Biest or Oestradiol?
Oestrogen choices for HRT and menopause symptoms.

Biest or Oestradiol ?
Compounded Bioidentical Hormones or Factory-made Bodyidentical Hormones.
Which ones are better? Who do you believe? And how on earth do you decide?
It is a tricky question, and this article is the starting point for you to understand the terminology used and then be able to engage in your research with an open mind.
It is important to remember that no matter what you decide, you can always change your mind. It is your body and your health, and you have the autonomy to choose.
Oestrogen Basics
Regardless of the option you choose to help navigate menopause, your oestrogen must be applied topically and not swallowed as a tablet. There is no debate around this statement as topical oestrogen is a safer option and more effective on the body when delivered this way.
Oestrogen is a term that encompasses several hormones – oestrone, oestradiol and oestriol. Often the terms oestrogen and oestradiol are used interchangeably, so please be aware of this when doing research.
Oestrone is produced in the ovaries and in small amounts in fat cells. It can be converted into oestradiol if needed and is the predominant form of oestrogen after menopause.
Oestradiol is the most powerful oestrogen and is produced in the ovaries, so levels plummet after menopause. This is the formulation used in all HRT.
Oestriol is a ‘gentler’ form of oestrogen and is only produced in very small amounts in the ovaries, so drops after menopause. Oestriol is only added to compounded HRT, though it is also available in factory-made vaginal creams.
For a full refresher on oestrogen types see the post entitled Types of Oestrogen!
Remember that if we prescribe oestrogen, of any sort, to a woman with a uterus, we also need to prescribe progesterone. There are benefits to taking progesterone for women who do not have a uterus, but it is not essential.
Compounding – huh?
Compounding is when a chemist takes raw active ingredients and combines them with ‘fillers’ to create a tablet, capsule, suspension or cream. Some pharmacists only change tablets into liquids for people that have difficulty swallowing, others have full labs where they make many types of different compounds. We need compounding pharmacies as some products used in regular medicine today are simply not available in commercial dosing. However, compounding is a self-regulated industry meaning that the quality of the product will depend on the quality of the ingredients and the skill/care of the pharmacist. Are they using ‘home brand’ products or top-of-the-line verified ingredients? Does their supply chain vary depending on what ingredients are on special, or do they stick to the one source for their production?
There are many variables, which is why you need to know your pharmacist and talk to them about their processes.
Do not buy online at a discount price! This is where there are highly likely to be inconsistencies in the production line.
So what is biest then?
Biest is the name given to compounded bioidentical HRT used in menopause, containing a mix of oestradiol and oestriol in one preparation. The most common application is via a cream but it is also available as a troche. A troche is simply a wafer that dissolves in your cheek pouch. I don’t tend to prescribe troches due to my own bias, as I tend to crunch things like boiled lollies, so am scared I would swallow the troche, negating the effect of bypassing the liver! If you like this idea or have always used this delivery method, I am willing to continue the supply.
The reason for the combination of oestriol with oestradiol is to help dampen any negative effects of the more powerful oestradiol. The negative symptoms of oestradiol overdose include moodiness, weight gain, anxiety, fluid retention, acne, tender breasts, spotting/bleeding, carb cravings or increased appetite. These tend to occur when increasing the doses of oestradiol to try and counteract flushes and insomnia. By adding oestriol the effect of oestradiol is enhanced, allowing a lower dose, and thus fewer side effects. Leaving only the positive experience of HRT in menopause, reduced flushes and night sweats, increased libido, improved vaginal atrophy, less brain fog and improved gut health and metabolism.
The usual ratio of oestrogens used in biest is 80:20. This means 80% oestriol and 20% oestradiol. This can be altered to any percentage needed. There are no clinical trials to say what ratio is optimal, it is a personal experience.
It does take some time to adjust which can be frustrating. Many women find it works well and they feel more balanced using this product.
Benefits and concerns with compounded Bioidentical HRT Hormones
Benefits of compounding
– individualised dosing
– creams are easier to apply than a gel
– can include other hormones such as testosterone in the preparation when required, which makes application easier and reduces cost
– bought in 3 monthly lots – meaning fewer chemist visits
Downsides
– needs a specialised chemist, preferably one with experience
– no regulation – strength and continuity of quality depends on the chemist
– can be more expensive, especially when starting
– bought in 3 monthly lots, so higher initial outlay
– you may get some raised eyebrows that you are not following the conventional route taught by medicine. This can then impact which doctors are willing to prescribe the medication.
I would also like to point out that just because a product is compounded and may be made from plants, it is not better, or more natural. It is still a processed chemical, regardless of source.
Benefits and Concerns with Bodyidentical Hormones in Menopause
The conventional, off-the-shelf version. What most of us call an oestrogen patch or gel.
These are the same as bioidentical hormones – the same structure outside the body as inside the body – just made in a factory. Thus, they are regulated and monitored by the TGA (Therapeutic Goods Administration), meaning that any oestrogen patch or gel that you purchase on a script, from a regular pharmacy in Australia, will be regulated and oestradiol alone.
Benefits
– oestradiol alone will combat most of the symptoms of menopause
– monitoring in the factory to ensure consistent dosing.
– no controversy around usage
– some versions are on the PBS, making it cheaper
– available at any chemist
Downsides
– limited by commercial dose ranges, which may make menopausal symptom control suboptimal.
– requires monthly chemist visits.
– if you require testosterone, it ends up more expensive than bioidentical hormones.
– currently (2023-2024), there are supply issues with patches
What do I prefer?
I love the flexibility of biest, along with fewer chemist visits. I also like the accessibility of straight oestrogen/oestradiol and the fact that some versions are on the PBS, though not enough. Because I prescribe bioidentical hormones I also get to talk to pharmacists and build relationships with them. And it is true, there are some I would recommend, and others who may not be quite so up to date, or particular about their work. This is not a criticism of pharmacists, merely an observation and is seen across all industries.
In an ideal world, women’s health, from conception to fertility and into perimenopause and out through post-menopause, would be taken more seriously, funded properly and research invested into future generations. In this ideal world, things like biest would be properly trialed despite there not being a big drug company involved! Then my choice would be simple! Sadly, we do not yet live in this ideal world, and so I am sitting firmly on a lovely comfy seat on the fence happy to support both points of view.
So, in the end, it comes down to a personal choice.
In my opinion, there is no incorrect choice, just what feels right to you, and helps you navigate your health, in your optimal fashion.