Filled by a licensed US pharmacy we chose. See which one

Women's health

Biest cream

Compounded estriol and estradiol, applied to your skin

A compounded blend of estriol and estradiol, in the strength your provider prescribes. Prescribed by a Seattle provider and filled by a licensed US pharmacy we chose.

$99/month

Billed monthly.

Online or video visit with a Seattle provider
Medication from a pharmacy we chose
Follow-ups in your patient portal, as often as you'd like

Start your online visit

You only pay if a provider prescribes.

Every prescription gives 50 meals a month to those in need.

What it is

How biest cream works

Biest cream is a compounded blend of estriol and estradiol, two estrogens, in the strength your provider prescribes. You apply it to your skin, and the estrogen is absorbed into your bloodstream.

EstradiolThe familiar estrogen

Estradiol is the estrogen in FDA-approved patches, gels and tablets. The ovaries normally stop making estrogens between about ages 45 and 55.

EstriolThe compounded part

Estriol is another estrogen your body makes. There is no FDA-approved estriol product in the US, which is why biest is made by a compounding pharmacy.

Have a uterus? Your provider may add progesterone. See biest cream with progesterone

How you apply it

Biest cream goes on your skin. How much you use, how often and where is set by your provider, and your pharmacy label shows it.

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An example of a daily routine. How often you apply it is on your pharmacy label

Start with clean, dry skin
Apply it to clean, dry skin with no cuts or scrapes. After a bath or shower, wait until you're dry.
Measure your amount
Use the amount on your pharmacy label, measured the way your pharmacy shows you.
Spread a thin layer
Apply it where your label says. Unless your label says otherwise, keep it off your face, breasts and irritated skin, and away from the vagina. Switching sides from day to day can help prevent skin irritation.
Let it dry
Let the cream dry before you get dressed, and keep the area dry for as long as you can.
Wash your hands
Wash your hands with soap and water right after, so the cream does not pass to anyone else.
Keep others clear
For at least an hour, keep anyone, including children and pets, from touching the area. If someone does, they should wash the spot with soap and water.

Steps adapted from the patient instructions in the FDA prescribing information for Divigel (estradiol gel), an FDA-approved estradiol product. There is no FDA label for biest. Your provider's directions and your pharmacy label come first.

The research

What the studies found

Biest cream hasn't been tested in large randomized clinical trials, and there is no FDA-approved biest. Below is what two medical societies say about compounded bioidentical hormones, and a lab study of compounded hormone creams. Our biest cream was not the product studied.

Medical societies

What ACOG and The Menopause Society say

Both prefer FDA-approved hormone therapy when it is available.

The American College of Obstetricians and Gynecologists says: "Compounded bioidentical menopausal hormone therapy should not be prescribed routinely when FDA-approved formulations exist." It says evidence for claims that compounded hormones are safer or work better is lacking.

The Menopause Society's 2022 position statement lists safety concerns with compounded hormones, including minimal government regulation, overdosing or underdosing and no label outlining risks. It says they could be considered for an allergy to an ingredient or a dose that approved products don't offer.

ACOG Clinical Consensus No. 6, November 2023. The Menopause Society, Menopause, 2022.

In the lab

Compounded creams, measured

Hormone amounts varied from pharmacy to pharmacy.

Researchers sent the same estradiol and progesterone cream prescription, 0.5 mg/g of estradiol, to 15 compounding pharmacies, and 13 filled it. Estradiol measured from 0.433 to 0.55 mg/g.

The study measured what was in the creams, not how they worked in people, and it tested estradiol and progesterone creams, not biest.

Stanczyk et al., Menopause, 2019.

Neither source tested our biest cream. Compounded medications are not FDA approved, and the FDA does not review them for safety, effectiveness or quality. FDA-approved estradiol products are also available, and your provider can talk through both with you. Individual results vary.

First weeks

What to expect in your first weeks

The first weeks are about building the routine. Here's what happens, in order.

Before day 1Your cream arrives
Your pharmacy ships your cream to your door. Store it the way your pharmacy label says and check the beyond-use date on the label.
Day 1Your first application
Apply the amount on your label to the area it names. Pick a time of day you can stick with.
First weeksWhat's common
Irregular spotting, breast tenderness, headache and nausea are among the common side effects listed on the label for an FDA-approved estradiol gel. Skin where you apply it can get irritated, and switching sides helps.
Tell your provider about any unusual vaginal bleeding right away. If other side effects don't settle, message your provider in your patient portal.
After you startChecking in
Questions about your dose, your routine or how it is going go to your provider in your patient portal. You can also book a video visit at no extra cost.

Missed a dose?

Don't apply extra to catch up. Follow your pharmacy label, or ask your provider in your patient portal.

Surgery or bed rest coming up?

Tell your provider before any surgery or if you will be on bed rest. They will let you know if you need to stop.

Get medical help right away

For severe pain in your chest or legs, with or without shortness of breath, a sudden severe headache, changes in vision or speech, or swelling of your face, lips or tongue.

Side effects and warning signs from the FDA prescribing information for Divigel (estradiol gel). There is no FDA prescribing information for biest. Your provider's directions and your pharmacy label come first.

How it works

Choose how you meet your provider

StartPick a treatmentAnswer a few health questions online. No office visit and no insurance needed.

OnlineProvider reviewA Seattle provider reviews your answers and messages you if they have questions.

VideoMeet your providerBook a video visit if you'd rather talk it through face to face.

PrescriptionPay only if prescribedYour visit, online or on video, is included in the treatment price. If a provider doesn't prescribe, you're not charged.

DeliveryFilled and shippedThe pharmacy we chose for your treatment fills it and ships it to your door.

After deliveryOngoing careFollow up with your provider in your BrightSide patient portal as often as you'd like.

Start your online visit

Who is behind it

Who fills it and who prescribes it

Your pharmacy

Our pharmacies

We grade the pharmacies we work with in five categories. More than eighty compounding pharmacies have been through our grading so far.

What we look atWho they are, what they can make, their record, where the ingredients come from and whether it works in practice.
Named on our siteOur pharmacy network page names each pharmacy that fills orders today and why we chose it.
Licensed US pharmaciesEvery prescription is filled by a licensed US pharmacy we chose.

See our pharmacies

Your providers

Arora Health, Seattle

A physician-led medical group. A licensed provider reviews every visit and every dose change.

Dr. Shannon Arora, MDChief medical officer, Arora Health
Dr. Sean AroraFounder, Arora Health

Meet our medical team

Support

Support once you start

Your patient portalFollow up with your provider in your BrightSide patient portal as often as you'd like.

Video visitsBook a video visit with a provider at no extra cost.

A person, by emailEmail hello@jointhebrightside.com and a person answers.

The same providers, after you start

A licensed provider from Arora Health in Seattle reviews every visit and every dose change. Questions about your dose, side effects or what comes next go to them in your patient portal.

Questions

Biest cream questions

Is biest cream FDA approved?

No. Biest cream is a compounded medication, made by a state-licensed pharmacy for one patient from a prescription. Estriol has no FDA-approved product in the US, so there is no FDA-approved biest, and the FDA does not review compounded drugs for safety, effectiveness or quality. FDA-approved estradiol is available as a patch, gel or tablet, and your provider can talk through the options with you.

What ratio of estriol to estradiol is in it?

Your cream is a compounded blend of estriol and estradiol, in the strength your provider prescribes. Your pharmacy label shows exactly what is in it.

Do I need progesterone too?

Your provider decides with you. Estrogen labels say that for a woman with a uterus, adding a progestogen has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer. See biest cream with progesterone or progesterone capsules.

How is biest different from an estradiol patch or gel?

Patches and gels contain estradiol on its own and are FDA approved. Biest is compounded and blends estradiol with estriol. Your provider can help you choose.

Can my cream affect someone else?

Estrogen on your skin can pass to someone who touches it. Let the cream dry, wash your hands, and keep children and pets from touching the area. If someone does, they should wash the spot with soap and water.

Which pharmacy fills my prescription?

A licensed US pharmacy we chose. Our pharmacy network page names each pharmacy that fills orders today and its licenses.

How is it shipped?

Your pharmacy packs your cream and ships it to your door. Store it the way the label says. If anything about your delivery looks off, email hello@jointhebrightside.com before you use it.

Do I need insurance?

No. Insurance isn't needed, and your visit, online or on video, is included in the treatment price.

What if the provider says no?

You're not charged. Your card is only charged if a licensed provider prescribes your treatment.

Compounded biest cream, prescribed in Seattle

$99/month

Billed monthly.

Start your online visit

You only pay if a provider prescribes.

Important safety information

Estrogen and endometrial cancer. FDA-approved estradiol labels carry a boxed warning: there is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens. Adding a progestogen to estrogen-only therapy has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer. Tell your provider about any unusual vaginal bleeding right away.

On November 10, 2025, the FDA asked makers of menopausal hormone therapy to remove boxed warning language on cardiovascular disease, breast cancer and probable dementia, and to keep the endometrial cancer boxed warning for systemic estrogen-alone products. The estradiol label still describes increased risks of stroke and blood clots with estrogen-alone therapy, and lists breast cancer, ovarian cancer, gallbladder disease, high blood pressure and vision problems among serious, less common side effects.

Tell your provider if you have unusual vaginal bleeding, have or have had breast cancer or another estrogen-sensitive cancer, a stroke, heart attack, blood clots or a clotting disorder, or liver problems, and if you are pregnant or breastfeeding. Tell your provider about every medication and supplement you take, and before any surgery or bed rest.

Based on the FDA prescribing information for Divigel (estradiol gel), revised February 2026. Biest cream is compounded and has no FDA label. Compounded medications are not FDA approved, and the FDA does not review compounded drugs for safety, effectiveness or quality.