CreamTransdermalNon sterile Rx only

Bi-Est Cream (Estriol / Estradiol) Compounded BHRT

Topical Cream Base

Compounded Bi-Est cream (estriol and estradiol), prepared in Chino, CA to a prescriber's order and shipped across California. Not FDA approved.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

USP <795> compliant
USP <800> hazardous drug lab
PCCA member

At a Glance

Preparation details for Bi-Est Cream (Estriol / Estradiol) Compounded BHRT
Dosage form	Cream
Route	Transdermal
Active ingredients	Estriol, Estradiol
Technology	Topical Cream Base
Strengths in literature	Ratios such as 80/20, 70/30, and 50/50 estriol to estradiol are prescribed. No ratio has been tested in a clinical trial.
Commercial product	No U.S. commercial product
Strength and directions	Per prescriber
Dispensing	Valid prescription

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Phone (909) 378-7301. Fax (909) 378-7071

Clinical Advantages

Multiple actives in one base
Custom strength available
Applied topically
Dye free option
Non sterile preparation

How It Works

What is Bi-Est cream?

Bi-Est cream is a compounded bioidentical hormone cream that combines two estrogens, estriol and estradiol, in one cream applied to the skin. Mixwell prepares it in Chino, California to a prescriber's order for menopause symptoms. The name means two estrogens, and it is not an FDA approved drug.

What does the 80/20 ratio mean?

The ratio describes how much of each estrogen the cream contains. An 80/20 Bi-Est cream is 80% estriol and 20% estradiol by weight, and 70/30 or 50/50 ratios are also prescribed. Estriol is a weaker estrogen than estradiol [4]. No clinical trial has shown that any particular ratio works better or is safer than another [1].

How it works

Estradiol is the main estrogen the ovaries make before menopause. It is the same molecule in FDA approved estradiol gels, sprays, and patches [1].
Estriol is a weaker estrogen that the body makes mainly during pregnancy [4].
Applied to the skin, the estrogens are absorbed into the bloodstream. How much is absorbed from a compounded cream is not standardized the way it is for approved products [1].

When prescribers choose it

Menopause specialists and gynecologists whose patients want estriol, which no FDA approved product contains
Prescribers whose patients react to an ingredient in an approved estradiol gel, spray, or patch
Integrative and functional medicine practices that prescribe bioidentical hormone replacement therapy (BHRT)
Prescribers who want a specific estrogen ratio or strength in a cream

Clinical Details

What does the evidence show?

The American College of Obstetricians and Gynecologists (ACOG, 2023 Clinical Consensus No. 6) found a lack of high quality data on the safety and effectiveness of compounded bioidentical hormones. It advises that compounded menopausal hormone therapy not be prescribed routinely when FDA approved options exist, and notes that FDA approved bioidentical options, such as estradiol and micronized progesterone, are available [1].
ACOG also advises against using saliva or urine hormone tests to dose compounded hormones, since the FDA has approved no saliva or urine test for these hormones. It recommends adjusting the dose to symptom relief [1].
The Menopause Society's 2022 hormone therapy position statement lists concerns with compounded bioidentical hormones, including possible overdosing or underdosing, a lack of safety and effectiveness data, and the lack of a label listing risks [2].
Weiderpass and colleagues (1999, The Lancet) studied 789 women with endometrial cancer and 3,368 controls in Sweden. Taking estriol by mouth, 1 to 2 mg daily, for at least 5 years was linked to about 3 times the risk of endometrial cancer and about 8 times the risk of atypical endometrial hyperplasia. Vaginal estriol showed only weak associations. This study used oral estriol, not a Bi-Est cream [4].

Findings come from the cited studies and do not promise any individual outcome.

Why is it compounded, and how is it typically used?

Is Bi-Est cream FDA approved?

No. Estriol is not in any FDA approved drug, so no Bi-Est product is approved. Estradiol alone is FDA approved as gels, sprays, and patches. Estriol can still be compounded, because it has an official USP monograph, which federal compounding law accepts [3].

Why it is compounded

A prescriber orders compounded Bi-Est cream to include estriol, to use a specific ratio or strength, or to avoid an ingredient a patient reacts to in an approved product. National guidance favors FDA approved hormones first, so the decision and the reason belong to the prescriber [1][5].

Can I get Bi-Est cream online in California?

Bi-Est cream requires a prescription from a licensed prescriber who has evaluated you. Your prescriber sends it to Mixwell, and we compound it in Chino and ship it across California, or you can pick it up at the pharmacy. Patients in Chino Hills, Ontario, Pomona, Rancho Cucamonga, and across the Inland Empire use our Chino pharmacy.

Dosage forms and strengths

Ratio and total strength set by the prescriber, such as 80/20, 70/30, or 50/50
Cream base applied to the skin
Progesterone prescribed separately or in the same cream when a patient has a uterus
Dye free versions on request

Dosing, the progestogen plan, and monitoring are the prescriber's decision.

How Mixwell prepares it

Mixwell compounds Bi-Est cream in Chino, California under USP 795 standards for non sterile preparations, in a facility with a USP 800 negative pressure containment room [7]. Our pharmacist confirms the ratio, strength, and application directions with the prescriber before compounding. Batch records document every preparation, and finished creams ship across California.

Safety information

Estrogen without a progestogen raises the risk of endometrial hyperplasia and endometrial cancer in people who have a uterus. Estriol is not exempt: oral estriol has been linked to higher endometrial cancer risk, and the study's authors advised adding a progestagen [4]. Prescribers decide how to protect the uterine lining, and any vaginal bleeding after menopause needs prompt evaluation [6].

Compounded Bi-Est has no FDA label, so it carries no official list of warnings, even though the risks of estrogen still apply. Its strength can also vary more than an approved product's [1][2]. The FDA's 2026 labeling changes to menopausal hormone therapy apply to approved products, not compounded ones [8].

Let the cream dry, wash your hands after applying it, and keep treated skin away from children and pets. Patient selection, dosing, monitoring, and duration are the prescriber's responsibility.

References

American College of Obstetricians and Gynecologists. Compounded bioidentical menopausal hormone therapy: ACOG Clinical Consensus No. 6. Obstet Gynecol. 2023;142(5):1266 to 1273. doi:10.1097/AOG.0000000000005395
The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767 to 794. doi:10.1097/GME.0000000000002028
Pinkerton JV, Pickar JH. Update on medical and regulatory issues pertaining to compounded and FDA approved drugs, including hormone therapy. Menopause. 2016. doi:10.1097/GME.0000000000000523
Weiderpass E, Baron JA, Adami HO, et al. Low potency oestrogen and risk of endometrial cancer: a case control study. Lancet. 1999;353(9167):1824 to 1828. PubMed 10359406
National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. Washington, DC: National Academies Press; 2020. doi:10.17226/25791
American College of Obstetricians and Gynecologists. Committee Opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):e124 to e129. doi:10.1097/AOG.0000000000002631
United States Pharmacopeia. General Chapters 795 and 800. USP NF.
U.S. Food and Drug Administration. FDA approves labeling changes to menopausal hormone therapy products. February 12, 2026. FDA news release

What to include on the prescription

APIs and strengths
Base or vehicle
Quantity
Directions for use
Refills
Allergies or dye free needs

Call (909) 378-7301 Fax (909) 378-7071

Compounded in Chino, CA. Delivered across California.

Chino
Chino Hills
Ontario
Pomona
Diamond Bar
Rancho Cucamonga
Eastvale

Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Compounded medications are not reviewed or approved by the FDA. Dispensed only with a valid prescription. Mixwell is a non sterile pharmacy and does not prepare sterile products or injectables. Compounded preparations are not presented as superior to commercially available products, and nothing here promises a specific result. Mixwell does not accept insurance. Call for pricing.

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