| Name | Biest 50:50 + Progesterone (e.g., compounded estradiol/estriol + micronized progesterone), used for hormone replacement therapy (HRT). |
| Uses | Indicated for hormone deficiency symptoms in elective settings: hot flashes, vaginal dryness, decreased libido, mood changes, night sweats, cognitive changes, and bone health support. Not for acute or emergency indications. |
| Route Of Administration | Topical (transdermal cream), Oral (capsule), or Sublingual (troche). Not administered via IV or IM in this context. |
| Frequency Of Use | Once daily; reassess every 4–6 months. Max of 1 prescription refill per 3-month interval unless otherwise directed. |
| Concentration(s) | Biest 50:50 (Estradiol: Estriol) typically 2.5 mg/mL total estrogen; Progesterone 100–200 mg/mL. |
| Maximum Dosage (Day, Wk) | Daily maximum: Biest ≤2.5 mg total estrogen; Progesterone ≤200 mg. Weekly max equals daily dose × 7. |
| Contraindications | Absolute: History of breast, ovarian, or endometrial cancer; active liver disease; clotting disorders; stroke/MI history; unexplained vaginal bleeding; allergy to estrogen/progesterone. Relative: High BP, smoking, thyroid disease (monitor closely). |
| Possible Side Effects | Common: Bloating, nausea, mood changes, breast tenderness, irregular bleeding. Rare: Stroke, thromboembolism, breast cancer, endometrial hyperplasia. |
| Compatibility With Other Treatments/Drugs | Avoid with blood thinners, tamoxifen, and estrogen blockers. Caution with corticosteroids and thyroid meds; monitor hormone levels. |
| Allergies | Estrogen or progesterone. Cross-check compounded ingredients (e.g., coconut oil base). |
| Administration Time | Apply/transmit once daily; oral progesterone at night to minimize drowsiness. Onset: 1–4 weeks for symptom relief. |
| Dosing/Settings | Typical Biest dose: 0.5–2.5 mg/day transdermal; Progesterone: 100–200 mg/day oral or transdermal. Adjust per labs/symptoms. |
| Test Spot Requirement | Not required. Full treatment can begin without test spot unless allergic history or sensitive skin. Monitor closely first 48 hours. |
| Pre-Treatment Guidelines | Ensure no contraindications per GFE. Recommend baseline labs (E2, P, FSH, LH, CMP, CBC, lipids, TSH). Avoid alcohol 24h prior. |
| Provider Clearance Guidelines | Only proceed if over 18, female at birth, experiencing menopausal or hormonal imbalance symptoms, with no deferral conditions in GFE. |
| Pre-Treatment Screening Workflow | See exam logic: Confirm age >18, female sex at birth, absence of high-risk symptoms or history, and reason for treatment. Labs and screenings preferred. Defer if active contraindications. |
| What To Do If Adverse Reaction Occurs | 1) Stop medication immediately. 2) Assess airway/breathing. 3) Administer diphenhydramine 25–50 mg PO/IM for rash/mild reaction. 4) For chest pain or stroke symptoms, call 911. 5) Document and notify supervising MD/NP. |
| Clinic Implementation Guidelines | Reception: Confirm exam completed, schedule follow-up, and flag contraindications. Supplies: Prescription pad or EMR access, treatment logs. Provider: Review GFE, approve prescription. |
| Photographic Documentation Protocol | Not required unless using transdermal in cosmetic area. If so, take standardized photos pre/post for documentation. |
| Post-Treatment Care | Apply at same time daily. Monitor for breakthrough bleeding. Follow up in 3 months or sooner if symptoms worsen. Continue regular mammogram/Pap if indicated. |
| Additional Documentation Requirements | Signed informed consent, symptom checklist, prescription logs, lab attestation if no labs submitted. Document provider decision rationale and dosing. |