From the Guidelines
Bi-Estrogen (BiEst) Hormone Replacement Therapy
Bi-estrogen hormone replacement therapy, also known as bi-estrogen therapy, typically involves the use of a combination of two estrogen compounds, estriol (E3) and estradiol (E2), in a specific ratio, such as 80% estriol and 20% estradiol 1.
Key Components and Administration
This combination can be compounded into various dosage forms, including:
- Oral capsules
- Transdermal creams
- Vaginal suppositories
The typical dosage range is 1.0-2.5 mg of the estriol/estradiol combination per day, administered in a continuous or cyclic regimen for a duration of 3-6 months or longer, depending on individual patient needs and response to therapy.
Considerations and Recommendations
It's essential to note that the FDA has not approved any type or class of bioidentical hormone therapy for the prevention of chronic diseases in postmenopausal women, and the safety and effectiveness of these products have not been evaluated through the FDA's drug approval process 1. The American Heart Association and the American Congress of Obstetricians and Gynecologists recommend against the use of menopausal hormone therapy for the primary or secondary prevention of cardiovascular disease 1.
Important Points to Consider
- Estrogen Replacement: Estrogen replacement in adult women can be achieved with various preparations, including 1–2 mg of oral 17β-estradiol (17βE) daily, 50–100 micrograms of transdermal 17βE daily, or 0.625–1.25 mg of conjugated equine estrogens daily 1.
- Transdermal Administration: The transdermal administration of 17βE seems to be the preferred route as it mimics the physiological serum estradiol concentrations, providing a better safety profile than oral formulations 1.
- Individualization: The decision to use hormone therapy should incorporate women's health and quality-of-life priorities, as well as personal risk factors such as risk for venous thrombosis, CHD, stroke, and breast cancer 1.
From the Research
Definition of Bi-Estrogen (BiEst) Hormone Replacement
- Bi-Estrogen (BiEst) hormone replacement refers to a type of bioidentical hormone replacement therapy that combines two types of estrogen, typically in an 80:20 ratio 2.
- This ratio usually consists of 80% estriol and 20% estradiol, although the exact composition may vary depending on the specific formulation and dosage.
Composition and Dosage
- BiEst is often used in combination with progesterone, and the dosage can vary depending on the individual's needs and the specific formulation being used 2, 3.
- Studies have investigated the pharmacokinetics of BiEst in comparison to conventional hormone replacement therapies, such as estradiol patches and oral progesterone 2.
Efficacy and Tolerability
- Research suggests that BiEst hormone replacement therapy can be effective in relieving symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness 3.
- BiEst has also been reported to have fewer side effects compared to conventional hormone replacement therapies, although some women may experience weight gain, breast tenderness, and bloating 3.
Comparison to Synthetic Hormones
- Some studies suggest that bioidentical hormones, including BiEst, may have different physiological effects and potentially lower risks compared to synthetic hormones 4.
- However, more research is needed to fully understand the safety and efficacy of BiEst hormone replacement therapy, and to determine its optimal dosage and composition 2, 4.