What Are Estriol / Estradiol / Progesterone Capsules?
They are compounded oral capsules that combine two estrogens — estriol and estradiol, together often called "Bi-est" — with progesterone. Prescribers use systemic hormone therapy to address menopausal symptoms such as hot flashes and night sweats. It is prepared by prescription for an individual patient.
How the Ingredients Work
Estradiol and Estriol — the Estrogens
Estradiol is the most active estrogen and does most of the work for menopausal symptoms; estriol is weaker. Together they form "Bi-est," a commonly prescribed compounded estrogen combination. Journal of Urology
Progesterone — Protects the Uterine Lining
In a woman who still has a uterus, estrogen alone can overstimulate the uterine lining; progesterone is included specifically to reduce the risk that unopposed estrogen poses to the endometrium. Oxford Academic
Safety Information
Systemic estrogen-plus-progestogen therapy carries boxed warnings, and clinical surveillance is important; the Women's Health Initiative studies reported risks including probable dementia in older women and other serious effects. Systemic estrogen is also associated with cardiovascular events, stroke, blood clots, and breast cancer. Any abnormal vaginal bleeding should be evaluated. Patient selection, dosing, and follow-up are the prescriber's responsibility, and Mixwell makes no recommendation about therapy. Endocrine Society
Quality and Compliance — Hazardous Drug Handling
Because these are hormones, handled as hazardous drugs, Mixwell prepares these capsules in a purpose-built lab meeting USP <795> standards for non-sterile compounding and USP <800> standards for hazardous drugs, including HD negative-pressure containment. They are dispensed only with a valid prescription for an individual patient. Mixwell is a non-sterile pharmacy and does not prepare sterile products or injectables. Compounded medications are not reviewed or approved by the FDA. Nothing here promises a specific result, and compounded preparations are not presented as superior to commercially available products.
References
- National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. Washington, DC: The National Academies Press; 2020.
- Stuenkel CA. Compounded bioidentical hormone therapy: new recommendations from the 2020 National Academies of Sciences, Engineering, and Medicine. Menopause. 2021;28(5):576–578.
- American College of Obstetricians and Gynecologists. Compounded Bioidentical Menopausal Hormone Therapy. Clinical Consensus. 2023.
- BIJUVA (estradiol and progesterone) Prescribing Information. U.S. Food and Drug Administration.
- Professional Compounding Centers of America (PCCA). Formulation science and compounding resources. https://www.pccarx.com/Blog/