| Name | Compounded Biest (Estradiol + Estriol). |
| Uses | Bioidentical hormone replacement therapy (BHRT) for menopausal symptoms, estrogen deficiency, and vaginal atrophy. |
| Route Of Administration | Oral (capsules), transdermal (cream, gel), sublingual, vaginal (suppository or cream). |
| Frequency Of Use | Typically once or twice daily, depending on provider recommendation and patient response. |
| Concentration(s) | Standard ratios: 80:20 (80% Estriol, 20% Estradiol) or 50:50 (equal Estriol and Estradiol). Strengths: 0.5mg, 1mg, 2mg, 4mg per dose. |
| Maximum Dosage (Day, Wk) | Oral: Max 2-4mg/day. Transdermal/Vaginal: Max 4mg/day. Long-term use should be reviewed periodically. |
| Contraindications | Active or history of hormone-sensitive cancers (breast, ovarian, uterine), undiagnosed vaginal bleeding, history of thromboembolism, active liver disease, pregnancy, lactation. |
| Possible Side Effects | Breast tenderness, bloating, headache, nausea, mood swings, fluid retention, increased risk of clotting events. |
| Compatibility With Other Treatments/Drugs | Use caution with progesterone (for balancing effects), anticoagulants, CYP3A4 inhibitors/inducers, thyroid medications (estrogen can impact thyroid binding globulin). |
| Allergies | Check for hypersensitivity to bioidentical hormones or excipients in compounded formulations. |
| Administration Time | Oral/Sublingual: Morning or evening. Transdermal/Vaginal: Evening preferred for best absorption and patient convenience. |
| Dosing/Settings | Oral: 1-2mg/day. Transdermal/Vaginal: 1-4mg/day. Adjust dosing based on patient response and lab monitoring. |
| Test Spot Requirement | Transdermal: Apply a small amount to the inner forearm and monitor for irritation over 24 hours. |
| Pre-Treatment Guidelines | Baseline hormone panel (estradiol, estriol, progesterone, FSH, LH), mammogram if indicated, endometrial assessment for postmenopausal women with bleeding. |
| Provider Clearance Guidelines | Ensure no contraindications, confirm hormone deficiency via labs if needed, discuss risks/benefits with patient. |
| Pre-Treatment Screening Workflow | 1. Verify indication. 2. Assess contraindications. 3. Obtain informed consent. 4. Evaluate hormone levels if needed. |
| What To Do If Adverse Reaction Occurs | For mild symptoms (bloating, breast tenderness): Lower dose and reassess. For severe reactions (clotting symptoms, abnormal bleeding): Discontinue and refer to specialist. |
| Clinic Implementation Guidelines | Confirm prescription, educate patient on proper use, document treatment details in EMR. |
| Photographic Documentation Protocol | Not required unless skin irritation occurs with transdermal formulations. |
| Post-Treatment Care | Monitor hormone levels every 3-6 months, adjust dosage as needed, assess for side effects. |
| Additional Documentation Requirements | Signed informed consent, treatment logs, prescription details, and adverse event documentation if applicable. |
| Special Notes | Biest must often be balanced with progesterone in women with an intact uterus to prevent endometrial hyperplasia. |