etc. It may be worth trying another pharmacy or having them remake the batch and see how you do.

      Whenever you switch dosage forms, you will change the pharmacokinetics of the medications, in other words you change how the medication enters the body and in what form. With troches, generally approximately half of the medication goes directly into the bloodstream through absorption under the tongue and half is swallowed and is metabolized extensively by the liver before entering the body. Since you were on an oral dosage form before, this may equate to a much higher amount of the actual hormone entering your body which could definitely give you a different effect.

      Insomnia is not always due to hormone imbalance, however hormone imbalance often leads to insomnia. I would certainly test you hormone levels to rule out any homone imbalances, then begin to look further into other causes of the insomnia.

      I hope that helps.


  32. 88 Dawn October 8, 2010 at 7:03 am

    Hello Peter,

    I could really use some help understanding all this. I was prescribed Biestrogen/Progesterone in Vanpen Cr 2.5mg

    After using this cream for 3 weeks, I found I was still having night sweats and insomnia, so I was told to up the dosage to twice a day instead of once, and to take a progesterone capsule 150 mg at night.

    I am 5’7″ and 130 pounds. I had a recent hysterectomy (3 months ago) but kept one ovary.

    Would 2.5mg a day be considered a high dose? I feel pretty good on all this, but I worry about the amount of estrogen I’m taking and wonder if I didn’t give the once a day dose long enough to take hold. I was estrogen dominant before the surgery and I am now rid of all of those symptoms.

    Thanks in advance for your help.

    • 89 thecompounder October 10, 2010 at 10:29 pm

      Hi Dawn,

      I often get questions from patients wondering if their dose of bioidentical hormones looks “right.” Since I have not looked at your medical history or done any sort of clinical work-up of you as a patient, it would be inappropriate for me to supercede the opinions of those who have started you on this therapy.

      There are a couple of things that I do see out there that are worth mentioniong. First, the symptoms of too much hormone are the same as those of not enough hormone. It is especially important not to overdose on the hormones, especially estrogens, for long term safety and for short term symptom relief. My motto is always to start low and go slow. It’s always easier to add more hormones in than try to get them out of the body. The physiologic output of estradiol during the folicular phase varies from woman to woman, but is generally less than a milligram per day.

      The second thing is that blood tests do not register increases in hormone levels with topical dosage administration. This misunderstanding often leads to a lot of overdosing. I always recommend saliva testing in patients on topical hormones. I know other practitioners who use blood spot or urine testing.

      Finally, symptom monitoring is very important. If your symptoms are not being resolved (or are getting worse), it is definitley worthwhile to follow-up with your prescriber and try to figure out what’s happening.

      I hope that helps.


  33. 90 Dawn October 11, 2010 at 8:06 am

    Thank you Peter. It does help. I think I’ll go back to see this doctor – I feel good on the 5mg total, but it does seem like a lot. I think I missed the “go slow” part and was impatient after taking the 2.5mg for three weeks. Maybe I didn’t give it enough time. I will also ask about the saliva testing. Thanks again.

  34. 91 J.Martins October 15, 2010 at 6:23 am

    I am using bioidentical hormones cyclic (1 to 24 of every month)from a year to now and I feel fine. However, i have the problem of bleeding while taking hormones. The bleeding should begin at the time of pause and this has not happened. At first my doctor increased progesterone from 50 ml to 200 ml (transdermal cream), but the problem remained. Then increased estradiol gel 0.5 mg to 2 mg. He says that perhaps the endometrium is not being formed. Is this the correct procedure?
    Thanks. Sorry for my bad english.

  35. 92 kdee October 16, 2010 at 2:36 pm

    Been on Estradiol since 2005 .5mg due to early menopause. hysterectomy in 1989. Still have my ovaries. all annual checkups fine.Moy Mom who is 77 still on hrt, no probs. Doc wants me to cut back, then get off. reccommended 1 every other day. Have done this for 1 month,feel awful, flashes are back , can’t stay asleep at night. awake each 2-3 hrs. I understand lowest dose for least amount of time, however…I felt so much better before?

  36. 93 Ingrid October 17, 2010 at 6:24 am

    I am using bioidentical hormones cyclic (1 to 24 of every month)from a year to now and I feel fine. However, I have the problem of bleeding while taking hormones. The bleeding should begin at the time of pause and this has not happened. At first my doctor increased progesterone from 50 ml to 200 ml (transdermal cream) and Prometrin (100mg), but the problem remained. Then increased estradiol gel 0.5 mg to 2 mg. He says that perhaps the endometrium is not being formed. Is this the correct procedure?
    Should I increse estradiol when I start bleeding in the the middle of the month?
    In my experience increase estradiol this month didn´t stop bleeading yet (I’m bleading for 10 days)
    Thanks. Sorry for my bad english.

  37. 94 lmiller257 November 1, 2010 at 11:28 am

    I started using a compound of Biest/Test 0.5/50/0.25 MG/ML for hot flashes and night sweats two weeks ago. I am taking a dose in the morning and one at night. It has definitely been helping with my hot flashes and night sweats.

    I would like to lose some weight using HCG homeopathic weight loss drops along with a low calorie diet. Do you know if I can continue using the compound HRT with this? It says if you are doing HRT and it contains HCG, you shouldn’t use the HCG weight loss drops. I’m not sure if my compound that I am using contains HCG.

  38. 96 Lori November 8, 2010 at 8:46 am

    I’m glad I found your site! I am wondering if you can answer a question for me. I have long felt estrogen dominant. I’m almost 48yrs old. Anyway, I have been dealing with an incredible increase of pvcs with my period and insomnia most nights. The pvcs have been running more constant the first 2 weeks of my cycle and seem to let up the last 2 weeks. So my dr is prescribing a very low dose (25mg 2xper day) of sublingual progesterone. Do you find that the progesterone helps calm the pvcs? I’ve been using over the counter progesterone cream that has helped with other estrogen dominant symptoms but has had no effect on these pvcs or insomnia. I’m just wondering if I’m feeling too hopeful that progesterone will stop this. I’m also taking a tincture of adaptogens to help with my adrenal function in hopes of leveling out my hormones. The reason I ask is because I read that too much progesterone can cause an increase in pvcs. So I don’t know what to believe or expect. Thanks!!

    • 97 thecompounder November 8, 2010 at 9:26 pm

      Hi Lori,

      I have found in my practice that often times late cycle symptoms like yours often come from progesterone deficiency. However, I would definitlely do a saliva test to look at, at least, estradiol levels and progesterone levels to make sure this is actually the case. I would recommend either doing a female cycle map where you do 10 or 11 samples during the course of your cycle or a single test on one of the days your are having symptoms. I think this would be very useful. If those tests show estrogen dominance/progesterone deficiency, I think it would be reasonable to address that imbalance with supplemental progesterone. In addition, it is never a bad idea to look at adrenal and thyroid function as well.

      I hope that answers your question. Thanks.

      • 98 Lori November 10, 2010 at 8:32 am

        Thank you so much for the reply. In October, I saw an endocrinologist who took a blood sample on day 2 of my menstrual cycle. I was having the heart palpitations pretty constant on that day and during that time of my cycle. He tested my thyroid antibodies as well as my FSH and estrodial? Is that what they normally check when testing for menopausal symptoms? Anyway, all levels came back normal. So based on that, would you think I am producing an acceptable amount of estrogen but possibly not enough progesterone? I can’t seem to get any of my doctors to really explain hormone function/fluctuation in regards to tests that I have had done and what any of it means. The reason I ask is I have been reading that too little estrogen can cause heart palpitations and insomnia just as too much can. But if I had blood drawn during the time of my cycle where my estrogen should be at its lowest and the levels were normal, then does it stand to reason that my progesterone could be lacking in ratio to my estrogen. I will begin my progesterone supplements on Friday of this week but want to understand as best as I can if the progesterone could be considered low since I did have FSH and estrodial checked and were considered normal.

        I so appreciate you taking the time to answer my questions! I am one who really wants to understand things as best as I can.

  39. 99 Marie November 16, 2010 at 4:21 pm

    My question is regarding the use of 32 Gm Estriol/DHEA 3MG/3MG/GRAM- using 1,2 MLS a night. I am 45 and still having regular periods, though extremely heavy, as I suffer from uterine fibroids. I took a saliva test this past June: Estradiol was 2.0, progesterone was 192 and Pg/E2 ratio a tad low at 96. DHEA was 5.4. Besides heavy periods, no other symptoms until August, when I started experiencing itching and soreness. Dr assumed it was a yeast infection, though I doubted this but took the diflucan…it went away. It came back in October and doc did an “exam”…I had my period and it was so heavy I had to leave sanitary product inserted. He did no swab. Doc said my issue was vaginal dryness….though I am not sure I even have this condition. He actually first prescribed Estrace, but I didn’t want to use that product, and after a consultation with a compounding pharmacy he works with and I trust and my research, they agreed estriol was the way to go. However, I started this on Nov 1st, day 6 of my cycle and started breakthrough bleeding on November 7th. On November 8th evening, I suddenly felt like I was hit by a truck and was freezing cold….had a temp near 101, which was gone by the morning…just a terrible headache, which left by the mid day. I stopped the cream on November 9th, as the bleeding was continuing, and it is still continuing today (November 16th) and it seems to be increasing. I am only using over the counter progesterone cream, and it has never caused any problems for me.

    Question: I assume this is the cream causing the bleeding. Is that a valid hypothesis? Could the fever also be due to the cream? It seems as if my saliva test showed I had quite enough estrogen. I have been looking at a condition called cytolitic vaginitis, and wonder if that is my condition, not vaginal dryness. Therefore, could excess estrogen potentially be causing these problems? Is it unusual for breakthrough bleeding to last this long, or should I expect this to last through to my next expected period?

    Thank you so much for your site.


  40. 100 Lisa November 20, 2010 at 8:28 am

    Hi! I just started taking bio-identical hormones 2days ago. I am taking estradiol/estriol/prog 50/50 .625/20 mg/ml cream. My Doctor refused to do any blood work or saliva testing. She said since I am 47 and menopausal, she didn’t need to test me.
    In the past 2 days I started taking the cream, I have had headaches, nausea, and pain in my lower right abdomen.
    I didn’t take it today and all the symptoms went away except for the pain.
    I will call my Doctor Monday. My question is , I see here that some people have side effects with their intestines. Why is that? Thanks.

    • 101 thecompounder December 5, 2010 at 3:24 pm

      I realize that this post is from a couple of weeks ago, so I hope your issues have been resolved. If you start the hormones and symptoms arise and then stop them and the symptoms go away, it is definitely important to look further at your regimen to make sure you are getting the appropriate dose.

      I’m not sure exactly why hormone imbalances or overdosing on hormones can cause gastrointestinal side effects, but I do see it occasionally. It is most likely due to estrogen effects on the small intestine as well as effects on neurotransmitters like serotonin.

      Good luck with everything.

  41. 102 Kathy December 26, 2010 at 2:52 pm

    Hi Peter —

    I am trying to determine how the dosage of a Bi-est cream compares to the Vivelle Dot dosage I am currently on. Have been having difficulty finding the correct mechanism to compare. Currently I am on 0.0375 Vivelle Dot and recently got prescribed by a different practitioner 80/20 Biest of 2.5 MG/0.5 ML. I am also currently on 100 mg daily Prometrium and considering switching to a cream. I haven’t yet decided if I’m going to switch to the Bi-est or not and am in research mode. Can you please help me understand how to compare the daily estradiol dosage between those two formulas? I really appreciate your blog as it’s been really educational reading it. Thanks for the help!


    • 103 thecompounder January 17, 2011 at 10:34 am

      Hi Kathy,
      It’s very difficult to come up with an “equivalent” bi-est dose to Vivelle dose. The strengths as they are described on the labels pertain to different things. On the Vivelle, the 0.0375mg/day pertains to a blood level achieved by using the patch. On the bi-est, the 2.5mg/0.5ml pertains to the amount of bi-est in the cream itself. Also, the bi-est, has estriol, which the Vivelle does not, therefore muting the effects of the stronger estradiol.

      Basically, switching from Vivelle to a bi-est is kind of like starting from scratch with the bi-est. It will require some symptom monitoring and possibly some dose adjustment to come up with the perfect dose. I hope that helps.


  42. 104 Jennifer C January 23, 2011 at 4:46 pm

    This is my 4th attempt to be on BHRT with different doctors each time. I have done the saliva test and my Dr precribed Biest 1 mg/0.1 ml cream in the morning, progesterone 150 mg SR capsule at bedtime, 25 mg DHEA in the morning as well. I have been taking biest/prog/dhea for 4 months now. At first things seemed fine except biest cream has caused blisters on my arms, thighs then my body became very itchy. Despite my regimen of working out my weight and breast have increased,I get headaches, a few hot flashes and insomnia some nights. Between 12:00 – 4:00 p.m. energy level drops and I become very sleepy.I have done another saliva test recently and have some blood test to do before scheduling an appointment with my doctor. I am 64 years old and I would like to feel better from day to day and to enjoy my retired but busy life.. Is it worth continuing on this treatment or am it wasting money.

    • 105 thecompounder February 5, 2011 at 2:17 pm

      Hi Jennifer,

      It certainly sounds like your hormones are not optimally balanced if you are experiencing those side effects. First and formost, what is your adrenal and thyroid function like? The energy drop in the mid afternoon sounds like diminished adrenal function so that should be checked out with a 4 point saliva test for sure. Some of the other side effects you mention sound like estrogen dominance or estrogen excess. It may be worth talking with your doctor about lowering the dose of your hormones (especially the estrogen) and then slowly titrating them up to see how you respond. It’s always easier to go up on a hormone dose than try to get hormones out of the body.

      I wouldn’t give up yet. This type of therapy can take a little tinkering to get the dosages right. I usually tell my patients to expect around 3 months of dosage adjustments before we have the regimen optimized.

      Good luck.


  43. 106 Jennifer C January 23, 2011 at 6:23 pm

    I am looking forward to a response from my email. Unfortunately, I did not indicate this in the box provided.

  44. 107 Diane February 5, 2011 at 7:27 pm

    I am a postmenopausal 59 year old that has been given boidentical hormones for just about a year. My latest blood results are: Estradiol 68.9; FSH 71.1; and Testrosterone 125.11. About 5 months ago I noticed a yellow staining in my panties. I really did not think to much of it until 2 months ago I began spotting. At first the bleeding was minimal then I had to wear a pad. I was taking Progest Troche (100mg) then was told to increase to 150mg at night. The bleeding as diminished but I still spot sometimes during the day. My questions are 1. WHAT IS GOING ON IN MY BODY? I have not had a period or spotted in over 15 years… 2. SHOULD I BE BLEEDING NOW? 3. SHOULD I STOP THE BIOIDENTICAL HORMONES?

  45. 108 Cindy February 11, 2011 at 8:31 pm

    I have no regular doctors where I’m at that prescribe HRT from a compounding pharmacy. So I am on Vivelle dot patch 0.1 and using Estrace vaginal cream. The problem is the Estrace is not strong enough. I was wandering if I could increase the dose myself by crushing a Estradiol pill and mixing in with a gram of cream? Estradiol is the ingredient in Estrace cream. How does a compounding pharmacy receive the raw product,In powder form? Would I need to make it into a paste first.


    • 109 thecompounder February 21, 2011 at 3:31 pm

      Hi Cindy,

      I wouldn’t recommend that. Compounding pharmacies use many sophisticated pieces of equipment to make sure that a product like a vaginal cream is accurately dosed and mixed properly with the lowest particle size. My suggestion is that if you doctor is not familiar with how to order a compounded medication, have the compounding pharmacy you want to work with contact your doctor to help facilitate the process. Most are happy to do so.

      Good luck.

  46. 110 Debbie February 13, 2011 at 11:43 am

    Dear Peter,
    I have some questions that I thought you might be able to help me with…I am a 51 yr old woman perimenopausal (started menses 9) and I started (Oct) into bioidentical with an Ob who has been practicing in this field for some years. After my bloodwork came back she started me on 1ml (4%) which makes it 40 mg progesterone, 1/2 gm natural Armor thyroid, and testosterone cream (1/4 gram of 2.5%).

    When I started in October…progesterone days 12-26, testosterone every night, thyroid in the early a.m. Now the first month I was more symptomatic w. breakthrough bleeding but period was on time. I get my period every 28 days still. Second month less symptoms bloating, moodiness, etc. Now after then my period did not come until the 27th of Dec. My recheck was 3 weeks ago and I told my doc I feel as if something is not right. My bloodwork looked good she said. I asked her why she does not use salivary testing she stated that there are different thoughts on that and she does not believe the scientific evidence on that form of testing is conclusive. My thyroid was on target, progesterone seemed fine, and testosterone needed to be increased to 1/2 gram. She also had me start the progesterone again as if I had a period. I am still here, day 49 since last period (once again) waiting, waiting…I feel as like someone needs to pop me with a pin! I am moody, tired, bloated for sure and regaining some weight in my abdominal region. I have a called in (although I feel I was blown off the last time due to being early in treatment and perimenopausal), to discuss maybe lowering my progesterone to 1/2 ml=20 mg? She wanted to increase! Any thoughts? Help…I feel like garbage.

    • 111 thecompounder February 21, 2011 at 3:38 pm

      Hi Debbie,

      Definitely symptoms are worth paying attention to and their importance should not be diminished because lab values look “normal.” Based on what you are reporting, it seems that something is out of balance. Several studies have shown that once or twice daily hormone administration does not show up in blood work. I would recommend finding another practitioner or compounding pharmacy that can set you up with a saliva test just to get another take on what your hormone levels are. Your current tests may be right, but it never hurts to look at the levels in a different way. If you are going to do a saliva test, I would recommend looking at adrenal function (4x cortisol) because abnormal cortisol output can contribute to many of the symptoms you are reporting.

      I hope that helps.

  47. 113 Debbie February 13, 2011 at 9:02 pm

    I would also like to add that I have asked my practioner about salivary testing (she does not believe in it) and about the possiblity of adrenal exhaustion…she does not believe in that either 😦

  48. 115 Heidi April 14, 2011 at 4:01 am

    Dear Peter,
    I am about to start BHRT, and I have a question. I have asked my compounding pharmacist this question, and she has given me an answer, but it doesn’t make sense to me.

    I did type of saliva test that had me take a saliva sample every other day for my whole cycle. The results showed that my progesterone and estradiol were both very low, my testosterone was slightly low, and my progesterone:estradiol ratio was about 47:1 (which is estrogen dominance, if I’m understanding the books I’m reading).

    My doctor had not worked with BHRT before, so I requested a consult from my trusted compounding pharmacist. She recommended supplementing progesterone and estrogen to start with, since my testosterone was just below the normal range. She gave me Bi-est 1 mg daily in the morning for days 1-12, and progesterone 100 mg daily at bedtime for days 12-24. Both compounds are made up in a transdermal cream base.

    I’m concerned that using the Bi-est before I get my progesterone level up might make my estrogen dominance symptoms worse. My pharmacist says that the dose of progesterone she gave me will compensate for the estrogen, but I can’t see how that will help for the first 11 days. I have severe time-limited mood swings on days 12-14 of my cycle. Could you give me your opinion please?

    • 116 thecompounder May 2, 2011 at 11:06 am

      Hi Heidi,

      I apologize for taking so long to get back to you.

      From your description of the saliva test you did, it sounds like you did what we call a “cycle map” where your hormone levels are tested every couple of days over the course of your cycle. The benefit for a test like this (if you are still having a menstrual cycle) is that your estrogen levels should be different at different times in your cycle. A rough explanation of this is that your estrogen levels are high in the first half of your cycle, with low progesterone, and your progesterone levels are high in the second half of your cycle, with moderately low estrogen. Therefore, many practitioners dose the hormones in a cyclic pattern to mimic this pattern. Evidence suggests that this pattern certainly confers the desired endometrial protection of the progesterone. Many patients, however, get direct beneficial effects from the progesterone, like improved sleep quality and decreased anxiety, which you would certainly want all month long. So this may be a conversation you need to have with your practitioner if you are suffering without the progesterone on day 1-12.

      Having done the cycle map, it will be easier to custom tailor a regimen to you that addresses specific imbalances throughout the course of your cycle and this may be what your practitioner is doing with the regimen you described.

      I hope that helps.


  49. 117 Tammy June 7, 2011 at 6:00 am

    Long story–I will be 52 in August & had been having periods every mth albeit 2 days of them would be extremely flooding. I had a hysterectomy (everything removed) on April 4th (2 mths ago) due to fibroids kept growing. They put a Climara patch (which I had a few hot flashes with) on me afterward. My GYN changed it to a Vivielle Dot Patch .1 when I returned for my 1 week incision check up & Ambien at night because I was having insomnia. I also had started having episodes of nervousness so he prescribed 1 Zoloft every morning 50 mg. which seemed to help at first. I had not been (& still don’t) having hot flashes/night sweats at all on the Vivielle patch but about 2 weeks later I started feeling nervous/anxiety again that eventually turned into a full blown attack with chills, hard pounding out of my chest, muscle jerking, insomnia–the works that lasted from 6 p.m. until I could get in to see my GYN the next morning. I asked if it could be the hormones & he said I was on the highest dose of the patch & could be my body getting use to the hormones but since I was in such an extreme attack condition he prescribed me Xanax 1mg morning & night to go along with my Zoloft in the a.m. Almost like a miracle I was sleeping (without the Ambien) & felt more like myself–no more nervousness. Since I knew Xanax can be addictive & was not use to taking any medicines prior to my hysterectomy, I wanted to start getting off of them. I halved the morning & night doses of Xanax for 2 weeks then went down to only 1/2 mg only at night (while still taking the Zoloft in the a.m.). Within 3-4 days my anxiety came back like it started out before I had the meltdown. I’ve heard of the bio-identical hormones & the sliva test & wondered if it would relieve my anxiety (heart pounding/nervousness) & let me get off of the Zoloft & Xanax completely. Have you ran into this type of situation before? Thanks…I’m not having the hot flashes/night sweats but hate feeling scared/anxious 24/7. I’m desperate. What could be off? Do you think they could help my situation?

    • 118 thecompounder June 13, 2011 at 2:51 pm

      Hi Tammy,

      Thanks for the post. Dispite the common practice of doctors putting women with a hysterectomy on an estrogen only regimen, there is no scientific evidence to support this approach. The only reason doctors do it is because they are no longer concerned about the risk of endometrial cancer. However, a good understanding of endocrine physiology would lead to the logical conclusion that anyone on estrogen therapy needs progesterone because progesterone augments and supports the effects of estrogen and vise versa. Furthermore, progesterone supports healthy sleep cycles and has natural anti-anxiety properties. I think its totally reasonable to ask your doctor for progesterone therapy and if he/she says you don’t need it, I would find someone who has a better understanding of the physiology of the sex hormones. For more information on progesterone, see my earlier blog post The Power of Progesterone.

      I hope that helps.


  50. 119 cindy June 14, 2011 at 6:22 pm

    I am on vivelle dot patch 0.1 and I would like to switch to Estrace pills.Could you tell me the equivalent dosage? In my research it seems to be 2mg.

    • 120 thecompounder June 16, 2011 at 4:52 pm

      I am curious as to why you want to switch to estrace pills.

      • 121 cindy June 19, 2011 at 9:57 am

        I want to switch to Estrace pills because of the cost. Estradiol in pill form can be purchased at most pharmacies for about $10 for a three months supply. Patches even with insurance are very expensive.

      • 122 thecompounder July 2, 2011 at 6:02 pm

        Yes, I totally understand your rationale. Some of the patches can be quite expensive.

        However, from a strictly health-related point-of-view, I do prefer topical administration of estrogens over oral administration. The oral estrogens have quite a bit of liver metabolism before entering the general circulation and recent clinical trials have indicated that they increase estrogen-related blood clotting potentially leading to heart attacks and strokes. You might check-in with a compounding pharmacy in your area to see if they can do something that fits your budget. It may be worth it in the long run. Good luck with everything.


  51. 123 Diane July 4, 2011 at 8:36 am

    I started natural progesterone and gained alot of weight. I stopped for about two weeks and stated on BI-Est 50:50 I feel very bloated and very irritable. I dropped down half the dose feel better but have bloatted. Do I need progesterone with my BIEST? My hair is falling out and all this weight gain I almost want to stop everything. I am 67 and had a hysterrectomy 30 years ago and know I need something. I had never had weight problem very small and since I started hormones I

    • 124 thecompounder July 5, 2011 at 5:52 pm

      I can’t think of any time where you would want to take an estrogen without progesterone. If you are experiencing side effects with your regimen, you need to talk with your prescriber about possible dose adjustments. Balancing your hormones should make you feel good (or at least not bad).


  52. 125 Virginia July 8, 2011 at 11:02 am

    If I do show a cortisol problem in my zrt testing, what is the treatment?

    • 126 thecompounder July 11, 2011 at 9:49 pm

      The treatment varies depending your presentation and medical situation. I recommend working with a practitioner experienced in treating adernal fatigue to help you with a treatment plan. I would also recommend the books “Adrenal Fatigue” by James Wilson and “Why Zebras Don’t Get Ulcers” by Robert Sapolsky as good resources information.


  53. 127 Karen July 9, 2011 at 11:19 pm

    This is a very informative blog. Thanks for putting out such useful information. I have a few questions.

    My practitioner has prescribed Bi-est along with progesterone, but the 80/20 ratio of Bi-est. Since you mention the newer thinking is that 35% estriol is closer to a woman’s physiologic levels, so then pharmacies are making 50/50 in response, can you cite an article or two for me to follow the studies?

    Also, you mention in one post on BHRT that the body is likely to reestablish the correct amounts of estrogen by converting estradiol to estrone and estriol. So… does this mean the 50/50 product is not really essential, and that the 20/80 will work itself out, or no?

    thank you,


    • 128 thecompounder July 13, 2011 at 12:24 pm

      Hi Karen,

      All good questions. The rationalle for the 80/20 Bi-est was originally mentioned in Dr. Jonathan Wrights book from the 80s and later published in Altern Med Review. 1999. 4(4): 266-270. The study that led to the 50/50 rationalle is in Xu X, Duncan AM, Merz-Demlow BE, Phipps W, Kurzer MS, Menstrual Effects on Urinary Estrogen Metabolites. Clin Endocrin Metab. Nov 1999; 84(11).

      I don’t know if one way is really “right” or “wrong”, but one thing to keep in mind is that the Bi-est 50/50 is much more potent than the 80/20 (about 3 times as much) due to the higher amount of estradiol and the lower amount of competition from the estriol. Estradiol does efficiently get converted to estriol but estriol does not. Estriol is more of an end product metabolite that is excreted in the urine.


  54. 129 K July 21, 2011 at 5:44 am

    I am a 23 year old girl about to start taking bi-est. I can’t find any information about someone as young as me taking these hormones and my only concerns are any long term effects. I guess I’m just looking for any advice or comments 🙂 thanks

    • 130 thecompounder August 14, 2011 at 9:39 pm

      Hormone imbalaces can affect women of any age. I have some patients even younger than you. A good place to start is just getting a good assessment of your symptoms (what they are, when they happen, etc.), then consult with a practitioner knowledgeable in treating women your age.


  55. 131 Amanda August 9, 2011 at 2:28 pm

    I am hoping that someone can help me out here. I am starting estrogen therapy today, the Vivelle® dot. I have been on Prometrium 100mg oral capsules 2x a day for a total of 200 daily. I started out trying to figure out why I have had a headache, confusion, insomnia, hot flashes, etc, for the past 3-4 months. After the endocrinologist put me on the prometrium after running labs that showed my progesterone at .4 & .8, she and I thought it might be perimenopause. My estradiol was also so low, never getting above 25 from 6 different labs. I went to the obgyn for biodidentical estrogen. She adamantly told me that my symptoms were depression and related to pcos, which I vehemently denied and asked her, begged her to let me try the estrogen. What I want to know, is am I taking enough of the estrogen? She told me that it was the highest available and was irrelevant for a woman my age, 32. Should I really look for someone to help me get compounded treatment? Thanks in advance for any help!

  56. 132 Glenys August 10, 2011 at 6:08 pm

    Too Much Progesterone
    After 3 years on progesterone with 4-5days/mth break the progesterone now causes insomnia and a pounding heart and I now feel better without it although as I am taking estriol/estradiol (7.5mg/.075mgl) every other day, I am not sure how long I should break, with the progesterone.
    My saliva tests have previously indicated high levels of progesterone, so I suspect this is the cause? If so how do I bring my progesterone level down. (supplements?) and How long will it take to reduce my accumulated progesterone.
    thank you

  57. 133 Nena August 16, 2011 at 12:34 pm

    I was using 1 ml biest cream and 25mg/ml progesterone cream for 25 days of month with 5 days off. But I started getting breast tenderness and actually felt better during the 5 days off. So I cut both dosages in half and I no longer have an issues with breast tenderness. However I am having some problems with sleep. Would it be appropriate to increase the progesterone again back to where it was? Will that help with sleep? Please advise.

    I also noted that I was losing more hair in the shower and am not sure why. I am low in DHEA and my doctor prescribed 10mg. I am taking only 5 mg to start every other day. Does DHEA, biest or progesterone creams contribute to hair loss?

    Thank you.

  58. 134 Virginia August 16, 2011 at 2:32 pm

    Is there a compounded hormone for birth control?

  59. 136 Brigid August 17, 2011 at 9:14 am

    Please help as my dr. is on vacation. I’m on 75mg progesterone cream twice a day for heavy bleeding. I’m 51 years and was bleeding for two months, iron level at 2. Progesterone cream stopped bleeding within 2 days. Had bleeding 3 weeks later which was 6 days and though heavy had no clots. 16 days later had another heavy bleed which has been ongoing for 3 weeks. Is the progesterone dose too high? Please give me some advice as I am truly worn out physically and emotionally.

  60. 137 Jo August 17, 2011 at 2:25 pm

    Hi Peter,
    Thanks for this Blog.. It is very helpful. I am almost 50. Went to a naturopath and I did the testing through her. She has put me on Bi-Est 1.25 /GM cream that I apply in the am and pm. Then I am on Progesterone 3% cream (30mg) in the evening only. She has recommended that I take everyday but I am wondering, after reading the comments, if I should only use the Progesterone on days 14-28 and Estrogen on days 1-25. Can you tell me what the best dosing is? I have pretty much eliminated my hot flashes, insomnia, headaches, and lost a little bit of weight but I am experiencing breast tenderness and not sure what to do about it. Can you shed some light on this?

  61. 138 Diane August 28, 2011 at 8:26 am

    Diane again, I am taking Bi-Est(50:50) 1-20mg/ml I felt so bad on that dose so I dropped down to half that dose. My hair is falling out but I feel better. Why would my hair be falling out? The dose I am taking is that low? Please help
    God Bless,

  62. 139 Tanya September 8, 2011 at 7:18 pm

    Hello, Very interesting and informative site. I read books of Dr Wright and Dr. Hertoghe. My wish was to go on BRT to get some protection for the heart and delay cognitive decline. I am 62 years old, 10 years postmenopausal, have some hot flashes, insomnia, etc. Reading your comments and posts from multiple people who are on BHRT, it looks like weight gain is inevitable with BHRT. Just wanted your opinion about the weight gain in the first place!. Another question abouot phytoestrogens (overthecounter) meds (black cohosh) that have some low doses. Should they alo be balanced by progesterone.

    Thank you very much


    • 140 thecompounder September 14, 2011 at 10:42 am

      I certainly don’t think weight gain is inevtable. If you were to start the therapy and weight gain was happening (expecially rapid weight gain) I would talk to your prescriber and see whether your hormones are really balanced appropriately. I’m not a big fan of phytoestrogens because they are not bioidentical (i.e. identical to human hormones) and therfore have unknown effects on the cells and unknown metabolism in the body. Plus, I find that they just aren’t that effective except for mild symptoms. Black cohosh has some research behind it for treating mild to moderate hot flashes, but is not really effective in treating other menopausal symptoms. I’ve found that black cohosh only works in about half of the people who try it for mild to moderate hot flashes.

      Good luck.


  63. 141 Sallie September 19, 2011 at 4:23 am

    My doctor just started me on HRT and I’m not very happy as I’m not seen any reall improvement. So, far I’ve done one week at 2mg/ml of Test; 40mg/ml Progest; 20mg/ml 7-KETOS-DHEA; 1.5mg/ml of Biest. Nothing changed and my hot flashes and night sweats are horrible! So, the doctor increased the dosage by 1/2 and still no results. I’m about to go insane from the lack of sleep and night sweats. How long using the HRT should I be noticing an improvement? I was talking BC pills, Yaz, before all this and didn’t have any trouble with hot flashes and night sweats. Should I see about increasing the dosage again or wait and see if the meds works? And how long should I wait.

    • 142 thecompounder September 27, 2011 at 11:35 am

      Hi Sallie,

      It’s always difficult to say, but I would make sure whomever is prescribing your hormones is also looking at your thyroid levels and your adrenal function by looking at your cortisol levels.


  64. 143 Traci HIll September 27, 2011 at 8:37 am

    Howdie all,

    I am writing for my 17 year old niece, Kelsey. She has horrible headaches with her period. Aside from that she seems pretty healthy with the acception of being wayyyyy too skinny. What can she take/do during her period? Any hormone creams, herbs…ect

    Thank you for listening,


  65. 144 thecompounder September 27, 2011 at 11:37 am

    The longer you leave it on the better. The general rule of thumb is to waiit at least 2 hours.


  66. 145 Johane November 14, 2011 at 2:04 pm

    I love this site…so much information! My question is, if my libido is remaining pretty close to non-existent, is it possible that my HRT is still too low? My saliva test initially showed that my free cortisol was elevated at 28, and my cortisol load at 46. My DHEA was depressed at 2, and Progesterone at 21.My blood test showed Estradio at <70, and my Testosterone at 2.3. I was initially started on 100 mg of Progesterone (Prometrium) (before bedtime) and 1.25mg/0.25ml of Bi-est (once a day). That didn't seem to make a difference, so after a month my Progesterone was increased to 200 mg (still before bedtime) and Bi-est 2mg/0.25ml twice a day. This is my second week at these new levels. My weight is creeping up, I still have heart palpitations, but my anxiety seems to have decreased somewhat. My sleeping is definitely much better. So, is lack of libido and continued heart palpitations a good indication that there are still adjustments that need to be made? Maybe the estrogen isn't yet high enough, or maybe I should try that 50/50? Thanks for your guidance.

  67. 147 Kristen November 17, 2011 at 7:47 pm

    I’m 41 years old and had a hysterectomy in 2010, but my ovaries were not removed. Prior to my surgery, I was taking birth control pills for about 6 years to help with my PMS symptoms, mentrual cycle, and acne. I stopped the birth control pills after surgery. I felt great after my surgery for about 4 to 5 months, then went into a depression, had insomnia, acne, brain fog, anxiety. I have finally convinced my OBGYN to use bioidentical estrogen and progesterone for the PMS symptoms even though she is not comfortable with the off labeled use. She says the blood work says I’m still ovulating and my estrogen and progesterone are within normal range, but I’m not having periods, so we don’t know when I’m ovulating. We are experimenting with Vivelle Dot 0.05mg and compounded Progesterone 5mg cream for 3 months. My question is.. ..What is the lowest dose of estrogen and progesterone I can use to prevent ovulation and PMS symptoms?? I’m a pharmacist and I can’t final any data on a conversion/equivalent chart from birth control or synthetic hormones to bioidentical for that purpose. I haven’t done the extensive hormone blood work or saliva testing due to $$$$. Do you have any input on the matter? My hunch is that the Vivelle 0.05 mg dose may be too high. Thanks.

    • 148 thecompounder November 29, 2011 at 11:01 am

      There is not data with conversions from the hormones in birth control pills and bioidentical hormones and well there shouldn’t. The synthic hormones in birth control pills have completely different pharmacokinetic and pharmacodynamic profiles than the bioidentical hormones, plus we are really trying to get away from a one size fits all approach to treating women with hormones.

      Symptom resolution is an important piece of the therapeutic evaluation of any hormone replacement regimen. Lab testing is the other important piece. I recommend going forward with your regimen until you feel that you are experiencing adequate symptom relief, then follow up with tests to make sure you are not giving yourself excessive doses. If you are on Vivelle, a blood test for estradiol will be adequate. The blood test may underreport actual intracellular (of free unbound) levels of the progesterone with topical administration, in which case a saliva test of that specific hormone may be a good idea.

  68. 149 Jill December 2, 2011 at 12:58 pm

    Do you fine that commercially produced products of estradiol such as the patches are given at a higher dose then what would be normally given for menopause symptoms from a compounding pharmacy?

  69. 151 Josie December 21, 2011 at 7:16 pm


    Id like to know if the combo of bi-est / progesterone cream (.5 ml) is known for weight gain

    I have always had to watch my weight as I gain easily, I am also taking DHEA 7-keto 20mg x 1 per day (this rather than DHEA as I am trying to avoid more facial hair growth)

    Id appreciate your thoughts on meno bio identicals and weight gain

    Thank You Kindly

    • 152 thecompounder December 22, 2011 at 7:52 pm

      If a patient gets rapid weight gain when starting a bioidentical hormone regimen, that is often due to fluid retention for excessive estrogen effects (aka “estrogen dominance”). Other than that, I rarely, if ever get patients reporting that the hormones caused long-term weight gain.

      I’d appreciate any comments from readers as to your experience with your hormone regimen and your weight.

      Thanks, Peter

      • 153 Stella July 6, 2012 at 8:55 pm

        Hi there,
        I just “ran into” your blog and I am so thrilled that I did! I started reading, as you may be able to tell, from comments made in 2009.

        I am 55 years old, had a partial hysterectomy 13 years ago due to fibroids. Started having hot flashes, night sweats, insomnia at age 49. I just couldn’t take it any longer. Thankfully a friend referred me to a holistic M.D. and I just started taking BHRT a little over a month ago. I was initially given Biest 4mg/gm with Progesterone 60mgs/gm .5mgs topically daily. I did notice about a 5# weight gain within that month. In addition it seemed that I had a hot flash immediately after putting the cream on at night-go figure! I can say my symptoms improved but I still am not best yet.

        I had a follow-up appt today and asked to have some Testosterone added to help with my libido. My new prescription is Biest 8mg/gm, Progesterone 180mg/gm and Testosterone 3mg/gm and I’m starting with .5mgs. I was told to increase my dose to .75mgs after one month if I felt I needed more help with my symptoms. I will then get saliva resting 1 month after.

        I have a few questions please:
        Is it better to use the cream during the day or at night? I have night sweats and insomnia but using Melatonin which helps.
        Do you think the Testosterone will help me lose the weight I’ve gained?
        Do you think the combo is a good one?

    • 154 Josie March 30, 2012 at 10:11 pm

      Thank you for your reply I appreciate it very much. Can you help me out with another question please ?

      I would like to ask if can tell me the amounts of each product in my BI-EST cream, the label reads bi-est / progesterone 8/120 MG/G.

      I am in Australia so I have no clue if RX Compounds are written up the same where you are, but would really like to ask so I can investigate the cream further.

      I am sure I am having to much progesterone, as I also take 100 mg capsules along with the cream. I am just not feeling right these past months and have been reading a lot about progerterone excess and I am showing more symptoms than I like.

      Again I Thank You I know you must be a very busy person and I appreciate you time and Knowledge more than you’ll every know

      Thank You Kindly

      Regards Josie

  70. 155 Charlotte December 27, 2011 at 8:03 pm

    Hi. I am a 60 year old post menopausal woman. A month ago I started taking biest 0.6 prog 100mg/ml crm – .5 ml per day. I became irritable, bloated and rapidly gained 5 pounds. I stopped using it two weeks ago. I am still bloated and uncomfortable. How long will this bloating last?

  71. 156 Estelle January 9, 2012 at 6:52 am

    Just read your site with interest. I would love some advice. Briefly started perimenopause in Feb 2009. Symptoms started in October, anxiety, depression, dizziness and anger. Oestrogen level was 60. Saw a doctor was prescribed oestrogel and testogel. Made my way up to 4 squirts a day and one quarter of testogel. Could not tolerate prog at all, tried utrogestan made me crazy. By this time oestrogen levels peaked 800. Had a total hysterectomy in May 2011, stopped oestrogel cos wasn’t working, tried premarin, that didn’t work. So 1 weeks ago started on elleste solo 1mg in morning and 1mg at night, awful side effects since starting, headache, more anxiety, fuzzy feeling in head, depression and anger. had a few good afternoons then 4 days ago increased to 2mg in morning and 1mg at night and felt worse again. When you increase something does it have a negative impact again before it gets in your system. Still on testogel. My oestrogen is 315 now. love your comments
    Thanks so much Peter

  72. 157 linda January 11, 2012 at 8:44 pm

    Asking: I had my transdermal bi-est cream prescription switched from one compounding pharmacy to another, and am having a horrible time adjusting to what is supposed to be the very same prescription. My ears are ringing, and I have too much nervous energy and can’t sleep whereas with the old prescription, I always felt serene and positive and it actually made me feel calm. I’m still taking the same progesterone pill. Why is there such a difference between compounding pharmacies for the exact prescription with the same base?

    • 158 thecompounder January 21, 2012 at 11:19 am

      Hi Linda,
      That is an excellent question. With compounded medications, unlike with mass manufacturered ones, there can be big quality difference between the product provided by one pharmacy versus another. If you haven’t seen it already, I recommend you take a look at my blog post How To Evaluate A Compounding Pharmacy. This post has some useful questions to ask any compounding pharmacy before getting your prescriptions there. I hope that helps.


  73. 159 Krystal January 27, 2012 at 10:42 am


    I’m 47 yrs old and have had a surgical hysterectomy approx 7 yrs ago and it has been a battle trying to get balanced, and honestly I’m at my end. Too make a long story short I went from patches to compounded creams to oral estradiol. The last 3 yrs or so I was on Estradiol 1mg sublingual in am and t Estradiol 1 mg sublingual pm. No progesterone or testosterone. I tried the oral progesterone 100mg through a conventional pharmacy and had GI bloating and wasn’t comfortable taking it. Also was put on Testosterone at one point 2.5 mg and gave me a very edgy feeling and developed facial hair. So for a few years I just continued on the estradiol (generic)1mg SL am and pm. This seemed to control my hot flashes. Now this dose has controlled my hot flashes but I kept on getting vaginal yeast infections, insomnia, mood swings, fatigue with exercise, and anxiety. Sometimes chilling at night and dizziness. So I cut down my evening dose to .5 mg SL for quite some time and no hot flashes but still problems going to sleep, dry skin, loss of elasticity of skin. Finally a physician gave me some progesterone cream 40mg/gm and was told to try 1 pump 20 mg at night. I think it helped me some but now have problems with my GI with bloating and reflux symptoms. I do have IBS and IC so notice these two areas seem to flare up with progesterone.

    Ok..well decided to change physician because wasn’t feeling right and was worried I was getting too much estradiol and wanted to go back to a topical system and give it a try again. In the past it didn’t seem to hold me and I would get hot flashes. My new physician started me off on Biest 5 mg cream 80/20 ratio and he told me to start out on 1 pump a day in am. Also to continue on my progesterone cream since I had it and use 2 pumps (40mg). Well the first thing I noticed with this change is I developed this strange feeling in my head towards afternoon a buzzing feeling along with a dull headache. My neck felt tense and if I turned my head real fast felt dizzy. In the past when I felt like estrogen was low my neck would tense up, just muscle tension. It wasn’t long and we up the dose to 1 pump in morning and 1 pump at night. This seemed to work ok for a while and before long I was having chills. In the evenings I would get so cold. My hands and feet cold, and goosebumps from head to toe. I would go to bed and feel chilled and as soon as I would awake it would turn into full on sweats. Something I really never had. Now my nernousness and anxiety seemed better on this topical creams. I did get real tired at night and the chills followed by sweats. We increased the dose to 2 pumps in am and 1 pump at night. The more I would take the worse the symptoms. It finally came to a point that I just couldn’t deal with these symptoms and went back to my estradiol SL dose of 1mg in am and .5 mg in pm along with the progest 20mg cream. Again on this dose no chills or night sweats but have brain fog, short term memory problems, gi bloating, fatigue, SOB with exercise, and problems sleeping.

    So I’m wanted to try the biest and progesterone again, but problem is I just can’t figure out how to start and my symptoms are always confusing if too much or too little estrogen. I almost feel like maybe even though I was having those chills followed with hot flashes that maybe it was too much estrogen because didn’t matter how much more I added I still had these awful chills followed by dripping sweats. So any suggestions on a good way to start back and also figure out dominance vs deficiency? Also the chills and hot flashes seemed to peak after I was on the creams 6-8 wks.

    Thanks for any suggestions.

  74. 160 Barbara February 2, 2012 at 5:23 am

    Hi, I’m sitting typing and experiencing heart palpitations which have come about since taking Biest1 / Dhea 25/ 75Pregnenol 250mg Progesterone as a troche – for the past 3months. I’m 55 and have had a hysterectomy(massive fibroid) 2 years ago and retained ovaries. Hot flushes and vaginal atrophy went but my heart is certainly not right now. Blood all normal except for elevated cortisol. FSH 102. Hormones all very very low. Im a lean build and prone to anxiety.
    My doctor has given me adrenal support herbs but so far heart still palpitating. I walk everyday for 30 mins and eat a gluten free low carb diet. Getting hormones right is so difficult and now I’m wondering weather to stop the hormones just to see if the palpitations go away but of
    course those sweats and vaginal problems will start for sure. Very interested in your opinion. Seems like I have swapped one sack full of problems for another. Thanks


  75. 161 joan February 6, 2012 at 10:31 am

    I have been on bio’s for 2 yrs now. All three hormones. I had severe symptoms, even throwing up with hot flashes, having pull off the road, feeling like I would, and HAVE passed our for a few seconds.

    BUT, the reason I wanted on the bio’s was for the severe migraines almost daily. I wanted to end my life they were so horribly painful.

    Imitrex works but Dr. will only give you 9 a month.

    The bio’s after 4 months simmered them now. I get 2 migraines a month, but still have headaches, neck tension daily. But tolerable with a quarter of an Imitrex. I have a life again, just keep Imitrex with me always.

    I really wanted them to go away, period. The hormones are costly. I never know when it will come on and how bad it will be, so I don’t make overnight plans ever.

    Why am I still having them? The Dr. have tried all different combo of doses, and on the highest of Estrogen, if I lower it, the pain increases. Am I doing something wrong?

    • 162 Noelle May 20, 2012 at 10:29 am

      I have exactly your symptoms. I felt very bad with daily migraines during my pre-menopause years, and I was taking zomig daily.BRT helped, only 1 migraine per week usually relieved with now 1/4 pill. After lab tests, no matter what I do, my estrogens can’t go up. Dr said it comes from my adrenals. I added Pregnenolone 12.5 to 25 mg/day. I feel better, but still not perfect. Less migraines, but still here and then.

  76. 163 Leigh February 7, 2012 at 9:18 am

    I am really confused – my gyn has one opionion of bio identical progestrone and biest and my HRT doctor has another. I am currently on ‘natural’ progestrone w/dosage of 1/4 tsp twice a day. On the container it says 1000mg/4oz. Biest is e2 .50mg e3 .75mg per day. Does this sound right?

  77. 164 Supira February 10, 2012 at 12:08 pm

    I have been on Biest for 10 years with good results. At what point should I stop taking it?

  78. 165 Jennifer March 21, 2012 at 4:41 pm

    I am a 61 year old menopausal woman. I have hot flashes etc.. My MD said she would give me some Bio-Identical Hormones and wrote a prescription for Bi-Est 1.25 mg/ml apply 0.1-0.5 ml daily start at 0.1 and increase as tolerated, Progesterone 50 mg/ml apply 0.5ml daily at bedtime and testosterone 10 mg/ml apply 0.1 ml daily. Does this sound O.K. for someone like me? I know you are not my doctor but I need some guidance. My MD seemed a little unsure. Thanks for your assistance

  79. 166 Sansra March 30, 2012 at 8:44 am


    I have just started a mist and the doctor also put me on a estradial, progesterone, testaterone cream. I am supposed to put “4” clicks on me everyday and it says it is 1 gram. Cannot seen to find out how many mgs I am supposed to be taking as 1 gram is 1,000 milligrams and oh that sounds high! Anyone know?


  80. 168 Dawn May 4, 2012 at 11:28 am

    Hi Peter,
    I am not sure if the last message was sent or not. So, I will send another one. Initially in life, I only had menstrual migraines but as I got older, things changed. I am now 43 year old and I have been taking progesterone cream now for 3 years, since 2009. I started have daily headaches in 2007 (MRI, everything was negative). An experienced gynecologist who had experience with bioidentical harmones checked my blood progesterone level in 2009 and found low progesterone. It was less than 0.02. I was then started on progesterone cream and my daily headaches completely got relieved! So, it was felt headaches were related to low progesterone. However in 2011, my periods became irregular with bleeding every 2-3 wks, and I realized that I was taking 600mg of progesterone cream during my periods to prevent headaches. Periods were all over the place. In Jan -March 2012, I was taking 600mg of progesterone cream daily and in April, my doctor added biest to my daily progesterone to prevent breakthrough bleeding due to high progesterone thinning the uterus lining. Now, I take 600mg of progesterone daily along with 2 mg of Biest. I am not sure if this is okey or not when I read that I am supposedly on a very high progesterone cream dose. I am still having menstrual periods every 3 wks and somehow I can’t seem to change that. I still get headaches, which I can’t figure out if they are from estrogen dominance (since supposedly my body is producing estrogen because I still have menstrual periods). However, if I try to decrease estrogen, I start having breakthrough bleeding due to high progesterone dose that I am taking daily. What do you recommend I do?
    I appreciate your help and advise.

  81. 169 Mari May 5, 2012 at 2:33 pm

    I am starting Biest5 PROG25 Today May 5, 2012 and also starting Synthroid 75 mcg and i am not sure if I should start them together. Because if I have any side affects which one would be. and if you think its ok to take them at the same time? I have never taken either one. I was on the cream but was never faith full. Please help

    • 170 thecompounder May 10, 2012 at 6:25 pm

      Thyroid should always be taken with an empty stomach. I usually recommend taking it at least 1 hour before any medications. Since your bi-est is in a cream form, it won’t really interact with the thyroid, so you can take them at the same time if that is most convenient.


  82. 171 Tracy May 9, 2012 at 4:22 pm

    I am 49 yrs old and taking both progesterone from a compound pharmacy and bi-est. I was taking 100mg of progesterone for about a year and had no side effects. after a while I started having more night sweats and trouble sleeping and my doctor increased it to 150mg and at the same time started me on bi-est. I am taking .1 ML currently in the morning. Over the past 6 months I have gained 5 pounds and retain a lot of water. No matter what I do the weight wont come off and keeps creeping up. I eat very clean and workout and the only changes was the bi-est. I had horrible insomnia for almost 3 weeks when my doc put me on the bi-est and that helped quickly. The dose is so small she says.. Could that small amount have caused the weight gain and water retention. She is suggestion cutting my bi-est in half. Could the increase in progesterone also be a contributor? Any suggestions. thank you

  83. 172 Deborah May 11, 2012 at 7:05 am

    In October of 2010 I started on bio’s I gained 30 lbs slowly, Dr tries to tell me its my eating habits, they are no different than before, I excersize regularly, no changes in the blood work, he increases to biest 80/20 prog test 7.5, i did the increased dose since 1/16/12, I felt fine except for the weight gain, I have worked very hard to lose the weight and I can’t, so I took my last dose the end of April, now my body is screaming at me, with the insomnia,and fever. so I see the other posts saying they are feeling these symptoms when they start the program, is this normal to feel this after getting off of the bios?

  84. 173 mpolom May 16, 2012 at 3:35 pm

    I am 53 years old and in menopause. I have not slept a decent night sleep for 3 years, since it started. 1 1/2 weeks ago I started Estriol 1mg. cream 3 times a week, Bi-est twice a day and armour thyroid. My insomnia is worse, my skin is crawling and I’m snapping at everyone. What is causing this?

  85. 174 Tammy May 17, 2012 at 3:30 am

    What is the difference between progesterone & progestin? I know you recommend it. I was applying a cream that had both Biest & progestin. Started seeing a OB/GYN in January for pellet insertions (some type of estrogen & testosterone) which helps for about 2 months but starts declining after that. She says without a uterus, I don’t need progestin. Pellets make me feel great for a while, but feel at the cost should last longer. Will go back within a week for another round (hopefully she’ll increase the dose/amount of pellets) which will make them last longer this time.

  86. 175 Kirsty May 17, 2012 at 6:06 am

    Do you have any experience using bHRT to suppress ovulation? I have PMDD and have been prescribed oestrogel to suppress ovulation. I have “3 pumps” daily, I think each pump is equivalent to 50ugs. Does oestrogel always suppress ovulation or is it possible to to still ovulate? My GYN says it isn’t possible to still ovulate on this dose but I am still getting cyclical sypmtoms.

  87. 176 Karin May 23, 2012 at 2:29 pm

    I am 64 and have been taking bio identicals for about 6 years. Once a day I take a troche containing the following ingredients: P300/TRIE3/TEST0.5
    I have read that the progesterone should be in the range of 100 -200. Do you think my levels are too high? I would like to give up my hormones due to my age but from day one, after feeling terrible for six years, I have felt so much better and have suffered no side effects.

  88. 177 Anna May 28, 2012 at 1:37 pm

    Hi – really confused as the doctor who prescribed me the estrogen cream and progesterone pills guaranteed me I won’t gain weight but I feel it after a few weeks. I’m 29 and estrogen levels are at 33. I’m an athlete and cannot afford to gain. Thinking about stopping – I see a lot of people gain weight from this. Any advice hugely appreciated, thank you.

  89. 178 Lynn Guzzetti June 4, 2012 at 7:46 am

    i have been on the 80/20 for about 6-8 weeks now. My doctor has me on 5 mg aday of estrogen and 200 of progestrone, I have ot tell you i feel worse. Hot flashes are still there I wake up soaked at night. i feel very swollen and bloated, obviously this isnt working for me

  90. 179 Carol June 7, 2012 at 1:10 pm

    I just received my results back on my hormones (blood test) I can’t afford to pay for the sylvia testing. My TSH 2.19mIU/L Estrogen, Total serum 137pg/ml, Testosterone, Free and Total, LC/MS/MS testosterone, Total, LC/MS/MS 29ng/dl, Testosterone, Free 1.1pg/ml, Cortisol Total 6.0mcg/dl, FSH 168.9mIU/mL LH 52.8mIU/mL, Progesterone <0.5ng/m and Estradiol <15pg/mL, Can you tell me what is high and what is low? I feel like my head is always in the clouds, cant think, cant sleep, exhausted all the time, dont go anywhere because I cant seem to be able to have a conversation without having bad memory lapses. Had a job interview and I couldn't even remember words, felt so stupid and embarrassed, needless to say I didn't get to position. depressed, weight gain, foggy thinking. Please help

  91. 181 Cynthia Chapman June 8, 2012 at 12:13 am

    I need your advice, please. I am taking biest 33:67 (5mg/ml) and progesterone sr 25mg, po. I was taking 250 my every day but my prog. Levels went sky high. I still did not feel well with the biggest difficulty being insomnia, hot flashes and fatigue.
    I am away from home x 30 days and began a Standard Process cleanse. Once again, I am back to No Sleep. My nutrionist Md thinks I am just detoxing. What do you think of these med doses together and what about the effect of these herbs? Please reply to my email in that I only have my iPhone with me. Thanks! Cynthia Chapman
    Ps. I am an RN

  92. 184 Karin June 9, 2012 at 2:01 am

    I would just like to thank you for all your time and effort in answering all of our questions. You are a wonderful resource!

  93. 185 Neeters June 21, 2012 at 10:15 am

    Hi. after suffering from adrenal dysfunction for a year, and severe hormone imbalance 2 years post menopause I am trying BHRT and wilson supplements for adrenals. I am glad to say the biest 2 mgs with 30 mgs progesterone twice a day plus half a dessicated thyroid pill (1/4 grain dose) has given me my life back! week 3 now and feeling better I more active overall. it seems that either the thyroid dose is wearing off after approx 6 hours or maybe its the hormones…I start feeling fatigued, yawning a lot and get that “starved for air” feeling that I need to breathe deeply around that same time each day. I know I’m not overdoing it I am off work actually and rest a lot …I dont see the doc for another 3 weeks. should I be calling him and asking to add more thyroid medicine or increasing the dose or is it too soon? or is it the biest dose that needs tweaking? my body temp in the am in now 97.8- to 98, and doesn’t seem to get much higher than that but at the 6 or 7 hour mark it does go down to 97.8 or 97.9. but at least it no longer drops with activity like it used to before I started BHRT. I barely get any flashes and I am sleeping well 8 hours since starting this regime. my thyroid bloodwork was low normal but he agreed to give me some as I needed the T3… should I wait the 3 weeks till I see him or should I try to get a hold of him now?

  94. 186 carmen June 27, 2012 at 3:56 am

    I had a hysterectomy 6 yrs ago and my doctor just put me on BI-EST 2 mg. cream and Progesterone 75mg capsules. First time last night and it was the worst night I ever had. I had trouble sleeping before but this it seems made it worse does it work that fast.

  95. 187 Dee Hanks July 3, 2012 at 8:39 am

    I had a hysterectomy 3 years ago and the doctor put on estradiol but I quit taking it cause I heard it was bad and it could cause cancer. My question is is the reason women take hormones is to prevent hot flashes. I do get them it’s not that big of a problem for me. My bones hurt and I don’t have the energy I had and I gained weight. But I just turn 50 maybe that could be the problem. I want to know if I should be on a hormone or not.

  96. 188 trisha jewell July 11, 2012 at 7:56 am

    do you just apply the cream 30 gm bi-est/ prog 25 cream in the thigh area and do you need to apply it the some time every day

  97. 190 Juliet Jimenez July 14, 2012 at 1:01 pm


    My doctor tried me on pregnenolone for extreme menopausal symptoms, but it didn’t help at all, plus my hair loss was exacerbated. He now feels that my remaining estrogen is too low, and started me on bi-est/progesterone 1/50mg SR one a day. The compounding pharmacist suggested I take it at night, since the progesterone might have a sedating effect. When I take it at bedtime (10-11 pm), I feel drugged all the next morning until after lunch. I tried taking it at 7 pm, and it made me feel woozy by 9:00. It’s too soon to tell if it’s going to help the hot flashes/rolling anxiety/nausea of my menopausal symptoms, but feeling drugged with an accompanying non-stop headache isn’t helping. Is it likely that these side-effects will go away at some point? I have also been on Armour thyroid for Hashimoto’s for a couple of years now, and take that separately. I also wonder about the effectiveness of the medications in pill form as opposed to topical.

    Thank you for your help,


  98. 191 Yolanda July 17, 2012 at 10:38 am

    I read your explanation of the 3 types of estrogens. That was really good! 🙂 I have been on bhrt for 5 months now, I am 26 and have premature ovarian failure. Initially I was taking vivelle dot patch for estradiol .075mg and c-progesterone 100mg but I recently noticed alot of pain in my legs, on my veins behind my knee and on the sides of my thighs. They did an ultrasound to make sure no DVT. But my dr said it was due to the synthetic estrogen in vivelle dot. (all along I thought it was bio identical!) she recommended I use biest cream. I just need to know the difference between the two. Is biest all natural??

    • 192 thecompounder July 18, 2012 at 10:15 pm

      Bi-est contains both estradiol and estriol whereas the Vivelle dot contains just the estradiol. I would consider both to be Bioidentical since they contain hormones identical to those made by the body.


  99. 193 Lipika Vig July 18, 2012 at 5:13 am

    I never knew how much information you could find online about this!
    Thanks for making it simple to grasp

    • 194 DB1985 August 3, 2012 at 8:00 pm

      Im 26 yrs old. I havent had a period in two years. Im starting bioidentical hormones in hopes of gaining balance and a period. I want my life back!!! Ive had weight gain, fatigue, extremely dry skin – which im guessing are all attributable to low hormones. I was on the pill for a 4 yrs in college….. should I just go back on the pill?! I went off of it to give my body a brea and have waiting two years to try to get a normal (drug free) period. Im getting desperate.

      My Saliva Tests (as May 2012 taking NO prescriptions or drugs of any kind) indicated low estrogen and low progesterone. Testosterone and DHEA are on the higher end but still in the normal range. Adrenals and cortisol levels in normal range (good news!).

      Ive seen two different doctors regarding bio-identicals and have had two different opinions on treatment:

      Doctor 1:
      Days 1 -14: 1.5 Biest orally/ 40mg progesterone – compounded oral pill – 1 daily.
      Days 15-25: 1.5 Biest orally/ 40mg progesterone- compunded oral pill AND 1/8 teaspoon progesterone cream (over the counter).
      Days 25 – 30 break for a period

      Doctor 2:
      Days 1 – 14 : .1ml Biest cream 1x per day and 25mg progest orally evening
      Days 15 – 25: .1ml Biest cream and 50 mg progrest orally evening
      Days 25-30: break for a period

      Which of the two protocols above sound the most “in line” with best practice? Does the .1 Biest (80/20) cream sound too low to start with?

      Does the 1.5biest (80/20) orally (Doctor 1) seem too high as a starting dose for a 26 yr old? If I were to switch the 1.5 bi-est orally to a cream form – what is the equivalent dosage?

      Would it be easier/ more effective for me to take the birth control pill?

      Please, share your insight!!!! My whole life has been on hold while im trying to figure this out.

      Thank you!

      • 195 Vanessa September 5, 2012 at 4:19 am

        Hi! I’m 26 yrs old also, and I have not had a natural period since I was 19. I started menstruating at 11, and then just one fine day I never again got a period again. I waited 6 months before I saw a dr, and at the time, being so young they put me on birthcontrol to make my body have a period. Then at age 23 I was married and decided I was going to come off the pill. All was good, except I noticed hotflashes here and there, during the day mainly. They were not extremely uncomfortable, but by age 25 I felt I would pass out with every hotflash! I also couldn’t sleep at night. I tried everything! And even heavy duty drugs like lunesta for sleep did not work. I began to get desperate, i went back on the pill, and my traditional dr suggested another pill with more estrogen. After one full month of the new pill, I went to the ER with a bump on my leg, possible blood clot from the horse estrogen found in birthcontrol pills. I was also having panic attacks and breakdowns due to no sleep for 2 months. I searched desperately for help and found something better than birthcontrol pills, more natural, identical hormones to what our bodies make. I was diagnosed with premature ovarian failure. Some call it early menopause. Sometimes, though it’s rare it can happen during your teen years or early 20’s look into it. If your body is not making much of its own hormones, your ovaries may be premenopausal. Mine measure the size of a post menopausal woman now, which explains he horrible side effects I’ve had his past year. It’s been a nightmare getting everything leveled with bioidenticals, but I did notice a good change from the very beginning. In the first month I got a period and was able to sleep 5 hours straight to start. Hope this helps!

  100. 196 Paige August 5, 2012 at 3:21 pm

    I am 51 post meno….I take 1.2mg estriol/ 3mg estradiol/200mg progesterone for a few month, felt much better, but am now putting on weight so am concerned. I have tried a few different doses, see gyn end of the month, she said just use cream 5 days a week for now and skip 2 days..

  101. 197 Paige August 5, 2012 at 3:50 pm

    I have skipped two days and I am feeling agitated and having headaches, possibly i should just use less cream until my next appointment.

  102. 198 anina August 17, 2012 at 7:25 pm

    I am 29, have suffered from many hormonal symptoms for years now, but have found nothing that really works. I’m living abroad now, where I can’t see any doctors who speak English, so I’m trying to go about this through careful research/experimentation with what’s available online. I’ve tried progesterone creams (o.t.c.) alone during the latter half of the cycle, but they don’t seem to help.
    My main issues are hair loss and lack of periods.
    I tried bi-est cream (also o.t.c.) with progesterone for a few days, and i felt amazing – however, i wasn’t sure about the dosing in order to STAY/BECOME FERTILE, as I don’t want the combo to work as birth control. Any ideas when it might be best to apply each cream to maintain feritility?
    2nd Question: If I were to apply progesterone cream in the evening one day, say, to my neck, and the same day, apply bi-estrogen cream in the morning, would I apply the bi-est cream also to the neck, or to a different part? And how would I rotate areas? Is it ok to apply the 2 creams to the same area on the same day, but at different times, or should I try to always rotate where I put each?
    Thank you! This is all so confusing!

  103. 199 Lisa Marsh August 24, 2012 at 3:42 am

    I have been using compounded Bi-est troches and progesterone cream for two months, most recently switched to Bi-est cream because extreme hot flashes are still occuring. Currently taking .5 ml (.375) of Bi-est and .3 ml of progesterone but after one week of changing to cream, I am still experiencing all-day hot flashes. The holistic N.P. has requested I take the saliva test three weeks after starting this new cream delivery method. A previous blood test result was 8 ppg of estridol but only 13 FSH. I am inclined to increase the amount of the Bi-est cream because I am still experiencing hot flashes. The holistic N.P. indicates I can’t make any adjustment because it may be too much – but my body is telling me otherwise.
    My question: If these hormones are only in your system for 8 – 10 hrs (and does not build up) why would I need to wait three weeks of this new adjustment before performing the saliva test? What is the purpose of taking the saliva test if I am still having such extreme hot flashes and haven’t reached any balance on these hormones?

    Lisa M
    Greenwood, Indiana

  104. 200 Beth Salant August 28, 2012 at 3:39 pm

    I am taking 20mg estriol and 25mg progesterone in a troche for perimenopause. My gyno said it was a low dose.

    Is this-from reading on here it seems high!

  105. 201 Dorothy lerma August 29, 2012 at 10:13 am

    Can I take bi-est and icool together? Icool works better that bi-est for me. I woul like to take them both if possible

  106. 202 Tammy August 29, 2012 at 5:06 pm

    Thank you so much for this very informative description! It is very scary when you have start this process.

  107. 203 Linda September 4, 2012 at 3:58 pm

    I have been on bioidentical Progesterone cream 15% for about 5 years and am currently 3 years post-menopausal. Since I am still having some hot flashes at night, my doctor added bi-est to my Progesterone cream. I am at the lowest dose of bi-est and have not seen any significant difference in my hot flashes, however, I have noticed weight gain and mood swings. I want to quit taking it, but now I am afraid of a re-bound effect. Can I safely just stop taking it without an increase in symptoms. I have only been on the bi-est for 2 weeks.

  108. 204 TANYA September 7, 2012 at 10:37 am

    What time of day should a biest/progesterone topical be taken?

  109. 205 elly September 13, 2012 at 12:37 pm

    Many of these issues are being addressed by Dr. Sara Gottfried of California and Dr. Anna Cabeca of Georgia. Both have websites and facebook sites. Look them up, you will get many many questions answered.
    I am 55, follow their advice, take it to my own doc and feel great.

  110. 206 Sylvie September 18, 2012 at 9:11 pm

    I was prescribed biest 1 mg 0.8 mg estriol 0.2 mg estradiol 40 mg prog. I am supposed to use 1 ml everyday. I had a total hysteroctomy. After using this cream for 3 weeks I am getting sore breast and retaining liquids.

  111. 207 mcwick94 September 29, 2012 at 5:26 pm

    45 yrs old with terrible skin issues. Rosacea, sebhorrheic dermatitis, and red hive like bumps that sometimes itch on sides of face and jawline.Moisturizing does zero to help dryness either. Have been on bio hormone cream for 6 months but started on a dose of biest-progesterone. Started out low at .325mg/25mg then increased to .650mg/25mg, then .9mg/40mg and now Im finally at 1MG/100MG and my face has never been worse. Redness and rashes and Im not sleeping a wink plus it has done nothing for night sweats..I thought BHRT was suppose to help skin and not hurt it? Im desperate for something to change with my face and body..Peter, I hope you have some thoughts…

  112. 208 Jeanette October 14, 2012 at 5:13 am

    I have been taking bioidentical hormones since May 2012, they are administered in pellet form. I have been taking 100mg testerone, 6mg estriol then I have been taking 100mg progesterone trouche every evening and a B-12 shot once a week in conjunction with LoLoestrine BC pills(which I began taking July 2011 after being on the Ortho evra patch for years). When I began the LoLoestrin I weighed 130 by May of 2012 I was up to 137 that was what prompted the hormone replacement as well as libido loss and menstral related migraines. I am not technically in menopause. Now I am up to 140, about a week and a half ago I received my next pellet therapy and began taking Armour thyroid since my thyroid levels have been steadily climbing since May. Now my weight is 142. I am 49 yrs old, in great health, (except for this) workout on the elliptical machine at least 5 days a week for 1 hour at a time try to throw in weight training and hatha yoga. I watch what I eat and try to take care of myself and really have not done anything differently to cause this weight gain but am really sick of it! I have more energy but more weight as well. Any suggestions??? Thank you!

  113. 209 Cindy Frye October 16, 2012 at 2:31 am

    I am a 53 year old female with horrible menopausal symptoms. hot flashes sometimes 1 every hour, only 3 hours of sleep a night. loss of energy, weight gain, rise in cholestrol levels, no libido. I have been in menopause for three years.
    The first year after my periods ceased i expierenced depression and was put on anti depressents with zeroed my libido took them for a year then started having panic attacks and severe anxiety episodes, couldnt even go out of the house. Was given Zanax and zoloft therapy which worked fine for depression and panic attacks, then enter severe hot flashes!
    I went to my gyn and she prescribed combipatch to combat extreme vaginal dryness and menopausal symptoms. Within the first week i discontinued the anti depressent I felt so good!
    This lasted for 9 months no problems at all. I then got terribly sick and was given a combination injection of a short acting and long acting steriod. The anxiety the next day was horrible! it took 3 months for it to go away with the zoloft and Zanax. All I could do is sit in my recliner and rock for 12 hours a day. I could not use my combipatch after the steriod injection, it gave me a headache that felt like my head was going to explode!
    I took off the patch and discontinued use of it. It has now been 7 months and I tried using the patch two diffrent times with the same resulting headache. I don’t understand before receiving the steriod shot I had no adverse reactions to the patch and life was wonderful! I was put n the lowest dosage patch.
    I am so miserable and searching for anything that can help. I tried premarin at age 50 horrible side effects. next came the combipatch which worked fine untill the steriod shot. Can BHRT help me? I cannot take the typically prescribed formulations like premarin or prempro. My doctors are telling the anxiety all at once was a product of menopause. The only thing I take now is Zanax .25 at bedtime. Please help! Cant live life this way!

  114. 210 Linda Setchel October 16, 2012 at 4:26 pm

    I’m taking BIEST/PROP 2.5 MG/50MG/ML HRT(made in compound pharmacy) daily. So now I’m doing the HCG solution…the NiGen Bio Tech. My question us do I need to stop my HRT progesterone until diet of HCG phase 2.

  115. 211 Kelley October 18, 2012 at 7:07 am

    I have been taking bio-identical hormones for about 3 years, synthetic for many years prior to that due to a total hysterectomy when I was very young. I changed to bio-identical, believing it was better for my health, but I have had so many problems with them. It seems as though my dose is never right, and it has been changed multiple times. I feel like a lab rat! I just changed to a troche that is C-Biest/50-50/PG2.5/150MG. The directions are to split the troche and take 1/2 in the morning, 1/2 at night. Is this a “normal” dosage? Within 8 days I have gained weight, my breasts are extremely tender, and I am weak and tired. I also experience extreme itching on my upper arm that I cannot satisfy by scratching. I have to put an ice pack on it. Can this be caused by the hormone imbalance? I have had this happen before when the estrogen level was too high.

    • 212 Lisa Marsh December 23, 2012 at 4:40 am

      Just a suggestion, you may want to try taking the estrogen troche either all in the morning or the other half in the early afternoon. Estrogen provides more energy and could interfere with sleeping soundly. Progesterone is calming and can even help sleep. While my first holistic doctor had no problem having me dose in this manner – and complaining about not being able to sleep – I changed doctor’s and this was one of the recommendations she made. If you also take DHEA it should be taken in the morning. Also your breast tenderness and weight gain indicate not enough progesterone in the ratio to estrogen. If I understand correctly, you take one troche which is a combination of hormones: This is a disadvantage because you can’t make an adjustment. I am not a doctor but have been working my way through this menopause nightmare for almost 2 years. If you haven’t before, you need to take a saliva test to see where you are. You can order it from ZRT Laboratory online or through Amazon. You should take the 5-panel Female test.

      • 213 Jackie Moran December 27, 2012 at 2:58 pm

        Hi Lisa, I’ve read through most of this blog, you seem to be pretty well informed. I started the BIEST cream Progesterone regiment in Sept. ’12. I am 59 and have been menopausal for 10 years. Anyway, since starting this, I have had a period the last 2 months, with this month having heavy cramping. I feel like quitting these meds, but truth is, I feel better. Did this ever happen to you, will it stop?

  116. 214 Kim November 13, 2012 at 4:01 pm

    I just found out that I am estrogen dominant. The compound pharmacy is prescribing that I take Biest and progesterone. How typical is it to take estrogen when I’m already estrogen dominant? I’m 50 yrs old and have my uterus and one ovary.

    • 215 Vanessa November 15, 2012 at 11:48 am

      Hi, I don’t have that particular problem, but my friend is in the exact position as you. She is 48. She has never taken estrogen, as it is she is at high risks for breast and ovarian cancer due to estrogen dominance, so they have her on progesterone and testosterone. Recently, her doctors took her off progesterone even because your body sometimes will turn it into estrogen. They didn’t want to take any chances. Hope this helps.

  117. 217 Katherine Borrousch December 8, 2012 at 5:25 am

    I wanted to know what the Pharmacist thought of the Wiley Protocol? I am thinking of starting this after reading T S Wiley’s books, and Suzanne Somers book.

  118. 219 Robin December 17, 2012 at 5:31 am

    Hi – I was prescribed Progest/Estra 50-0.5 mg/ml from a compounding pharmacy. I had a hysterectomy a year ago. I would like to know which type of estrogen this is. Also, is it safe to continue to take Estroven along with this? Thanks.

  119. 220 Julie February 19, 2013 at 9:20 pm

    Hello Peter 🙂 Thanks for this great website! In what situations would the Bi-est 80/20 (E3/E2) be better than the Bi-est 50/50 (E3/E2)? I have been on BHRT for six months. Bi-est 50/50 .2 mg and 20 mg Progesterone for the first three months, then adjusted to Bi-est 50/50 .2 mg and 40 mg Progesterone for the last three months and currently. I apply the compounded cream to the same inner thigh six out of seven days. After four months on BHRT, I had to have my first breast biopsy and the diagnosis was “Fibrocystic changes including prominent cyst formation, apocrine metaplasia, stromal fibrosis and ductal fibrosis hyperplasia without atypia. Negative for malignancy and atypia.” To date, I can say that my BHRT has been 75% effective in relieving my hot flashes and night sweats, and in doing so has helped with my anxiety. However, I have gained weight, have breast tenderness and swelling, decreased libido, still some anxiety and mood swings. The weight gain is the most uncomfortable for me… my hips, belly, butt, upper arms, breasts, inner thighs, face… i can’t stand the feeling of this extra fat on my body! I am so puffy!! I can’t stand it! I am extremely active and I swim one to two miles 4-5-6 days a week. This weight has absolutely nothing to do with my diet or lack of exercise! I am concerned about the breast issues now. My dosage has been based on symptoms and ZRT saliva testing at the beginning, and then another ZRT saliva test after three months on BHRT. I completed your ‘Symptoms of Hormone Imbalance’ and most of my symptoms reveal Estrogen Excess, Progesterone Deficiency, Adrenal Fatigue. I started out with my doctor a couple of years ago being treated for Adrenal Fatigue, and after diet changes and good supplementation, I was feeling better and my blood work was improving significantly. My last menstrual cycle was 4/15/12 and the hot flashes, night sweats, and extreme anxiety started within a month after that, and got really bad quickly, so I started on BHRT four months later and have been on BHRT for six months now. Obviously, my hormones are still out of balance. BHRT has helped with my hot flashes, night sweats, and extreme anxiety, but I have traded that for very uncomfortable weight gain, breast tenderness and swelling, decreased libido, still some anxiety and mood swings, and most concerning is the issue with the changes in my breast. I have a check-up with my doctor next week and will go over all of this. As a Pharmacist, I am hoping you have some suggestions for me to take to my doctor appointment. I do believe a Pharmacist is an important part of the team when taking BHRT. After reading your “Bioidentical Estrogens Explained” and “Life Extension White Paper on Bioidentical Hormones: Why they are still Controversial ?” I am wondering if the Bi-est 80/20 might be a better match for me and if you can offer any ideas or suggestions on what might help me? I read in your blog where you gave the conversion from Bi-est 80/20 to Bi-est 50/50… what is the conversion from 50/50 to 80/20? I am 55 years young, and I am on no prescriptions drugs, except the BHRT. Bottom line, I believe the BHRT is still worth trying… if I can reduce the fibrocystic breast issues and the weight gain. Please help me. Thank you very much for your time~ Live Well!

    • 221 thecompounder February 23, 2013 at 3:54 pm

      Thank you for your thorough comment. I am not able to comment on any specific therapy for an indivudial patient. Take care.

      • 222 Julie February 23, 2013 at 5:16 pm

        Peter – I just re-read my comment again… whew! I guess I did just lay it out there. I am trying to figure out what might work for me… I will get there 🙂 I have learned a lot from this website and I thank you for that! Take care~

  120. 223 Julie February 19, 2013 at 9:30 pm

    Peter – Oops! Correction to my post… just in case it matters. My BHRT dosage was adjusted after three months, and I am currently on Bi-est 50/50 .2 mg and 30 mg Progesterone — not 40 mg Progesterone. My script reads: C-BI-EST 0.2(50)PROG30MG/ML
    Thanks! Julie

    • 224 Lisa February 26, 2013 at 3:22 pm

      Before I started bio-identical hormones, I was diagnosed with fibrocystic breasts. There are other natural supplements available if your lower dosage of BHRT works for your symptoms. Look up the use of the following: iodine, tocotrienols (E), and D-3. They could help you. Since using these there is a noticeable improvement in the softness and lumpiness.

      • 226 Julie March 7, 2013 at 6:08 pm

        Lisa – Thanks for your comments! I have never been diagnosed with fibrocystic breasts until now… so I believe the changes in my breasts are due to BHRT. I have decided to continue with BHRT, and go back for the six month mammogram, then see where I am at that time. Just had a check-up with my doctor, and he slightly upped my progesterone and wants me to start low dose of Iodoral. I am already supplementing with E and D-3. Because of your comment, I was aware of the possibility of the Iodine when he recommended it… so thank you! I must say that I do experience of lot of benefits from BHRT… I just want to be as aware and safe as possible. Thanks again. Take care~

  121. 227 Andy Chevalier March 17, 2013 at 5:08 am

    Great article! Are you aware of any protocols for replacing birth control with bio-identical hormones? I would love to decrease risks for my female patients who need a reliable contraceptive.

    • 228 thecompounder March 23, 2013 at 2:17 pm

      Great question. Unfortunately, currently there is no regimen using bioidentical hormones that is proven to prevent pregnancy.

    • 229 dee wick March 24, 2013 at 6:31 am

      whats going on that peter is not commenting? Whats the point of leaving a thorough explanation if its not being answered?

      • 230 thecompounder March 24, 2013 at 8:44 am

        I understand your frustration. Because each individual’s treatment plan for any condition needs to be worked out with her doctor and pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. Take care.

      • 231 thecompounder March 24, 2013 at 8:44 am

        I understand your frustration. Because each individual’s treatment plan for any condition needs to be worked out with her doctor and pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. Take care.

  122. 232 Darlene March 19, 2013 at 9:35 am

    Peter, I’m a 51 year old who was having sever symptoms of insomnia, anxiety and hot flashes. When initially tested in Aug 2012, my saliva test said that my Estrodial level was less than .5 and my progesterone was 15. I got connected to a compounding pharmacist who specializes in women’s bioidential hormones and he said he was my low estrodial that was causing the insomnia paritcularly. So he originally prescribed 100mg protesterone twice daily along with 3.25mg Bi-est and .625mg of testosterone compouned with the Bi-est twice daily. All sublingual tabs. At the same time I started the hormones, I was also taking a powdered greens product that contained Maca and also a chinese herb liquid that was supposed to be hormone balancing. All seemed well, I was sleeping well, anxiety was under control. After 30 days, I ran out of the chinese herbal liquid and so stopped taking it. Now I’m down to the BHRT and the maca greens powder. That lasted for another 30 days, again all appeared to be well, then I ran out of the maca greens powder. It was then the that the insomina reared it’s ugly head. So I bought some powdered maca and began taking that. It did help the insomnia, but when I told the pharmacist about it, he wanted me to stop the maca and he raised the Bi-Est to 3.65mg twice per day. Same Progesterone and Testosterone as before twice per day. I gave it 3 or 4 days and STILL the insomnia persisted, so I added the maca back in at 1/2 teaspoon. I started sleeping well again. I’m a little foggy thinking, but not bad. So last week I had my saliva tested. Did the test at night before I took my nightly tablets (as suggested by the pharmacist), my Estradiol is now at 28.1 and my progesterone is at 11,670, EEEKKKK!! It appears those levels are quite high. Now I’m a bit panicked over what to do. I was sleeping fine most of the time, but these levels have me quite concerned. I took the test on about the 20th day of my cycle. Any recommendations? Thank you!

  123. 234 teresa March 23, 2013 at 5:42 am

    Hi, I am currently on E2 2mg/PROG 50 mg per 0.5 ml. cream applied daily. I can tell that my hormone levels have dropped… AGAIN… from the increase in hot flashes, irritability,fatique, etc… my doctor has to increase (adjust) my dosage about every 6-8 months. I’m concerned about the continued increase although my symptoms are so bad I guess I have no choice. I want to ask if it would be better to split the application to twice a day? I am currently applying to inner arms and thighs, would it be better to apply vaginally? I’m doing everything on my end to help with this. I exercise 3-5 times a week including weights and cardio. I take vitamins including B vitamins and D., multivitamins,etc. I’ll be contacting my dr to have levels checked again. Always good to get another opinion.

    • 235 thecompounder March 23, 2013 at 2:14 pm

      Thank you for your thorough comment. I am not able to comment on any specific therapy for an individual patient. Take care.

    • 236 Yolanda March 23, 2013 at 2:54 pm

      Hi Teresa. I had the same problem, my dr changed it to vaginal cream, but I began to spot everyday. On top of that my hotflashes were still present. I too was afraid of heavier doses because of risks of blood clots and cancers. I have been doing acupuncture for 4 months and it is really helping! I’m no longer of anything no hormones. Just acupuncture, you should really try it.

      • 237 Julie March 24, 2013 at 10:28 pm

        Yolanda- Acupuncture is something I have been curious about trying. How many times a week do you go, and how long are your treatments? How long did it take to feel results? Are you taking any Chinese herbs? Herbs that I have heard or read about are Eight Flavor Tea or Zhi Bai Di Huang Wan, and Nine Flavor Tea or Liu Wei Di Huang Wan. As I understand it… Nine Flavor Tea is based on Eight Flavor Tea and is more suitable for long-term treatment of yin deficiency heat symptoms. Appreciate any comments or clarifications on this.

      • 238 Yolanda March 26, 2013 at 4:29 am

        Hi again! I started by going twice a week for the first 3 wks of treatment, then once a week, eventually she said depending on how quickly your body responds, it’s only once every other wk, and then once a month for maintenance. Let me tell you I started to feel positive results after the second month. But I went in feeling most horrible. I had been in the emergency room because I hadn’t been able to sleep in 3 months, I was having anxiety and panic attacks, and horrid night sweats. After the second month, all anxiety and panic was under control, with no Xanax or any medication! I was able to get off my sleeping pills after the 3rd month. I am not taking Chinese herbs currently, my Chinese medicine dr told me she wants to see how my body responds with acupuncture only and if she thinks it needs extra help, she’d introduce the herbs next. From my experience with acupuncture you have to find a Chinese woman who is a Chinese medicine doctor and if she is a medical doctor in the USA certified also that is best. Make sure they use sterile one use only disposable needles. Also that they have experience treating menopausal symptoms. My dr specializes in women problems, even treats infertility, so I know she’s qualified for the job. Hope this helps!

      • 239 Julie March 31, 2013 at 9:03 pm

        Yolanda – Thank you very much for sharing your experience with acupuncture. It is most helpful. Thanks a lot! 🙂

      • 240 Yolanda March 26, 2013 at 4:36 am

        I forgot to mention, each session is about 30-45 min. It’s very relaxing and you feel Minimal prick when the needle goes in, if u feel it at all. And no pain or discomfort as you lay down, close your eyes, relax, they play relaxing music and dim the lights and you fall asleep. Before going, don’t eat a heavy meal, but don’t be straved. Also, don’t do any heavy activity after, (like work out at the gym) that way you allow the treatment to do its job! Best wishes!

  124. 241 Susan March 27, 2013 at 5:53 pm

    I had a TAH BSO in 1997 and about 5 rough years until I found a doctor who specializes in bioidentical hrt. I was sublingual estradiol .5mg, estriol 1mg, and testosterone 1mg for 9 years and did great. Last year I started having low hormone symptoms. Hot flashes, heart palps. terrible fatigue, inability to handle stress, muscle and joint pain just to name a few. I had bloodwork done and my estradiol was low normal and testosterone free was .2. SHBG was 135. My doctor raised my estradiol, testosterone and added progesterone. I had to tweak several times but was getting close to my balance. I was having trouble dissolving the sublingual as it took 2 hours. My doctor talked to the pharmacist and they said it was hard to make it that way. Anyway my doc decided to switch to the cream with all hormones combined. Within 2 weeks I started feeling extremely fatigued, hot flashes, intense muscle pain and feeling very bizarre. I didnot at the time attribute the symptoms to falling hormone levels. Last week I could barely function and thought I was going to die.Also my memory was gone. I thought it was my thyroid. This past week I finally realized that cream was not absorbing. Called the doctor and they drew levels yesterday. I went to the pharmacy and asked what base they were using and it is Suave lotion! I was shocked. In the meantime I had some sublingual tabs left and started back on and I am starting to feel like I am going to be normal eventually. The cream certainly doesn’t work for me and I will go back to the sublingual but have a separate one for the estrogen/testosterone and one for the progesterone. It does take time to get balanced and there will be bumps in the road. I truly believe though everyone can get there.

    • 242 Susan April 15, 2013 at 12:56 pm

      Are troches a good delivery system for hrt? The cream was not effective. After a month on it my estradiol was 21. It was 47.prior to that. My testosterone was borderline high. My doctor lowered my T and increased my estradiol and estriol. My estrogen and testosterone are in a separate troche. I take progesterone at night between 25-50mg. I would appreciate any feedback on troches and also how to dissolve them properly.

      • 243 thecompounder April 15, 2013 at 3:08 pm

        Troches can be a good way to go for some patients. Keep in mind that some of the dose from a troche will be swallowed and therefore become an oral dosage form. To properly dissolve a troche, place it under the tongue or between the lower gums and cheek. Leave the troche there and let it dissolve slowly. The longer it takes the troche to dissolve, the better absorption through the oral mucosa.

        I hope that helps.


  125. 244 laura May 13, 2013 at 9:03 pm

    Dear Peter –
    First, thank you for this site. It is very helpful, and so needed. I have to think you will earn some very good kudos for this!

    I got on synthetic hormones as a result of being overseas and having some bleeding that was approaching dysfunctional. (I did very well on them, but they changed my scent, which was awful.) I promised myself I would convert to bio-id. when I got back to the states, which I did in January. I haven’t had a full night of sleep since; a good night is only waking 3x w/ mild sweats. Things really got bad when I tried an oral prometrium; the next morning my back went out so badly I couldn’t get off the floor. I’ve been down for 3 weeks (normally I’m swimming in the ocean and dancing.) (Estrogen surges can affect the tone of ligaments – mine have been hyper elastic.) I went back to the topical progesterone, but the hot flashes and nightsweats are over the top (even my eyes sweat!) I’m fit, eat well, and am pretty body aware. (I know this makes no sense…sorry.)

    What I’m trying to figure out is the conversion. I was taking 37.5 patch of estrogen (I assume estrodial at .0375mg) 2x/week. The progesterone was a 100mg suppository 10days/mo. What I can’t figure out is how to convert the dosage. Originally a doctor put me on E2 1GM, E3 4MG, TE 3/MG/0.01 daily. Initially the progesterone was in the mix. The second time I tried taking it separately (both as topical creams.) The dosage of estrogen seems very high compared to what I was on previously and for the last 10 days I have felt premenstrual. (Jan was my first month w/o a period – I’m 51.)

    My next step is to remove the testosterone. (I have always built muscles w/o trying and have enough rogue hairs that I think it’s not necessary.) Any suggestions for dosing?

    Ever so Grateful,


    • 245 thecompounder May 14, 2013 at 8:45 am

      Thank you for your thorough comment. Because each individual’s treatment plan needs to be worked out in dialogue with her doctor and her pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. I wish you the best as you work out the best possible treatment plan with your practitioners.


  126. 246 C Shumaker May 20, 2013 at 7:05 pm

    I am trying to figure out if my first time prescription for HRT dosage is weak, average or strong. I am 48 years old, my symptoms include elevated FSH, and diagnosed severe generalized anxiety disorder resulting in job loss along with weight loss, sleep problems, burning chest, and memory and cognitive impairments. Just picked it up today, it says “Estradiol/Estriol/Prog 50/50 1.25/30 MG/0.25 ML Cream”. Any assistance with this is greatly appreciated! Christina

    • 247 thecompounder May 21, 2013 at 1:59 pm

      Tha label is a little difficult to decipher. I would call the pharmacy who made your prescription to get some clarification as to what is in your cream. They should be able to answer all of your questions about the dosage.


  127. 248 Yolanda May 21, 2013 at 4:13 pm

    Where are you placing the cream? If its vaginal, it is high. If its on your arm or limb, they usually will prescribe a higher dose because the absorption is not instant. Regardless, I am responding to your post mainly because I know how horrible it is to go through this. The anxiety and all the effects of low hormones is unbearable! I am 27 yrs old, and I have had premature menopause since the age of 19. I have tried many treatments, including bhrt. I found nothing really helped control my anxiety. Though it did relieve the hot flashes. The I found in my research that oriental medicine works to treat menopausal symptoms effectively. I tried it for 6 months, going once a wk. interestingly after the first month, my severe anxiety was gone!!!!!! I could leave my house without fear again! I could start to do the things I love! I have no been taking any medicine, only acupuncture. My current blood work shows my estradiol increased 13 points all by itself in these 6 months of acupuncture. The reason I share this with you is because I wish someone would’ve told me about this along time ago! I went so long feeling awful, lost my job, and my desire to live. I hope this is helpful to you.

    • 249 Paige May 21, 2013 at 4:42 pm

      I am 52, and have had an absolute horrible time with the change of life. Tried the Bhrt cream, patches etc…nothing seem to work, absorption issues etc…Missed many weeks of work throughout the last three years. I am currently on an estradiol/testosterone injection every 21 days, and feel pretty good. My doctor said is only temporary until I stay stable at that point am thinking of trying a sublingual. I totally sympathize with every woman who has a rough menopause.

      • 250 Susan May 21, 2013 at 6:06 pm

        Hi Paige. I sure can relate to your plight. I have been dealing with this since I had a tah bso in 1997. About 10 years ago I started bioidentical hormones and did very well up until 2011 when my estradiol plummented. I had to have increased but still was not well. I finally consulted with my Dr who is wonderful back in Sept and he doubled my hrt and added some progesterone. I felt pretty good, but then felt I had too much estrogen and so we started tweaking more. I was on sublingual which I tolerate very well, but the pharmacy had trouble compounding everything into one pill. I then tried the cream and my estrogen fell to less than 20. I thought I was dying. I am now back on sublingual and a higher dose of estrogen and testosterone. I deciced to stop the progesterone as I thought it was complicating things and I really didnot feel good after being on a while. Well I am in withdrawal from it. It is similar to a sedative type withdrawal. I pray I get through this soon. I am getting better, but slowly. I am 59 and never thought I would be going through this, but it takes much patience and determination to get balanced. I have been at both extremes and it is not comfortable. Down right frightening. I know things will improve for you. Just keep researching and listen to your body. God Bless and God Speed.


  128. 251 Yolanda May 22, 2013 at 4:39 am

    I was on the patches too for a while. Spent so much money getting monitored. Bloodwork every 3 months. They told me the same thing, that it was temporary, but as soon as they tried to wean me out, my symptoms would return with a vengeance. In the final months of this, I was getting breast pain and by lower abdomen and lower back hurt so much. I panicked, I know this bhrt comes with possibilities of creating cancers. And to be honest with you, the estrogen/ progesterone bhrt never got my sleep cycle back on track. At best, I would get 3 maybe 4 hrs of sleep. And it was not consistent. The problem is, doctors try to treat symptoms only. They try to prescribe a pill for everything, instead of undoing out why you’re having such a hard time what’s going on inside. I highly recommend you research and read on what oriental approach can do for you.

  129. 252 Amanda June 22, 2013 at 8:25 am

    I have been taking biest/prog-v since March. At first I was put on a higher dose but I had vaginal and urethra burning as well as breast pain and anxiety so we lowered my dose until I could tolerate it. I’m currently on 0.5/200 cream that I it on my forearm. I still have vaginal burning even though I’ve lowered my dose to .01 ml a day. The compound pharmacist used a lubricant that we knew I wasn’t allergic to to compound an estrogen cream thinking that maybe the burning was vaginal dryness. I burned just as much. So that makes me think I’m reacting to the active ingredients in the compound. Is this rare or common and is there a work around or alternative for this issue? I have interstitial cystitis which makes me very sensitive to medications and chemicals. Thanks for your help!

    • 253 Yolanda June 26, 2013 at 4:12 pm

      I had the same problem with the bio identical estrogen cream and progesterone pills. Breast tenderness and dryness and occasional burning of the urethra. I took it for 8 months, and my dr played around with the doses, hoping it would improve. She told me the high levels of estrogen in the cream were causing it so she lowered it, then she thought maybe adding more progesterone would help. At the en of 8 months I still had the symptoms, and in addition had new ones , like spotting for weeks straight and light bleeding. Needless to say I stopped this treatment, and in my desperation tried something I knew very little about, acupuncture. I did some research and thought I should atleast try it for a few months. I noticed my anxiety was gone after the first month of treatment, night sweats went away, and as I continue treatment, I’m sleeping better and have fewer hot flashes. My estrogen levels have improved all on their own without any medication. I would highly recommend you research on the subject and try it out!

  130. 254 Michelle June 26, 2013 at 11:13 pm

    I have been using plant based holistic replacement therapy and was going well until I guess drug makers are missing out. New FDA ruling that any estriols and such cannot be sold for oral consumption. They are reformulating but in the meantime, I am roasting, sweating and can’t remember my point mid sentence. I agreed to try the combi patch for a few weeks since its also plant based. My problem: I put one on this evening and by bathtime, the patch was MIA! Lasted 2-3 hours max before falling off. I was busy and outside in the most sultry heat ever. Is there am alternative spot I could put the patch so it maybe dont get sweat off. I know you can put creams on thin skin areas like under top part of arms, inner thighs , buttocks? I don’t want to keep losing them. Guess I could tape them on but that doesn’t sound appealing for life! Any thoughts would be appreciated immensely! What about inner arm and wrap a loose coban dressing around to keep in place? Thanks in advance!!

  131. 255 ann munro July 4, 2013 at 8:13 pm

    Is 1.5mg bi-est 50/50 and .75mg progesterone good or should I stay 2mg bi-est 20-80 with progesterone 100 mg? My estrdiol blood is 10. I am 55.

    • 256 thecompounder July 5, 2013 at 6:20 pm

      Thank you for your comment. Because each individual’s treatment plan needs to be worked out in dialogue with her doctor and her pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. I wish you the best as you work out the best possible treatment plan with your practitioners.

  132. 257 jan white July 26, 2013 at 10:09 am

    I just today started on the 50/50 if the cream @ 0.02 once a day..will I be gaining weight,,I already-since my cycle stoped back in 07 went from 120 to 153 lbs. If it helps me inthat area plus my hot flashes it will be great !

  133. 258 karen July 28, 2013 at 5:15 am

    I started BIEST 80/20 (along with progesterone/DHEA) three months ago and it seemed to work well. My cream was suppose to be a months supply but seem to go on forever….(still have some) but needed to get my progesterone pills refilled twice now. My cream tells me one pump is .05 mgs of BIEST. Well, over the last month, my hot flashes are back in force, insommnia, painful intercourse and muscle aches… it because I am not getting the right amount of cream since it has lasted WAY longer than it suppose to? I am going to ask my dr. to order a test for estrogin and progesterone levels, but I also am wondering about the cream. I never had these problems on vivelle dot. ? (I am postmenapausal)

    • 259 karen July 28, 2013 at 5:25 am

      Me again…I got my prescriptions here and thought I should modify what I reported in my last post as I made a few mistakes…

      35 gm. BIEST 80-20, one pumo is 0.5 ML. one in the AM
      I take progesterone, one at night, 100 mgs.

      • 260 thecompounder July 29, 2013 at 2:25 pm

        Thank you for your comment. Because each individual’s treatment plan needs to be worked out in dialogue with her doctor and her pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. I wish you the best as you work out the best possible treatment plan with your practitioners.

  134. 261 August 3, 2013 at 3:58 pm

    In terms of dosing, what are the equivalencies between dosing Bi-est 80/20 topically versus buccal troche? Thanks

  135. 263 Cynthia Munoz August 5, 2013 at 2:04 am

    My dr started me on progesterone sr 100 mg once a day evening and bi-est/ testosterone 0.625/1 mg cream twice a day I have been getting palpitations at nite I can’t sleep I feel like my brain is going and going is that normal it’s just at nite during the day I’m fine please tell me if that normal

    • 264 thecompounder August 5, 2013 at 11:28 am

      Thank you for your comment. Because each individual’s treatment plan needs to be worked out in dialogue with her doctor and her pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. I wish you the best as you work out the best possible treatment plan with your practitioners.

    • 265 Yolanda August 5, 2013 at 2:54 pm

      The palpitations and the inability to shut off brain at night is a “normal” menopause symptom for a woman going through the change and not taking anything for it. But you’re taking hormone replacement, so it means the balance is off. When I had those symptoms my dr gave me a higher dose of progesterone, because he said its “earth’s Xanax” . It will releave anxiety that is causing palpitations and inability to fall asleep. It did help for a while for me. But ultimately after using it for 8 months, I found that it wasn’t achieving “normalcy”. I didn’t feel all that better. What I have found recently that is helping is acupuncture. Hope this helps!

      • 266 Beth salant August 5, 2013 at 6:12 pm

        Do palpitations usually happen more at night? Usually I feel mine early evening before bed. Interesting about the racing thoughts- I get old songs stuck in my head

  136. 267 Aramis August 28, 2013 at 7:23 am

    Hello, I have just started Bi-estro Cream (80/20)…previously I was on 2mg per day of Estradiol in a tablet. Could you please tell me how much of the Bi-estro cream (80/20) I need to take to equal the effect of 2mg of Estradiol.

    Thank you,


  137. 268 Lisa August 28, 2013 at 6:20 pm

    I have been on 50/50 Biest for about 4 years, In the past year I have really packed on the belly fat which I believe is stress/cortisol related. I have done some research and found that high estradiol can cause higher cortisol levels. I am wondering if, in theory, switching to 80/20 bi est could help lower cortisol levels. I have taken the saliva test and I am waiting for results.

  138. 269 Terry hawks September 13, 2013 at 6:00 am

    I am taking biest, testosterone creams for HRT. So I am on vacation and left my luggage in the car for several hours in the hot hot sun. I have noticed a change with my emotions very tearful and experiencing a lot of anxiety. My question is can the heat destroy the biest and testosterone cream.

    • 270 thecompounder September 17, 2013 at 4:27 pm

      Although there are no studies that I know of that look at the stability of hormones in a cream base at high temperatures, it seems plausible that your creams experienced some loss of potency as a result of their exposure to the direct sun and high temperature. I would recommend getting a fresh batch.


  139. 271 Lisa Marsh September 13, 2013 at 8:21 am

    Question for the Compounder: In your intro on this blog, you state that estriol (E3) makes up to 50-80% of a female’s circulating estrogen. This appears to be contradicted by verifiable data. It has been established that the only instance there is any measureable estriol is during pregnancy, actually deriving from the placenta. Based on this information, why would Bi-est, commonly prescribed in a 20/80 (estradiol/estriol) ratio be preferred when it is not the levels we had before our estrogen levels began to plummet? If our blood levels of estrogen were tested when we were 20 years old, it would not be 20% estradiol and 80% estriol, unless we were pregnant. Estradiol would always be the highest. I’d like to increase my understanding of the bio-identical creams but logically this dose does not make sense. Why wouldn’t we want to supplement with bio-identical hormones with the ratio that we had naturally which would also include the Progesterone for half the month? I have been dealing with the horrible effects of low estrogen and progesterone, cortisol, DHEA, and testosterone (verified by saliva and blood tests) for more than two years, trying all strengths and methods of Wiley Protocol, bio-identical patches, creams, and pills without much success.

    • 272 thecompounder September 17, 2013 at 4:25 pm

      Yes. You are correct. The only time that a woman has appreciable levels of estriol in her system is during pregnancy. The 80% / 20% estriol to estradiol ratio came from recommendations from doctors in the 80’s who stated that this was roughly the ratio in women’s bodies. That statement was later disproven by further studies that show that the amount of circulating estriol is much less relative to the amount of estradiol (although it is rarely zero since it is a metabolite of estradiol and estrone). I think the continuation of the 80/20 ratio of estrogens now is more of a convention rather than and adherence to some sort of physiologic marker. Since estriol has been shown to be quite safe and is effective in treating specific conditions like vaginal dryness and urogenital frequency (as well as improving general skin tone), I think many doctors still feel comfortable with that amount of estriol in a formulation. Many doctors have switched to a 50%/50% estradiol/estriol ratio which more closely mimics average physiological levels in non-pregnant women. I hope that helps answer some of your questions.


  140. 273 Mary Ann September 14, 2013 at 6:16 pm

    Hello, I’m 49, been dealing with premenopausal symptoms for some time, with no help from Gyn. My period ceased in March, 2013, but reappeared in August, 2013, but during the time that 5 month time frame, the PMS symptoms were brutal. Needed to find someone who would listen to me and not make me feel as though it were all in my head! I finally found a great Dr. who deals in bio identical hormone therapy. Had the saliva test, which showed low to non-existent levels of estrogen & progesterone, and DHEA, with normal levels of testosterone, so Dr. started me on Biest 80/20 2mg + Pro 30….. hot flashes have ceased (was having at least 20 per day), daily headaches subsided, now I get, maybe 1 per week, insomnia has gotten much better, and heart palpitations are not as severe and often……BUT, my libido is still non-existent, my breasts are perpetually tender (have extremely dense breast tissue which compacts the issue), and still have bouts of extreme fatigue, also bloat is unbelievable at times. I’m also taking 120 mg of Armour for thyroid. Due to return to Dr. for follow up visit in 2 weeks, but was wondering if dosage is too high, and can I cut in 1/2 until I see her?

    Also, have gained 10 pounds, which is extremely depressing! I eat well, cut sugar from diet, exercise daily, and even began (again), a daily food journal to see if certain foods were causing the bloat and excessive gas….that didnt work! Have battled weight issues my entire life, along with endometriosis, and when I finally got to a normal healthy weight (135 @ 5’4) and a handle on the Endo, (both controlled for well over 10 years), good ole premenopause steps in and turns over the apple cart!!! My whole system is out of sorts and want to know how long this lasts? My mother had a full hysterectomy @ 33, and on Premarin ever since, so have no real reference, in regards to family history.

  141. 274 Gail Presson September 28, 2013 at 12:19 pm


    I hope your still active on your forum. I have not had a period in a year and developed Post Menopausal symptoms in the last 3 months. I have been to a Holistic doc which prescribe me Biest an prog 50 ml. I received it in the mail today, a Saturday of course, and applied it. The delivery system is a bottle that looks like a deodorant bottle, and I am to turn it 4 clicks. Because there was not directions, I turned the know not realizing how many times, and noticed the cream had come out. I may have gone 6-8 clicks, but without thinking applied the cream. I then figured out the bottle on the Biest and applied the prescribed amount. I cannot get ahold of anyone to determine what side effects if any I may experience by doing this? Can you tell me whether or not I should be concerned as this is my first time ever using Bio-Identical creams?

    • 275 Yolanda October 1, 2013 at 4:17 am

      Hi! It sounds like you’re concerned you may have overdosed the first time on the biest cream. Don’t worry, aslong as you’re following the directed use since then, you should be alright. The only thing you may have noticed after applying the large amount the first time was maybe breast tenderness, and lower abdomen and lower back soreness or pain. This happens when you are taking too much estrogen. My dr had me on too high of dose of estrogen for 2 months one time and those were the symptoms I experienced. It’s a balancing act, and I will tell you this: it’s very hard for any dr to get it right. I spent 1 yr trying to gt balanced until I finally have up. I was waking up in blood each morning because of high estrogen the last month. So I quit taking everything. Lately what I’ve done to help my symptoms is acupuncture. Hope this helps!

  142. 276 Amanda September 30, 2013 at 8:50 am

    Hi, my menstruation stopped completely when I was 47 years old. I am now 53. I have no menopause symptoms at all. However, in Feb 2013, I noticed that my eyebrows became very thin and a bit of receding hair line. I got worried that I may experience hair thinning or hair loss problem due to menopause. I started taking Troche, Biest 20:80/Progesterone 20/60mg in Apr 2013. I did notice regrowing of arm-pit hair and eyebrows. But my breasts were very tender for 4 months and now still a little tender. Since started BHRT in Apr 13, I continue to have excessive hair loss. I went to see a hair specialist (doctor) and she said my hair loss could due to the trauma I had in Oct 2012 when I lost my dad and I broke my bone and had my gallbladder removed. Furthermore, I lost 10kg of weight intentionally from Feb to Jul (5mths). The doctor got me to take Hair Protein supplement, tyro-sine and iron supplement. I have been taking these supplements for about 10 weeks now.
    My uterus wall was thicken by 4mm in 2 months after taking the BHRT. I had breakthrough bleeding in the first 2 months. I had a D&C done in mid Aug 13 and the result showed no problem. However, I bleed continuously (like menstruation 3rd day) especially these 2 weeks. I am having few problems right now. 1st, my prolong breakthrough bleeding. 2nd my excessive hair loss during these 3 weeks. 3rd, I might have overdosed on iron as have joints and neck pains middle of the night. I guessed the HRT is causing my bleeding problem and I am planning to stop. But I am afraid that by stopping BHRT may worsen my hair loss problem. If I continue, likely to have breakthrough bleeding. Can BHRT cause hair loss? I m very confused now.


    • 277 thecompounder September 30, 2013 at 6:17 pm

      Thank you for your comment. Because each individual’s treatment plan needs to be worked out in dialogue with her doctor and her pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. I wish you the best as you work out the best possible treatment plan with your practitioners.

  143. 279 Debbie October 5, 2013 at 6:49 am

    hello, im menopausal for 6 years now and have been afraid to take even bio identicals.. i suffer at night with sweating then being cold. i also have hasimotos thyroditis some say its caused by the menopause. i started to take nascent iodine which seems better to me than lugols and less irritating. my doc wants me to only take troches he says creams saturated the fat tissues. i am estrogen dominant but also have low estrogen levels his protocol is 0.25 biset 80/20 2 a day and 25 mg of progestorone 2 a day sublingual. i also read if you apply progestorone vaginally it wont get stored as fat. i was wondering could it be applied to just the labia area of the vagina since i don’t have a way of putting it in further? I might not take the biest at all and just try the progestorone. i once did that 2 years ago for 3 weeks i got breast tenderness so i stopped. any thoughts?

    • 280 Yolanda October 7, 2013 at 3:25 pm

      Your experience sounds like mine. First off, yes that’s how you apply vaginal creams: on the labia. Like you, I had a bad experience with bhrt, mainly because I couldn’t find a dr that could get the balance right. I suffered 8 months with breat tenderness, vaginal bleeding and lower back and abdomen pain. I tried a few drs, but non could get it right. Balancing hormones is very tricky, and even when I was getting blood work every few months I was still not well. I have up on it, fearing cancer and other side effects from taking. And I went a more natural route. I admit, I didn’t know if it would wk, but I gave it a shot. I have been successfully treating my heavy night sweats, hotflashes, insomnia, and anxiety with acupuncture. I’m on zero meds (before I was on Xanax for anxiety and even tried lunesta for sleep). Hope this is helpful to you 🙂

  144. 281 Linda October 6, 2013 at 7:17 am

    Can biest cause cold chills shortly after application?
    Happens every time

  145. 282 lisa geis October 8, 2013 at 7:11 pm

    I just started biest/test via troch and progesterone via pill; i’ve noticed my heart pounding (which has happened in the past with food/drug allergies); i will stop the drugs and see and of course call the doctor, but just wondering if allergic reaction possible?

    • 283 thecompounder October 14, 2013 at 12:17 pm

      An allergic reaction to a bioidentical hormone is unlikely, since it is a hormone your body already makes. You could have a reaction to one of the excipients in the medication. More likely, the dosage and balance of dosages of the different hormones needs to be adjusted. Stopping the medications and calling your doctor is the right thing to do.


  146. 284 Bethanne October 10, 2013 at 7:37 pm

    Hello, Peter:

    I am taking 1 ML of compounded progesterone cream each night. I’m seeing my doctor tomorrow so that I can get a bioidentical estrogen cream because I am having several menopause-related symptoms such as insomnia, thinning hair, frequent urinary tract infections, and about 8 pound weight gain. I am most interested in taking Bi-est but would like to know what a good Progesterone/Estrogen ratio would be for me. I am also prone to depression so I am concerned about the dosage. My doctor starts out very slowly with low doses, but I’m also wondering if a cream is best for me or a vaginal cream is a better idea. Can you provide any input on proper ratios? She said my estrogen was very low in my latest blood test.

    Thank you in advance.

    • 285 thecompounder October 14, 2013 at 12:18 pm

      Thank you for your comment. Because each individual’s treatment plan needs to be worked out in dialogue with her doctor and her pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. I wish you the best as you work out the best possible treatment plan with your practitioners.

  147. 286 V November 7, 2013 at 9:28 am

    Hi, Thank you so much for the information! I have not read through ALL of the replies, so I hope I’m not repeating something you’ve already dealt with.

    I am 44y.o. and had a complete hysterectomy at the age of 35. I was on regular hormone replacements until a couple years ago. I saw a doc that ordered bio-identical hormone replacements – Bi-est gel, Progesterone and Testosterone.

    Well, my insurance does not cover the Bi-Est gel and after a couple years of paying out of pocket on a limited income, I’m looking for alternatives.

    My questions – I understand the Bi-Est gel is made up of the Estradiol and Estriol. I found out today that my insurance pays for these seperately. Would it be the same taking them seperately as together? Are these forms bio-identical?

    The gyn I’m seeing now ordered the Estradiol alone in hopes of saving me a lot of money and it does, but the pharmacist was telling me the reasons for adding the Estriol and it has me concerened that I really need to have it too. As well as the Progesterone.

    My insurance tells me Progesterone is covered, but is there a specific bio-identical progesterone?

    Just getting really confused about all of this. Every doc (and pharmacist) has a different opinion (very confusing and frustrating) and the cost of bio-identical without insurance covering them is getting a little steep.

    I appreciate your help with all of this. What a blessing!

    • 287 thecompounder November 13, 2013 at 8:39 am

      Applying hormones separately or in combination generally doesn’t make any difference so if it’s cheaper to do them separately, that sounds like a good option. Progesterone is bioidentical. If it says anything else, like medroxyprogesterone, it is not bioidentical. Good luck

  148. 288 Debi November 9, 2013 at 6:30 pm

    Hi – I was wondering since my Dr. Put me on CMP progesterone 75 and T-5 mg:ml and I apply 1 ml a day with rotation , I feel better but still have + tired brain* if that makes sense … Do I need estrogen also?? I’m 52 no surgeries but still not feeling right… Thank you… Debi Adams

    • 289 thecompounder November 13, 2013 at 8:40 am

      Thank you for your comment. Because each individual’s treatment plan needs to be worked out in dialogue with her doctor and her pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. I wish you the best as you work out the best possible treatment plan with your practitioners.

  149. 290 Sarah November 12, 2013 at 10:22 pm

    Hi Peter,
    I am new to your blog and scanned back over the posts going back about 4-5 years. So many desperate women, going through the life change and needing guidance, and so many times you have to post your stock response (I assume for liability reasons). I wish it were a different world and advise could flow more freely without the fear of litigation or repercussions.
    Anyway, I am 52 and though I’m very healthy with no specific health issues, I’ve also suffered from insomnia, and increased belly fat as I’ve been in perimenopause for about the last 5 years. I was on Vivelle Dot and prometrium for a while, but got off them about a year ago.
    My questions are these: I am very interested in understanding what’s happening with my hormones (I use a progesterone cream at night, but I’m sure my estrogen is low and haven’t been using an estrogen cream), because I feel my quality of life would be improved if I was using some bioidentical hormone products to balance my declining hormone levels.
    My female internist has steered me away from hormone testing, telling me that it’s unreliable to get tested for estrogen/progesterone levels because they are so variable and fluctuating that results don’t yield useful information. Is this true in your experience? Is it worth paying $400 to be tested through ZRT labs or some such lab. Is a saliva test more accurate than a urine test (I’m not even sure what’s available for hormone testing)? What about cortisol levels–are these tests accurate and worth performing? Should I work with a holistic doctor or is it okay to try to get and interpret test results myself through researching on the internet, etc. I am financially strapped these days as a single mom and would prefer to do things as cost effectively as possible. Thanks for your thoughts.

    • 291 thecompounder November 13, 2013 at 8:42 am

      Hi Sarah,
      Good questions. I will refer you to my blog post “Saliva Testing – is it useful?” ( Hopefully that helps.

      • 292 Sarah November 13, 2013 at 1:37 pm

        Hi Peter,
        Thank you for your reply. I will take a look at your Saliva testing blog post. One other question: I thought that belly fat accumulation in an otherwise slender person was a sign of estrogen dominance (or possibly metabolic syndrome). However, from looking back on some posts, it seems that the Biest cream or other estrogen treatment can help that particular symptom. I am not asking for any specific medical advice, but can you clarify what the belly fat is an indication of and whether progesterone or estrogen would be helpful in reducing unwanted muffin top?
        (one thing I have noticed in my particular situation is that hypothyroid can also lead to an accumulation of belly fat) Any light you can shed on causes of belly fat would be appreciated.
        Thanks a million!

  150. 293 Nikki December 5, 2013 at 8:28 pm

    Hi my esterone has come back as high but my estradiol is low. My doc prescribed 1mg of estradiol gel on days 5-15, is this a good idea considering my esterone is so high? many thnaks

    • 294 Vanessa December 10, 2013 at 8:44 am

      Sounds like he’s trying of offset the estrone. Estrone is the bad type of estrogen, the kind that causes breast and other female cancers. So when that’s high, it’s definately of concern. Personally, Are u taking progesterone with it as well? Usually my dr would increase progesterone when my estrone tested high. And as a side note, my dr never prescribed estrone, only estradiol if needed. How long have you been on this?

      • 295 nikki December 10, 2013 at 8:28 pm

        Thanks for your reply vanessa. I have been on it the last two months on the days stated above also I am on progestosterone capsules 100mg at nite on days 15-28 and I do feel better when I am taking the progestosterone so im not sure wether to up the dose or even to take it more days than prescribed? Also i am on androfeme 1mg daily.

  151. 296 Cindi Bender. December 16, 2013 at 12:32 pm

    I am 54 and started pre- menopause in the 40’s – and now have been in full menopause for the last 2 years-the worst symptoms ever – what a shock for me when I read up on it – I have a Doc thank goodness that believes in Bio – compo – BI – EST and the pharmacy is next store to his office I call him a god sent because my OB would not put on hormonal replacement therapy due to the cancer fears – I found something in a magazine explains what the person was going through with menopause and how she went to her Doc and a compound was made – long story short I took this to my Doc and he wrote a RX for compd estriol 1 gram 2 to 3 times a week for vaginal dryness and it appears to be working still not much desire as it’s painful but the med helps – my question and I know you do not give patient by patient advice but just a question – my Doc started me on BI-EST (80/20). 5 mg – testosterone 10 mg CR -applied to the arm or thigh daily – at first I felt like my old self again energy – etc – then I started feeling like I did when the menopause started no more hot flashes though thank god – but mood swings – aches pains – fatigue – depression – I know there is no magic pill to replace what I once had just want to get better – I have read all of your messages over the past couple of years and see that maybe it’s a comfort level RX my Doc wrote even though he is all for helping me – is there tweaking that can be done with by compd it’s been 6 months – I feel there is and continue reading all you post to see if u any any questions like this – I care for my 81 year old father who lives with me and he had a stroke – I need to believe there is light at the end of the tunnel as I sometimes have no enters to even get out of bed -if I do I am crying – happy achy – dry skin – but back to question of tweaking the dose – I go back in Jan for the saliva test and feel sure I can discuss tweaking – just asking – Thank you for any advice on compo bi-est – I thank god I found your site and that I have a Doc who believes in it – just want to feel better – nothing will bring back what naturally I lost but just want to see if tweaking is a thought – thank u

    • 297 Vanessa December 17, 2013 at 4:31 am

      Hello! I was on bioidentical hormone replacement for 1yr. Yes there’s tweaking that is constantly done based on blood work every 3 months. I will b honest with you, I tried 2 doctors that did this, an neither one could get it right. The first one had me feeling cramps on lower back and abdomen for months, my emotions were a roller coaster. The next one had me waking up in blood every morning…. I wanted to share this with you, not to discourage you, but to give u hope. I too went through menopause very early in life. I’m 27 and am considered post menopausal. After realizing hormones weren’t really getting the balance right, I tried acupuncture. Let me tell you it helped immediately with anxiety and my emotional health. It reduced hotflashes considerably! I think it helped me get through the horrible menopause stage. Hope all works out with you too.

      • 298 CindiBender December 18, 2013 at 11:09 pm

        Thank you very much Vanessa – won’t go that way then I already cry at tiger drop of a host and bleeding no wat not worth it hugs and thank u

      • 299 Monica Beavers January 19, 2014 at 12:07 pm

        Vanessa, What type of acupuncture are you using. I also have used acupuncture for other problems and have had success. I would love to find out more. How often do you go for the treatment. Does your treatment include electrodes? Any info would be greatly appreciated as I am the most miserable woman currently. BHRT is not working for me or maybe I have the wrong doctor. Both is probably accurate as my doctor is a very young woman no older than 33 or 34 years old.

      • 300 Vanessa March 26, 2014 at 6:58 am

        Hello Monica,
        Sorry to hear you’re miserable! But there is light at the end of the tunnel. I’ll try my best to answer all your questions. I was going once a week, the session was about 30-45 min. I saw a doctor of oriental medicine. They are the best, because they are Doctors, and most will also have a pharmacy of Chinese herbs to complement the treatment. I didn’t do herbs, I did acupuncture only, but I hear the herbs help speed up the process greatly. After about a month, my anxiety was almost completely gone, after about 2 months I could tell a difference in my sleeping patterns, I was staying asleep and hotflashes greatly decreased. I did this for a yr, but after a while I didn’t do weekly visits but every other wk, and so forth, decreasing. I don’t have to go now. So it was very helpful. If you have any other questions, feel free to ask

  152. 301 Angela January 8, 2014 at 8:02 pm

    I am SO happy to have found your site after my countless hours of researching!
    Long story short…
    I’m now 39-1/2 years old and have been losing hair for 2 years exactly. I had my thyroid panel tested – all normal.

    I mentioned to my gynecologist that I’ve been having some spotting before my period for several years now and he suggested progesterone and he said it could even help with my hair loss.

    I ordered saliva test via ZRT labs (Progesterone and Estradiol).

    I took the saliva test on day 20 of my cycle. Here are my results:
    Estradiol E2 is .7 (normal range is 1.3-3.3)
    Progesterone is 127 (normal range is 75-270)
    Ratio: PG/E2 is 181 (optimal range 100-500 when E2 1.3-3.3)

    I was informed that even though my estradiol is LOW, I’m still estrogen DOMINANT since the ratio is 181:1 and optimal is like 600:1.

    Question 1) First of all, IS THIS TRUE about me being estrogen dominant with such a low estradiol number?

    For 1 week now, I’ve been using Emerita Progest cream. I see absolutely no signs of my hair loss stopping. I could lose about 200 strands while showering and always find it on my clothes FYI. Very very upsetting. Am I just awakening estrogen receptors? I don’t know but it’s still making me wonder if I should stop the cream.

    I’m seriously considering a Estriol cream (maybe a bi-est cream) although reading about estradiol is a little scary.

    Question 2) Does Estriol cream raise Estradiol levels? I don’t even know what my Estriol levels are. Maybe a bi-est is better?

    WOULD LOVE TO HEAR YOUR THOUGHTS. I’m really desperate to get to the end of my hair loss problem.


    • 302 Vanessa January 11, 2014 at 6:13 pm

      I wanted to share my observations with my hormone treatment, maybe it will be of some help. I should state I’m deficient in both estrogen and progesterone. At first they gave me mostly progesterone with very small amounts of estrogen combined in one pill. I was doing great! Then that medication was discontinued and I was given one with heavier estrogen. All I can say is that my hair began to thin and fall out as you described. For me it was the increase of estrone that caused the hair loss. It was very obvious. Needless to say when I stopped taking that medication my hair came back. For all it’s worth, I would like to say that in the 2 years I spent trying to get the right “balance” with hormone replacement, at times I felt I was only making matters worse. Lately I tried acupuncture, and let me tell you it opened my eyes. That I didn’t need to be taking that poison. It balances hormones naturally. I can give you more details about what it was like and how long I took to notice a difference, if this is a route you would even consider taking. Best regards, vanessa

  153. 303 Mo January 19, 2014 at 11:55 am

    Hi, I was diagnosed with uterine fibroids both large and small, thus causing me heavy periods and sometimes two periods per month. I am 49 years old, active and healthy woman. I have been peri-menopausal for years, but was having troubles due to large fibroids. Three different OB/GYB’s told me a Hysterectomy would help me with symptoms and I could be put on bHRT to help me with symptoms. On October 28, 2013 I had a total LAVH procedure that went good. Every day since I woke up in the hospital post surgery, I have had severe symptoms. My surgeon gave me a saliva test kit to bring home and take two weeks after the surgery. It took an additional three weeks to get the results back to the Dr. office. I was given a RX. for BIEST 1.2(50/50) /P 40/T 1 combination all in one tube and told to take two clicks daily before bed and never take on Sundays. She told me to rotate on inside arms, outside arms, inside leg, outside leg, both left and right limbs. I tried the two clicks as told with no symptom relief. I called the doctor and explained the symptoms were still there and she told me to go to three clicks daily, never on Sundays. As I am typing this reply message, I feel like the most miserable person on planet Earth. I’ve been doing the three clicks about two weeks now and I have a list of symptoms that fill a 8X10 piece of paper. I felt better before with Fibroids, heavy periods and low back pain than I do today. I am gagging, foggy headed, weak, flu like symptoms, pain behind my right eye,pounding heart, nausea, hotflashes any where from 25-30 a day/night, loss of appitate, depression to point of laying in bed crying, stomach cramps, spinning when I stand, memory loss, fear, back pain, tiredness,fear, vaginal dryness, horse in voice, loss of things that make me happy, quick to react, sweat then cold, no concentrating, trouble sleeping, frequent urination and more. My doctor has not even looked at surgical site or examined me since after the surgery on 28, October 013. Any suggestions…Desperate for relief. Want my life back. Want to exercise, ride my horse and socialize again. I can’t leave the house w/o feeling like i’m going to faint. My husband has been so understanding and I don’t know why he don’t throw me under the bus because I’ve been awful moody since surgery.

    • 304 Lisa marsh January 21, 2014 at 6:37 am

      You should request another saliva hormone test to see what they are since taking the transdermal bhrt. Otherwise you can order directly with ZRT Labs. By the results, you can determine if all your symptoms are hormone-related. Also recommend taking the full hormone panel test – not just the progesterone and estradiol. This will cortisol and DHEAS. These hormones are all interdependent on each other. When one or more is high/low it has a cascade effect.
      If you haven’t had your thyroid checked, you should request a full thyroid panel to determine if this is contributing.
      I’ve never heard of only applying bhrt six days out of the week. Sometimes the symptoms are related to the highs and lows (the dramatic swing) of the levels and not the levels themselves, if your levels are within expected range. Physiologically your body didn’t make sex hormones six out of the seven days before your surgery.
      Another aspect of dosing with bhrt I’ve realized is that most doctors have in mind that there is a standard and they don’t like to exceed a certain amount. But more is not always better. It’s what works best for you individually.
      You are your best advocate. You shouldn’t rely on any one else to educate you about what’s happening with your body. I recommend reading Screaming to be Heard, Elizabeth Vliet.
      Also, sometimes it is beneficial that the bi-est and progesterone is separate so you can make adjustments independent of each other.

  154. 305 Tammy January 21, 2014 at 7:17 pm

    I feel for you. Have you thought about hormone pellet therapy? The doctor tests your blood periodically to make sure you are getting the right amounts. I tried the saliva test, patches, & creams, but the pellets worked best for me. I feel normal again and more youthful as well. Would be worth a try & no more daily doses since they are inserted just under the skin. I’m up to once every six months now. Good luck to you.

  155. 306 Bonnie January 22, 2014 at 9:06 am

    Help! I am 23 and in surgical menopause, I have no ovaries and no uterus, but I did get to keep my cervix. I have been on bioidentical hrt since sept of 2013, and I have been all over the place! The main problems I am having are hot flashes, dizziness, fatigue, MAJOR headaches, and painful sex(which really means inability to have sex). I am married, and it is killing my husband. Right now I’m on Biest 50/50 1.2 mg per day, 40 mg @ 4% progesterone, and 2mg @ 2% testosterone. I am still having hot flashes and night sweats, no sex drive, exhausted, and have headaches. My main question is, is there too much progesterone in comparison to the biest? Or vice versa? I can’t drive due to the dizziness and light headedness, and I do not want to loose a job that I love, plus, I’m ONLY 23!!! And I don’t know if it is the hormones or just me, but I am becoming depressed, I feel useless! Any advice or opinions are welcome!!!

    • 307 Stephanie July 26, 2014 at 12:44 pm

      Have you started to feel better? I had a radical hysterectomy in September of 2011. I was only given 200 mg of Prometrium (progesterone). I was having severe anxiety and panic, so I started 1 mg biest and 2 mg of testosterone a month ago. I feel horrible. My anxiety is nonstop now. I am also dizzy and lightheaded. I went back to the doctor on Thursday, but she said there is not anything she can do until she gets blood tests back. She did the blood tests, so I will have to wait another 2 or 3 weeks for results. I am a teacher and starting school next week, but don’t know how I can teach feeling like this. I am 42 now, but have been dealing with this for 3 years. I am sorry you are so young and having so many complications. I hope you are doing better.

  156. 308 Elaine January 30, 2014 at 12:12 pm

    Easy question for the compounder (thanks in advance for the help). I started bi est one week ago. My hot flashes are still happening regularly. Is this an indication I should increase the dosage of my bi est? (currently .625/25mg/0.1ml)
    PS I am taking these not due to hot flashes but in hopes they help with my migraines that only started after I became menopausal and I have high hopes this will be the ticket.

    • 309 Gail PResson September 7, 2014 at 9:08 am

      Biest did not work for me. I was on it for 5 months and when I had blood work done, it showed that I did not have any estrogen? I found a new doctor, and began using Evamist, which immediately stopped the hot flashes, night sweats, and I began to sleep normal again. The bio-identical creams did not work for me at all, and I went through 2 different compounding pharmacies. Don’t allow yourself to wait too long, the creams may not work for you either. You should know fairly soon once beginning hormones, and I believe 5 months was plenty of time to adapt?

  157. 310 Vanessa Hooper March 7, 2014 at 8:09 pm

    I was very glad to find this blog because I’m at a bit of a loss. I am a 40yr old female who is premenapausal. I recently had blood work done and my progesterone was in the very low category (<0.1). My doctor prescribed a cream. I got it compounded from my local pharmacy. But once I got home and looked up the dosage, I'm finding that it is very high. I want to make sure this is safe, and won't have undue side effects. I appreciate your help. The cream is progesterone 20% (200mg/gm)

    • 311 thecompounder March 12, 2014 at 4:08 pm

      Thank you for your thorough comment. Because each individual’s treatment plan needs to be worked out in dialogue with her doctor and her pharmacist, I cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page. I wish you the best as you work out the best possible treatment plan with your practitioners.

  158. 312 JoAn Chesser April 17, 2014 at 3:21 pm

    Does a person have to have a prescription to obtain Bi-est?

  159. 314 Unknown April 24, 2014 at 5:16 am

    I am a nurse who takes Biest/Prog/Test 0.9/50/0.5. Had some diarrhea and abdominal pain. Thought I had a bowel obstruction. CT scan showed liver hemangiomas (benign tumors.) They are very common with hormone (Estrogen)supplementation. Please look these up on the internet for more information.This may help another so I am posting.

  160. 315 Laure Siepman May 17, 2014 at 11:44 am

    I am having plastic surgery in a few weeks. I have been told that I need to discontinue my Biest/Testosterone (4/7.5), which I have been taking various doses of since my hysterectomy 10 years ago. What can I expect to be the side effects for the two weeks before my surgery and the one week after?

    • 316 thecompounder June 3, 2014 at 6:09 pm

      I’m able to answer general health questions but not patient-specific questions on this blog. I encourage you to talk with your doctor or pharmacist about this question of possible side effects of going off of hormone therapy for a short amount of time. Thank you for taking the time to write! Take care,

  161. 317 Billie Bates June 3, 2014 at 5:06 am

    Hello, I am 36 and recently had hormone testing done. My testosterone was slightly elevated, and my estriol was depressed (less than 5) although my other estrogens where within range. Is it worth supplementing the estriol? Or can this be a precursor to even higher testosterone? I

  162. 319 Shari G July 2, 2014 at 5:06 pm

    Great info!
    Can you tell me what the “delivered dose” of E2 and E3 via:
    1) Bi-Est 80/20 5mg/ml, dosed at 2.5ml 3x per day? 2x per day?
    2) Bi-Est 60/40 5 mg/ml, dosed at 2.5ml 3x per day? 2x per day?
    MANY thanks!

    • 320 thecompounder July 5, 2014 at 10:23 am

      It’s very difficult to say and really depends on the quality of your compounded cream. The best way to see if the cream is entering the blood stream is to do a saliva test or urine test.

  163. 321 MizzzTake August 1, 2014 at 2:21 pm

    Hi Peter

    Very informative indeed – thank you for all the time and effort you have obviously put into this site. Learning about hormones has become almost a passion of mine in the last few years. I have read 90% of the above posts just out of curiosity. One thing I’ve been wondering about regarding estrone (E1) in older women (because fat tissue produces that once the ovaries stop making E2). Why don’t the doctors start with ONLY progesterone in the beginning to offset estrogen dominance, especially when the woman is overweight and maybe having issues like PCOS, fibroids etc. – and then gradually introduce E2/E3 as needed once it balances off the E1?

    And another related question that I haven’t been able to find an answer to – when a woman uses bioidentical progesterone cream, isn’t there a pathway for it to make E2 if it’s needed by the body, since it’s a precursor to most other female hormones? Or can it only be a precursor to other hormones if it’s naturally made by the body? I’m asking also because many women on here report pretty high doses (up to 200 mg) when a younger, healthy woman seems to be producing no more than 40-50 mg a day in the later half of her cycle. Why are the doses sometimes so high for older women?

    Best regards,

    • 322 thecompounder November 12, 2014 at 3:14 pm

      Hi JS,
      Thanks for posting these questions to the blog back in August. I’ve noted your questions about why doctors don’t start off prescribing progesterone to offset estrogen dominance, and if progesterone can be a precursor to E2. It sounds like another post about progesterone from Peter would be welcomed by the readership of the blog.
      Thanks again for writing. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm,

  164. 323 pam August 27, 2014 at 9:48 pm

    love all this info! but why does my rx say to take my progesterone on days 15-28 of my cycle when my cycle stopped 7 months ago? too late to call my o.b. and lately it’s been so hard to get hold of her…thought i’d ask here and see what I could find out. Thanks all!

    • 324 thecompounder November 12, 2014 at 3:23 pm

      Thanks for posting this question to the blog back in August. I hope you’ve gotten your question answered by this time that you’re receiving this reply!
      You’ve raised a good general question, which is how and why progesterone might be prescribed cyclically or continuously. I’ve added this question to a list of topics for Peter to weave into the next post he writes about hormones.
      Again, thanks for writing. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm,

  165. 325 Carol R August 30, 2014 at 7:45 am

    Hi Peter, Great website! I am a healthy, active 56 year old. I have been on and off bioidentical hormones for years, trying to get things balanced. I was using progesterone creams, then pills, testosterone cream, DHEA pills. Nothing helped, and seemed to get worse. At present, my testosterone and estrogen levels are on the low side, and my evening and middle of the night cortisol levels high(heart pounds, wide awake, etc). I did have saliva/urine tests thru ZRT which showed my thyroid normal. I have been having severe insomnia for a few years, and tried everything to address it. Most recently, after the results of my saliva/urine tests, my doc had prescribed 20mg DHEA in AM(which doc is switching to cream), 15mg pregnenolone in AM, and an Estriol 0.5mg/testosterone 0.5mg cream-pea sized amount, vaginally, all daily. I was using the e/t cream at night for a week, then switched to AM for about a week now. It seems to make me stronger and more energetic during the day, and at workouts. However, at night, my heart is pounding worse than ever, and I’m wide awake. I’ve been dealing with this insomnia for years, and thought I was getting it under control when I had my saliva levels checked, until the recent hormones were added. If there is any info missing that you need to know to help-Please, help if you can! I’m desperate! Thank you.

    • 326 thecompounder November 12, 2014 at 3:30 pm

      Thank you for writing in to this blog back in August. I hope you’ve found answers to your questions. We have found at our pharmacy that people who have strong relationships with both their doctor and pharmacist have the best outcomes. In our experience, it takes in-person visits, close analysis of lab results and good follow-up to best address health issues like the ones you’ve raised here. If you would like to add a pharmacist to your health care team, we recommend the online resource of the Pharmacy Compounding Accreditation Board,, which allows you to search for compounding pharmacies by state that have the highest quality standards in the field of customized medications.
      I hope this information helps. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm,

  166. 327 Gail PResson September 7, 2014 at 9:01 am

    Hi Peter, I hope you can help. I have been on Evamist 3 sprays twice a day and two weeks ago my doctor up my progesterone to 200 mg taken at night. she did this because I had up my sprays to three from two, and she felt I needed more estrogen. My recent test before upping my progesterone, was Estradiol fertility 112, and Progesterone 3.9. I am one year into menopause, and today I began bleeding as if I am having a period. I have been on hormones for about 10 months. Can you tell me if this is normal, of course I will be seeing my doctor again, but she is new to the menopause phase of life, so I would really value your opinion?


    • 328 thecompounder November 12, 2014 at 3:38 pm

      Thanks for writing into this blog back in September. I hope that you have had the chance to talk to your doctor about the question that you raised here. Having a good compounding pharmacist to check in with about these questions is a good idea, too. In our experience, it is important that your pharmacist and your doctor know your full situation to best address your questions. If you need a good resource for compounding pharmacists that would be geographically close enough for you to work with, we recommend the Pharmacy Compounding Accreditation Board, which allows you to search compounding pharmacies by state that have met the highest standards for quality in the field.
      I hope this information helps. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  167. 329 Susan September 23, 2014 at 5:33 pm

    Hi Peter, I have been on bi est for many years sublingual. After 12 years I started having low E symptoms and tested at 11. My Dr increased the dose and it went up some. Finally tried the cream for 6 month and did not absorb. My level went from 64 to 23 with 4 dose increases. My Dr put me on the bi est troche 10 weeks ago. I had levels drawn 2 weeks ago and my level went from 23 to 237 in 8 weeks. I do know that I am absorbing which is great. I have been having nausea, fatigue, anxiety and depression for the last 3 weeks. I felt good before that so I went past my optimal level. My Dr wants my levels to be between 90-150 and also wants me to feel optimal. I was on 2mg of estradiol and 3mg of estriol twice a day. He is now decreasing the dose to 1.5mg of estradiol and 1.5mg of estriol twice daily. Should I taper down by .25mg for a couple of weeks until I get to that dose? I hate to have to many symptoms of fluctuation at this point. I am 60 and at one time 237 would have been great but now it is not what I need to be at.

    • 330 September 24, 2014 at 11:28 am

      Hi Susan,
      Just FYI, I don’t think this blog is active anymore. I and others have posted questions, and Peter has not replied
      Sent from my Verizon Wireless BlackBerry

      • 331 thecompounder November 12, 2014 at 3:46 pm

        Thanks for writing in here back in September. The blog is still active, but Peter is just not able to respond to patient-specific questions in this online format. I’ve been noting several general questions that have come up recently about progesterone, so that Peter can write a post about this topic again.
        Thanks again,
        Krista Shaffer, Outreach Director at Koshland Pharm

    • 332 thecompounder November 12, 2014 at 3:44 pm

      Thank you for writing to Peter back in September. He’s not able to respond to specific questions through this blog, but I wanted to make sure you know about a resource we recommend in case you want to find a compounding pharmacist who could work with you and your doctor as a part of your health care team. The resource is the Pharmacy Compounding Accreditation Board,, and their site allows you to search for compounding pharmacies by state that have demonstrated a high commitment to quality. We have found through our work at our pharmacy that having a strong relationship with both your doctor and pharmacist can really help in adjusting dosages to best fit each person’s needs.
      I hope this information is helpful. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  168. 333 Susan September 23, 2014 at 5:38 pm

    I also wanted to add that I have had terrible symptoms when my E is low like below 80. I just want to avoid dropping so low again. I also take testosterone cream .2mg-.5mg everyday and my T level is 61. My free T is normal. Thanks so much for your help.

  169. 334 angela October 14, 2014 at 11:19 pm

    hi I have been started on 0.5% progesterone cream in 100g. I am to take 1ml per day. Just wondering how many grams of progesterone I would be taking per day, and is this a small or large dose. Also should I split the dose or start off with a smaller amount. Cheers Ange

    • 335 thecompounder November 12, 2014 at 4:08 pm

      Hi Ange,
      The question about whether you should split the dose or start off with a smaller amount is a good question to ask the pharmacist who you are working with. If you need a good resource for compounding pharmacies that are geographically close to you, you can see the website of the Pharmacy Compounding Accreditation Board, which allows you to search compounding pharmacies by state that have met the strictest national standards for quality.
      The question that you raise about converting grams to ml is a good general one I can ask Peter to incorporate into a future blog post about hormones.

      I hope this is helpful. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  170. 336 Shannon Potter Wilcox November 7, 2014 at 11:42 am

    Hi. I started taking bioidentical hormones in May of this year. Changed doctors in October for insurance purposes. The first doc put me on testosterone pellets and said they would convert to estrogen, and 25 mg of progesterone pills before bed. They worked well for about 2 1/2 months, but then I crashed and felt awful and gained 6 pounds in my thighs, belly and upper arms. Not at all happy with that since I worked hard to lose 53 pounds and maintained that for almost 2 years until this weight gain. Second doc found out the pellets never converted into any estrogen and my testosterone levels were very high. My estrogen levels were so low. She put me on 200 mg nightly progesterone and I sleep like a baby. She also put me on 1/2 ML of biest everyday. I have had breast tenderness starting about a week into using it. I am hoping this will settle down after my body gets used to the estrogen.

    1. when my hormones balance should I see that weight gain leave or am I prone to gain weight with hormones?
    2. Will the breast tenderness subside as soon as my body gets stable?
    3. is it necessary to rotate where I use the biest cream daily? I have read that you don’t need to. I have read that it should not be put in areas where fat stores easily, i.e. thighs, buttocks, stomach. I have read you should use it on your wrists, chest above the breast just below the neck area, and inside of your upper arms. I read your body uses it better below the umbilicus others say above is fine. So, where do I use it for best results and do I need to rotate it daily or just monthly.?
    Thanks you so much for taking the time to answer my questions.

    • 337 thecompounder November 12, 2014 at 4:29 pm

      Hi Shannon,
      Thanks for writing your questions on this blog. I’ve noted them for the next blog post Peter writes about hormones. Since Peter is only able to write in answer to general topics rather than patient-specific questions in this online format, I’ve noted the questions as:
      Is weight gain a common side effect of hormone replacement therapy?
      Is breast tenderness a common symptom of hormone replacement therapy?
      Where should creams be administered for the best results and should they be rotated daily or just monthly?
      Thanks again for writing these in. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  171. 338 Maureen November 21, 2014 at 7:54 am

    I appreciate the great info you provide on bioidenticals; has helped me tremendously!
    I have been in estriol vaginally just shy of 4 moths. Every 2nd day .75 g vaginally. 3 weeks ago I moved the Rx to a compounder closer to home and am noticing some distinct differences after week 3. The estriol now is very irritating and in the morning leaves the vagina with a burning sensation which is magnified when urinating. I’m at the end of the tube of estriol and wondered if the compound may have separated somewhat leaving more estriol per dose? I also am experiencing a large gush of clear fluid each morning which has not happened in the past. Any insights would be much appreciated.

    • 339 thecompounder November 26, 2014 at 10:52 am

      Hi Maureen – Thank you for writing. These are important questions you have raised and would be good ones to talk with both your doctor and compounding pharmacist about.
      In regards to your general question of whether it’s possible for a cream to have different doses of estriol at the beginning and end of the tube: if a compound is well-made, this should not happen. You could confirm with the compounding pharmacy you are working with that they are using a piece of equipment called a homogenizer for their creams. The purpose of a homogenizer is to mix the cream base and the active ingredients at a high speed to ensure that each teaspoonful has the same amount of active ingredient as another. Another important piece of equipment for a compounding pharmacy to use on all creams is an ointment mill, which makes the active ingredient micro-sized, improving penetration through the skin.
      I hope this information is helpful and that you are able to talk about these specific questions with your doctor and pharmacist. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

      • 340 Maureen Grellette November 26, 2014 at 2:29 pm

        Thank you very much for your detailed response. I met with the compounder and was able to determine they mix the powdered estriol into versa base with a spatula but it isn’t processed in a harmonizer. He also said that it goes into a mixer that spins quickly which I’m going to assume is the ointment mill. The owner pharmacist was not in today so I will be asking these questions again tomorrow.

        Found out they use powder estriol and versa base. The 1st Rx I had from another compounder was 1 Mg/gram vs the current Rx indicating 1mg/1ml. I suspect this is a problem because both ingredients are not the same weight/density for having a gram equal a ml.

        Appreciate your help and will share the outcome with you.

        Many thanks!


        Sent from my iPhone


  172. 341 LuAnn November 30, 2014 at 7:33 am

    Hi, I just learned of your site and thought I would ask a few questions. I have been on Bi-est 0.2 mg + 15 mg Progest for the past year. My blood work for estradiol showed 6 before I began the treatment and only 7.6 after almost a year. I am still losing hair rapidly but was sleeping better and have no more hot flashes, but belly fat has increased. My doctor took me off this and put me on Vivelle Dot 0.1 mg and the side effects were awful. She is now recommending 1 mg estradiol in pill form, but from what I am reading, this worries me because it passes through the liver. My recent bone density scan shows that I have osteoporosis, which is very depressing, since I have always been very active. All the medications for treating osteoporosis are very scary, with some very alarming side effects. I am only 58 and don’t know where to turn at this juncture.

    • 342 thecompounder December 3, 2014 at 11:12 am

      Thank you for writing. You have raised here important big picture questions that I’ve noted for future posts by Peter regarding considerations for oral vs. transdermal estrogen therapy, as well as steps that can be taken when osteoporosis is detected.
      The more specific question you are raising about why your doctor has chosen an oral form of estrogen in your particular case (considering some of the benefits you’ve read about regarding transdermal alternatives) is a good one to follow up with her about.
      A good website to check out if you would like to use a compounding pharmacy near you as another resource to discuss these questions with is– PCAB is a national organization that accredits compounding pharmacies that have demonstrated adherence to the strictest standards in the industry for quality, and their website allows you to search for accredited pharmacies by state. A good compounding pharmacist who knows you and who can work in partnership with your doctor can be a helpful addition to your health care team.
      I hope this information is helpful. Thanks again for writing.
      Krista Shaffer, Outreach Director at Koshland Pharm

  173. 343 Annette bohls February 13, 2015 at 7:25 pm

    well this also help me lose the water retention retention and the weight gain

  174. 344 Yaleigh March 21, 2015 at 4:48 am

    I am someone that is exquisitely sensitive to most hormones. I cannot tolerate even the smallest doses of pregnenelone, DHEA or oral progesterone because I think in me they must be converting to cortisol. I am now using the tiniest dose of estrogen (instead of .5 cc I use less than a lentil sized amount – so small I cannot even estimate actual dose). I recent did the 23andme genetic testing. One of the things it revealed was a mutation in one of my methylation genes. I am homozygous for COMT met/met (as is apparently 10-15% of people of northern European decent). This means I am a very slow metabolizer of stress hormones, dopamine and estrogens. It is the worrier vs warrior gene. Very interesting info and sure explains a lot. I am doing much better now but sure went through havoc before figuring this out. If anyone gets the testing done via the 23 and me website, it is something to look for if you are having similar issues.

  175. 345 Maggie Woods April 1, 2015 at 2:18 pm

    I just started Bhrt with 2mg estradiol/2mg test twice daily…once in the am and once in the pm. I feel great for the first four hours after a troche but I crash HARD in between… Like sleep under my desk I seem like a drunk person hard. Is this normal? Can I cut those babies in two and take them four times a day instead? The crash time is even worse than the fatigue and brain fog that led me to BHRT to start with. Of course I’ve only just started these less than 1 week ago so it may just be an acclimation kind of thing but seriously I not safe to drive or really do anything during that crash time. Thank you in advance for any thoughts!

  176. 346 Susan April 7, 2015 at 5:08 pm

    Hi Maggie,
    I went through this last year while on the troches. The dose spikes and then drops over a period of 4-6 hours and that is why you feel the crashing fatigue. It would be a great idea to split the dose 4 times a day until you adjust. It does take time but you will gradually be able to probably space out the dose as you go along. I do the sublingual drops and I had to do them 3-4 times a day for the first month or so. Now I do them twice a day. Hope this helps.

  177. 347 Christi April 8, 2015 at 11:00 pm

    Just starting on progesterone lipoderm 100mg/ml cream. I just applied my first dose and am hopeful for some relief soon! I’ve been on vivelle dot for the past 6 months, but recently the night sweats and hot flashes returned. I should add that I’m 43yo going through surgery induced menopause. Fatigue is also a major complaint. My new ND us starting me on the progersterone as well as thyroid usp. How long would you assume I notice a difference in energy levels? The weight gain and fatigue are my primary complaints. Thank you!

    • 348 thecompounder May 20, 2016 at 11:33 am

      Thanks for writing into the blog last year. I’ve noted the general question you’ve raised here that he could write about in a future post, which is how long it might take to notice a difference in energy levels after starting progesterone and thyroid medications. Thanks again for writing. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  178. 349 Angela May 1, 2015 at 8:53 am

    Hello! I just found this blog and have found the information very helpful! I am in Perimenopause and for the last year been managing my symptoms with compounded Progesterone in the form of troches. My last saliva test showed I am now a little low on estrogen so my doctor has decided to start giving me estriol. For the first 7-10 days she wants me to take .1ml. For me that sounds like an awful lot for someone that has never taken it before. I am very worried about initial side affects, water weight, breast tenderness, etc. I also have another cream that only has 5.6mg. It’s been years since I dealt with metrics but isn’t that a lot less then .1ml? Any information you could provide for me would be very helpful and appreciated. Thank you so much!


    • 350 thecompounder May 20, 2016 at 11:42 am

      Thanks for writing into the blog last year. While Peter can’t respond to patient-specific questions in this online format, I’ve noted a general question you’ve raised here that he could write about in a future post, which is ml to mg conversions in hormone creams.
      This would also be a great question for the compounding pharmacy you work with. If you need a good resource for finding a compounding pharmacist you could consult with in addition to your doctor, we recommend the Pharmacy Compounding Accreditation Board,, which allows you to search for compounding pharmacies by state that have met the strictest national standards for quality.
      Thanks again for writing. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  179. 351 Mindy July 19, 2015 at 8:28 am

    I was on the vivelle dot now switched to estradiol 0.5 I’m nervous to take the pill I have hot flashes, depressed and an emotional wreck

  180. 352 marina meyer July 21, 2015 at 3:25 am

    I recently started utrogestan 100mg together with one squirt of femigel. Is the relation good or is 200mg better?

    • 353 thecompounder May 20, 2016 at 11:45 am

      Thanks for writing into the blog last year. While Peter can’t respond to patient-specific questions in this online format, I’ve noted a general question you’ve raised here that he could write about in a future post, which is to comment on non-compounded hormones such as utrogestan and femigel.
      If you need a good resource for finding a compounding pharmacist you could consult with in addition to your doctor, we recommend the Pharmacy Compounding Accreditation Board,, which allows you to search for compounding pharmacies by state that have met the strictest national standards for quality.
      Thanks again for writing. All my best, Krista Shaffer, Outreach Director at Koshland Pharm

  181. 354 Teresa August 2, 2015 at 1:46 am

    Is there any research/ or proof that none of these do not cause any kind of cancers.

    • 355 thecompounder May 20, 2016 at 11:52 am

      Thanks for writing into the blog last summer. This is a great question to discuss with your doctor and compounding pharmacist as the research is very important to discuss in relation to your particular health history. Here is a link to another blog post Peter wrote aboutone article that came out summarizing some of the research on bioidentical hormones: In addition, if you are looking for a good compounding pharmacist to consult with along with your doctor, we recommend going to the website of the Pharmacy Compounding Accreditation Board at There you can look up compounding pharmacies by state that have met the highest national standards in the compounding industry.
      Thanks again for writing. All my best, Krista Shaffer, Outreach Director at Koshland Pharm

  182. 356 Emily October 2, 2015 at 3:22 am

    Hello, I am 51, periods have been erratic for 2-3 years, however I have had 3-4 periods in 2015. Four weeks ago, on a Sunday, I abruptly entered what appears to be hot flash hell, 30-40 hot flashes a day. Prior this I had not experienced hot flashes. I went to my doctor and my serum estradiol level was tested and the result was 18.9. I was prescribed Biest compound cream 80/20 at 2ml, along with 100ml Progesterone. I’ve been on this dose for three weeks, the hot flashes are maybe 5% better at most…I’m still having tremendous difficulty and diminished quality of life with these things! Is three weeks too soon to evaluate? …I’m so miserable and it’s very depressing to live each day like this. Thank you.

    • 357 Gail October 7, 2015 at 6:32 am


      I went through the same thing when first going into Menopause. My first attempt to resolved this with bio-identical was the Biest and progesterone cream, and it did not work at all. The doctor and I have been to six told me it could take 6 months, which was unsatisfactory. Finally, I got on progesterone pill and Evamist, which worked instantly. After two years, i am not on pellets, and Bio-identical micronized progesterone, 400 mg. The only symptom is break through bleeding, and they are telling me that it is because of the progesterone, and trying to get the dosage of everything right. Good luck, I hope you find a good doctor, that is always the problem!

    • 358 thecompounder May 20, 2016 at 12:11 pm

      Thanks for writing into the blog last September. While Peter can’t respond to patient-specific questions in this online format, I’ve noted an important general question you’ve raised here that he could write about in a future post, which is how long one should expect to wait for relief from hot flashes after starting treatment.
      This would also be a great question for the compounding pharmacy you work with. If you need a good resource for finding a compounding pharmacist you could consult with in addition to your doctor, we recommend the Pharmacy Compounding Accreditation Board,, which allows you to search for compounding pharmacies by state that have met the strictest national standards for quality.
      Thanks again for writing. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  183. 359 Lola November 13, 2015 at 1:05 am

    Thanks for your blog. I’m 49 with terrible hot flashes. Have been taking Estrace (micronized estradiol) 1mg for a year, and micronized progesterone 100mg at night. Worked for a while, but the symptoms are getting worse again. My question is: can I continue to take these low dose oral hormones, and supplement them with a transdermal formula that I was prescribed by a different doctor (that cream didn’t work on its own) .. the cream formula is progesterone 100mg/Biest 2.5mg? Is there a risk of combining oral and transdermal HRT?

    • 360 thecompounder May 20, 2016 at 12:24 pm

      Thanks for writing into the blog last November. Peter can’t respond to patient-specific questions in this online format, but this is a really important question to ask the compounding pharmacist you work with. I have noted the general question you raised about whether oral and transdermal HRT can be combined that Peter can discuss in a future blog post. Thanks again for writing. All my best, Krista Shaffer, Outreach Director at Koshland Pharm

  184. 361 Ida December 19, 2015 at 2:24 am

    I am wondering the proper conversion of going from 4 pills per day of 1.25 biest, to now taking biest in cream form.

    • 362 thecompounder May 20, 2016 at 12:26 pm

      Thanks for writing into the blog in December. While Peter can’t respond to patient-specific questions in this online format, I’ve noted a general question you’ve raised here that he could write about in a future post, which is oral to transdermal conversion.
      This would also be a great question for the compounding pharmacy you work with. If you need a good resource for finding a compounding pharmacist you could consult with in addition to your doctor, we recommend the Pharmacy Compounding Accreditation Board,, which allows you to search for compounding pharmacies by state that have met the strictest national standards for quality.
      Thanks again for writing. All my best,
      Krista Shaffer, Outreach Director at Koshland Pharm

  185. 363 Ida December 19, 2015 at 2:34 am

    I have been taking 4 pills of 1.25 biest per day, for the last couple of years and resented was switched over to biest in cream form, the strength is 2.5. I was told to apply it once per day, and if that was not enough to double the dose. I was wondering if that is the correct conversion, as the strength of the pills was working perfectly fine for me.

  186. 364 Ida January 27, 2016 at 10:28 pm

    Dear Sir: I really need your insightful knowledge, I am 55 years old and have been taking 2 biest 80:20 from 2009 to 2013, after going into menopause. Due to increased side effects and additional blood work tests my biest dose was increased at the being of 2014, to two 80:20 pills twice a day.

    Due to the current research of biest capsules being filtered via liver, and the hazards of threat of stoke and additional health issues, I switched to biodentical biest 80:20 cream. The starting strength given to me is 3.5 mg, to be rubbed on my inner arms.

    I have noticed some night sweats, foggy thinking and bladder issues, lack of energy. All of which I never had on the 5 mg of capsules.

    I am getting frustrated, but not wanting to return to the capsules, I was wondering the suggested proper strength of cream that I could try and wondering how much of cream is actually absorbed into the skin, for when I was taking 5mg capsules that seemed to work better.

    Also would you know the amount of biest that would have been absorbed after going via the liver, I was thinking 50%.

    Also I am going for additional blood work within two months; and was wondering what should be the proper precent that my blood work should be, if in a prefect world I had balanced hormones. Just to give me an idea of what to be working toward.

    I desperately am in need of you expert knowledge, in order to work towards balancing my hormones.

    Thank you Sir in advance for your help.


  187. 365 Tina March 16, 2016 at 12:13 pm

    I’m on BHRT as follows:

    Bi-est cream: .5 am / 1.0 pm
    Progesterone cream: .5 am
    Progesterone oral: 300 pm

    In mid-January we upped my progesterone as a trial for 10 nights to see how I would react. It went really well when I took a 200 mg with a 100 mg pill. I stopped the trial, then began working out the beginning of February, using the treadmill light to moderate for an hour.

    I am on the doses I listed at the top, and am now, once again, having hot flashes and night sweats. I’ve been on HRT since June 2015. We decreased my bi-est to .75/2xs day, then increased to 1.0 2xs day. Nothing helping with the hot flashes and night sweats.

    • 366 thecompounder May 20, 2016 at 12:51 pm

      Thank you for writing into the blog in March. While Peter cannot respond to patient-specific questions in this online format, I’ve noted your question that could be addressed more generally in a future blog post, which is approaches to take when hormone therapy is not addressing hot flashes and night sweats. Thanks again for writing, Krista Shaffer, Outreach Director at Koshland Pharm

  188. 367 Donna March 20, 2016 at 10:48 am

    I’m 52, post menopausal for two years, and have been researching ways to relieve my symptoms for three years now. One of the most informative and helpful doctors I have come across is a Dr. Diana Schwarzbein, who is an Endocrinologist specializing in menopause and bioidentical hormones. She herself is post menopausal and can personally relate to the various symptoms and problems associated with menopause. I recently learned that my own doctor who practices integrative medicine, actually received some training from Dr. Schwarzbein. I signed up for her free Menopause Minutes and now I receive an email every two weeks from her with a 5-6 minute audio file with a wealth of information on how to balance your hormones. Check her out at . She also has some videos on YouTube.

  189. 368 Lisa Marsh March 23, 2016 at 3:09 am

    You should consider a saliva test for Progesterone and Estrodial. Unless you know what amounts are actually available for your cells to use, those dosages of what you’re taking aren’t really relevant. Many doctors seem to use the dosages as something that can’t be deviated from but the fact is that each person metabolizes differently. For example, I’m on Vivelle Dot .1mg (estradiol) which is the highest available and a high dose of compounded Progesterone cream but when tested in saliva and in a blood test, my levels are moderate at best. And the ratio of the two is important too. It tooks two years and three doctors to get to such high dosages because many aren’t comfortable thinking outside the box.
    Also frequently it’s more than just estradiol and progesterone that causes hot flashes – norepinephrine and epinephrine have an effect.
    Also, I tried the biest cream for a year and had absolutely no decrease in hot flashes. Biest is commonly 80% estriol which the normal female only has a minute amount in their cells unless they’re pregnant.

  190. 369 dimpeledoll76 April 21, 2016 at 6:24 am

    What kind of pre testing and post testing do ypu recommend? I just started my biest today at .5mg transdermal q2 daily. I am also on 100mg progesteone bioidentical capsule q1 daily. I am 39 and irregular for the first time in my life and have been since 2014 after i stopped breatfeeding for three years. My OB has taking a seeum test to check my ovulatory status. I will know the results of this serum test next week. I believe i am perimenopause. I am a pack a day smoker and that tends to start peri menopause earlier than nonsmoking women.

    • 370 thecompounder May 20, 2016 at 12:47 pm

      Thanks for writing in this great question about recommended pre and post-testing. There are pros and cons to different kinds of tests – I’ve noted this topic for a future blog post for Peter. Thanks again for writing, Krista Shaffer, Outreach Director at Koshland Pharm

  191. 371 Jenn (jenn2014) May 5, 2016 at 4:04 pm

    I have a question I’m hoping someone can help with. I’m 37, in early peri-menopause, and my Dr. just prescribed 200mg bio-progesterone (half the month) and 1gr. Divigel/day. Took the progesterone last night for the first time and used the Divigel for the first time this morning. I tend to be very sensitive to anything I put in my body, but I had a pretty unpleasant reaction that started about 20 min after putting on the gel. I got super jittery, felt like I drank about 20 cups of coffee, mind buzzing, tightening in chest/stomach, heart pounding. It lasted about 4 hours and then slowly went away, left with just a slight headache the rest of the day. (also had a weird taste in my mouth). Anyway, I thought maybe we just started way too high. I called and left a message asking if I can just apply half or a quarter of the gel and explained my reaction. Nurse called back and said stop taking and come back in (which of course is weeks away). I found one other site with a lady who said she feels the same way when she gets too much estrodiol. Anyone heard of this? Do you think it would be foolish to just try and start with 25%ish (can’t measure it’s gel in a packet)? Or should I wait for my appt?

  192. 372 Joyce Redger May 16, 2016 at 6:45 pm

    When is the most therapeutic time to take BIEST/DHEA/TESTOSTERONE?? THESE RX’S ARE IN A TRIT/TROCHE

    • 373 thecompounder May 20, 2016 at 12:36 pm

      Thanks for writing in this question about the best time of day to take bi-est/dhea/testosterone troches. I’ve noted this for a future blog post by Peter. Have you also asked the compounding pharmacy that you work with? It’s an important questions. All my best, Krista Shaffer, Outreach Director at Koshland Pharm

  193. 374 Donna May 28, 2016 at 9:22 am

    I realize that bioidentical estradiol is prescribed based on test results, but I’m curious, what is the most common or average amount of estradiol filled by your pharmacy?

    • 375 thecompounder June 14, 2016 at 4:07 pm

      Thank you for your comment – I am planning to sit down with Peter soon to transcribe a “commonly asked questions about hormone therapy” blog post, and will make sure to ask him this question. All my best, Krista Shaffer, Outreach Director at Koshland Pharm

  194. 376 Eva October 6, 2016 at 11:30 pm

    Dose anyone have side affects from this like raceing heart headache chest hurt

  195. 377 Marti October 11, 2016 at 2:53 pm

    Hi, I have been using lifeflo progesterone cream everyday for about ten years, one pump per day. I am 57 years old, needless to say knock on wood I basically skated through menopause unscathed! Absolutely no symptoms what so ever, but in the last year I have been having severe painful intercourse, with burning. I have also started to notice I’m getting thicker around the middle with a lot of fat on stomach and legs , could I use the progesterone and estriol cream? Would it help with the fat and weight gain around stomach and legs ? I’m kind of afraid because of the bad things I’ve heard about estrogens , I just had a complete physical and I am a very heathy person except for type 2 diabetes which I control very well with metformin and januvia, PLEASE HELP! I have worked so hard to control my weight and be healthy!

  196. 378 Jane Strickland January 3, 2017 at 9:28 am

    I would like to know more about the side effects. Started the cream a week ago and now my food is tasting bad?

  197. 379 Beth March 16, 2017 at 5:52 am

    I am off of Vivelle 0.05 patch and Prometrium to see if I’m fully in menopause. I started these at age 49 and am turning 51. I was thinking of using LifeFlo Biestro cream along with Pro Gest progesterone cream. My question is how do you equate the dosage level of the Biestro compared to patches? Patches were 0.05 estradiol designed to deliver relatively steady state over 3-4 days. Biestro states one pump delivers 1mg or Estriol and 0.25mg Estradiol. I need/want to know how this compares to the level of estradiol delivered from the 0.05 patch. I assume its significantly less but not sure how to ‘translate’ the different in dosages/delivery mechanisms. Help please! Not looking for medical advice, just an explanation of how the dosing compares one to the other. Thank you!!

  198. 380 Fred Roosli May 16, 2017 at 10:52 am

    My wife has had hot flashes for 30 years. None of the prescriptions she got from her doctor seemed to resolve that problem. Through a friend she was able to try a compound, and hallelujah, the hot flashes diminished to short and less severe intervals. Problem is that we cannot get this compound from our doctor in the USA. Where can we get “Bi-Est (50/50) 0.4% Progresterone 8% HRT” – Our doctor will give a prescription, so can we possibly get it in the USA and/or Canada? Thanks for your help.

  199. 383 Sven Marcus May 29, 2017 at 12:04 pm

    Good day.
    I am currently on bi-Est 50:50 gel (E3:E2) 2 times per day, still having mild hot flushes especially at night – so wake up 2, 3 or sometimes 4 times per night. Really affecting me. I’m also taking cooling chinese herbs. But not really helpful. Been on all of it for many months. So it’s not like I’m impatient. I was wondering in your opinion should I try the 80:20 bi-est. Thanks

  200. 384 Manon November 20, 2017 at 1:52 am

    Hello, I’m petrified of starting the Biestrogen as have tried patches before and am very sensitive to progesterone. Was using Emirita Progest and realized my sleep disturbance was caused by it. It’s was like having 2 cups of coffee, buzzing within 45 mins of applying. I feel awful though, weakness, crashing fatigue, painful intercourse, hair getting very fine and srawy, I’m basically shrivelling up like a prune at 53! 😕 The biest is 20/80 for total 2.5 mg with 100 micro mg progest. Will the estrogen balance the negative progesterone side-effects?? I do have Hasimotos but that’s in balance. Help pla!

    • 385 Vanessa February 6, 2018 at 6:17 pm

      I have tried both, only progesterone for a while and the combination of estradiol and progesterone. I do feel better when I do both. I think when you do only one they tend to throw your body off balance. I have had similar symptoms to yours since I was 19 yrs old, I am now 32. I have tried so many things, since I too am extremely nervous about using hormones. I found acupuncture and Chinese herbs helped me so much. I think for someone like yourself just looking to relieve natural menopause symptoms, this may be a route you can investigate.

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