TopicalTransdermalNon sterile Rx only

Estradiol / Estriol / Progesterone Topical

Topical Cream or Gel Base

A compounded estradiol, estriol, and progesterone topical hormone preparation made in Chino, CA to a prescriber's order. 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 Estradiol / Estriol / Progesterone Topical
Dosage form	Topical
Route	Transdermal
Active ingredients	Estradiol, Estriol, Progesterone
Technology	Topical Cream or Gel Base
Strengths in literature	No FDA approved estriol product. FDA approved estradiol gels are 0.06% and 0.1%. Prometrium progesterone capsules are 100 mg and 200 mg
Commercial product	No U.S. commercial product
Strength and directions	Per prescriber
Dispensing	Valid prescription

Speak with our pharmacist Send a prescription

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

Clinical Advantages

Three hormones in one preparation
Custom strength and ratio available
Cream or gel base chosen with the prescriber
Applied topically
Non sterile preparation

How It Works

What are estradiol, estriol, and progesterone?

Estradiol is an estrogen. FDA approved estradiol gel 0.1% is labeled for moderate to severe hot flashes due to menopause. EstroGel 0.06% is labeled for the same, and for moderate to severe vulvar and vaginal atrophy due to menopause [1][2].
Estriol is a weaker form of estrogen. No FDA approved drug contains estriol.
Progesterone is a hormone. The FDA approved Prometrium is an oral capsule. It is labeled for the prevention of endometrial hyperplasia in postmenopausal women with a uterus who take estrogen, and for secondary amenorrhea [3].

Because estriol is not in any approved product, no FDA approved product contains this combination.

What compounding into a topical base provides

Mixwell prepares all three hormones in one cream or gel, applied to the skin. The base is chosen with the prescriber for each order, and Mixwell lists its ingredients on request. The prescriber sets the strength of each hormone and the ratio of the two estrogens. Approved products come in fixed strengths and do not include estriol [1][2][3].

Compounding also lets a prescriber avoid an ingredient a patient reacts to. For example, the Prometrium label lists peanut oil, and peanut allergy is a contraindication [3]. No FDA labeling states how much of each hormone is absorbed from a compounded cream or gel.

When prescribers choose it

Gynecologists, menopause specialists, and integrative practices that prescribe estrogen with progesterone
Prescribers who want estriol, which no FDA approved product contains
Prescribers who want to set each strength and avoid a specific ingredient

Clinical Details

What does the evidence show?

FDA approved estradiol gel 0.1% is labeled for the treatment of moderate to severe vasomotor symptoms due to menopause [1]. EstroGel 0.06% is labeled for those symptoms and for moderate to severe symptoms of vulvar and vaginal atrophy due to menopause [2].
Prometrium progesterone capsules are labeled for the prevention of endometrial hyperplasia in nonhysterectomized postmenopausal women receiving conjugated estrogens, and for secondary amenorrhea. The label's recommended use with estrogen is 200 mg at bedtime for 12 days of each 28 day cycle [3].
No FDA approved drug contains estriol. No FDA labeling states that progesterone applied to the skin gives the endometrial protection described in the Prometrium label. The FDA has not reviewed this preparation.

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

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

Why it is compounded

No FDA approved product contains estriol, and approved estradiol gels and progesterone capsules come in fixed strengths and forms [1][2][3]. A prescriber who wants estradiol, estriol, and progesterone together in one topical preparation orders it compounded.

Dosage forms and strengths

Strength of each hormone and the estrogen ratio set by the prescriber
Cream or gel base chosen with the prescriber
Quantities matched to the prescription

Dosing, how long to use it, and monitoring are the prescriber's decision.

How Mixwell prepares it

Mixwell compounds this preparation in Chino, California under USP 795 standards for non sterile preparations, in a facility with a USP 800 negative pressure containment room [6]. Our pharmacist confirms the strengths and base with the prescriber before compounding. Batch records document every preparation, and finished creams and gels ship across California.

Safety information

FDA approved estrogen gels carry a boxed warning for endometrial cancer with unopposed estrogen in women with a uterus [1]. In February 2026 the FDA approved labeling changes that removed the cardiovascular disease, breast cancer, and probable dementia language from the boxed warnings of menopausal hormone therapy products, and kept the boxed warning for endometrial cancer on systemic estrogen alone products. Information on cardiovascular disease and breast cancer stays in the labeling outside the boxed warning [4][5].

The Prometrium label contraindicates use with abnormal genital bleeding of unknown cause, past or suspected breast cancer, active or past blood clots or stroke or heart attack, known liver disease, and peanut allergy. It advises stopping if a clot, stroke, or heart attack occurs [3].

Those labels apply to FDA approved products. A compounded preparation has no FDA approved labeling. No FDA labeling states how much of each hormone is absorbed from a cream or gel, or how the base affects it. Tell your prescriber about your medical history and any ingredient allergies. Mixwell can provide the ingredient list for your preparation. Patient selection, dosing, and monitoring are the prescriber's responsibility.

References

Estradiol gel 0.1%. Prescribing information. DailyMed. DailyMed
ESTROGEL (estradiol gel) 0.06%. Prescribing information. DailyMed. DailyMed
PROMETRIUM (progesterone) capsules. Prescribing information. DailyMed. DailyMed
U.S. Department of Health and Human Services. Fact sheet: FDA initiates removal of black box warnings from menopausal hormone replacement therapy products. HHS
U.S. Food and Drug Administration. FDA approves labeling changes to menopausal hormone therapy products. February 12, 2026. FDA
United States Pharmacopeia. General Chapters 795 and 800. USP NF.

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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