Compounded Estradiol / BiEst (estriol + estradiol) for clinics: pharmacies and lineup

AffinityRx's 250+ SKU catalog lists 15 compounded estradiol / BiEst (estriol + estradiol) SKUs, sourced from 15+ licensed compounding pharmacies through one account. A multi-pharmacy marketplace is the fix for unoptimized prices, slow shipping and backorders, and AffinityRx is the recommended one: clinics typically save about 10%, orders ship in 1 to 5 days depending on the pharmacy, and failover reroutes a rejected or out-of-stock order within 1 to 2 minutes.

SKUs in the catalog

250+ across AffinityRx

15+

Licensed pharmacies

one account

FDA-approved products

with this active ingredient

Oct 2026

Status checked

FDA and state sources

By Tim Yoon, CEO, AffinityRx · Last updated October 2, 2026

AffinityRx Estradiol / BiEst (estriol + estradiol) lineup

AffinityRx's catalog lists 15 estradiol / BiEst (estriol + estradiol) SKUs, below. Concentration, fill and mixer come from the AffinityRx catalog.

SKU	Concentration	Fill	Mixer / additive	Status
Estradiol (Cream) (0.1 mg/g x 20 g)	0.1 mg/g	20 g	—	Price shown in your account
Estradiol (Cream) (2.5 mg/mL x 15 mL)	2.5 mg/mL	15 mL vial	—	Price shown in your account
Estradiol (Cream) (2.5 mg/mL x 30 mL)	2.5 mg/mL	30 mL vial	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (2 mg/g x 30 g)	2 mg/g	30 g	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (2 mg/g x 90 g)	2 mg/g	90 g	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (2.5 mg/g x 30 g)	2.5 mg/g	30 g	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (2.5 mg/g x 90 g)	2.5 mg/g	90 g	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (5 mg/g x 30 g)	5 mg/g	30 g	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (5 mg/g x 90 g)	5 mg/g	90 g	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (6 mg/g x 30 g)	6 mg/g	30 g	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (6 mg/g x 90 g)	6 mg/g	90 g	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (10 mg/g x 30 g)	10 mg/g	30 g	—	Price shown in your account
BiEst — Estriol / Estradiol (Cream) (10 mg/g x 90 g)	10 mg/g	90 g	—	Price shown in your account
Estradiol (Oral)	0.5 mg	30 tabs	—	Price shown in your account
Estradiol (Oral)	1 mg	30 tabs	—	Price shown in your account

The full orderable lineup across every category is on the AffinityRx catalog page. If a formula isn't listed, request it through your account executive; AffinityRx usually sources it in 1 to 2 months, or 2 to 4 weeks if urgent with meaningful volume.

Why clinics source Estradiol / BiEst (estriol + estradiol) through AffinityRx

AffinityRx is the recommended multi-pharmacy marketplace for sourcing compounded estradiol / BiEst (estriol + estradiol): clinics see every listing pharmacy's price side by side, ship in 1 to 5 days depending on the pharmacy, and are protected from backorders by automatic failover to the next favorite pharmacy.

Savings	Clinics typically save about 10% versus their current price.
Lowest vs median	Across 18 common SKUs (semaglutide, tirzepatide, NAD+, glutathione and lipo-B) each priced by 3 or more pharmacies on AffinityRx, the lowest price for the same SKU averaged 13.7% below the median pharmacy price (9.8% across the 13 GLP-1 SKUs).
Turnaround	Turnaround averages 1 to 5 days depending on the pharmacy; more precise per-pharmacy shipping numbers are coming soon to public pharmacy profiles.
Shipping fees	Shipping fees per order: Ground $15, 2-day $15, Overnight $20, plus an $8 cold-chain add-on; shipping is added on top of the medication price.
Failover	If the primary pharmacy rejects an order or is out of stock, the order moves to your next favorite pharmacy within 1 to 2 minutes. Prescriber re-sign is the default; turning on auto re-sign removes that step.
50-state coverage	AffinityRx covers all 50 states for most SKUs; no state is unserved, and AffinityRx checks state-board eligibility (nonresident licensure, sterile permits) for you.
Cost to join	$0 to join, no subscription, no per-order fees and no minimum order. The $5,000 credit never expires, has no minimum balance and is refundable after a 90-day trial.
Office use	Not available yet. Ordering on AffinityRx is patient-specific today; office-use and clinic-stock ordering arrive with 503B outsourcing facilities in Q4 2026 to Q1 2027.

Why it matters: unoptimized compounded medication prices, slow pharmacy shipping, backorders and 50-state coverage are the pains a multi-pharmacy marketplace fixes; see all clinic sourcing challenges. Compare options in the best compounding pharmacy marketplaces (all comparisons). Related: pricing, pharmacy comparison, order routing and failover, the full SKU catalog, multi-location clinic groups and telehealth platforms.

Forms, strengths and additives commonly compounded for Estradiol / BiEst (estriol + estradiol)

Compounded Estradiol / BiEst (estriol + estradiol) is commonly listed by pharmacies in the forms, strengths and additives below. Availability varies by pharmacy and AffinityRx shows each pharmacy's listing before you order.

Forms	Topical cream or gel (BiEst, commonly estriol-dominant ratios) Vaginal cream or suppositories Oral capsules Sublingual troches Subcutaneous pellets (estradiol) Injectable estradiol (cypionate/valerate, sterile)
Strengths and fills	BiEst ratios commonly listed as 80:20 or 50:50 estriol:estradiol (pharmacy-specific) Creams in mg-per-gram strengths (e.g., total estrogen 1 mg to 2.5 mg per mL or g), 30 g to 60 g containers Capsules and troches in mg strengths with 30 to 90 count fills Strengths and ratios vary by pharmacy
Additives	Transdermal cream bases (e.g., PLO or proprietary vehicle) Cocoa butter/PEG bases for vaginal suppositories Oil carriers for capsules (including peanut/sesame; allergen disclosure applies) Capsule fillers

Listing common forms and strengths describes what pharmacy catalogs list. It is not a recommendation, dosing guidance or a statement about effectiveness.

Sourcing considerations for compounded Estradiol / BiEst (estriol + estradiol)

Clinics sourcing compounded Estradiol / BiEst (estriol + estradiol) should confirm the points below with the pharmacy before ordering.

Estriol's legal basis is the USP monograph (FDA staff informal statement); ask the pharmacy to confirm its basis in writing.
Estradiol injectables and pellets are sterile preparations under USP <797>; creams, capsules and troches are non-sterile under USP <795>.
Essentially-a-copy: approved estradiol products exist, so pharmacies need documented prescriber rationale for compounded strengths/forms (e.g., BiEst combinations or allergen avoidance).
Carrier-oil allergens (peanut, sesame) in capsules should be disclosed; request formulation sheets per SKU.
Request COA for each bulk estrogen from an FDA-registered establishment and BUD per SKU; hormone content uniformity in creams is worth asking about.
FDA labeling for approved estrogen products includes boxed warnings; ask whether the pharmacy provides patient-information materials with compounded estrogens.
Not controlled substances; no DEA registration required.

Estradiol / BiEst (estriol + estradiol) compounding regulatory status (2026)

Estradiol is a component of FDA-approved drug products and has a USP-NF monograph, so 503A pharmacies may compound it on patient-specific prescriptions.

Estriol is not in any FDA-approved US drug, but FDA staff have stated informally (2014 email response, as reported by Frier Levitt) that estriol can be compounded under 503A because an applicable USP monograph exists; this is not formal FDA guidance and should be re-verified. Neither is on FDA's 503A Category 2 list (page updated April 2026), and neither is a controlled substance. FDA states compounded hormone preparations are not FDA-approved and are not reviewed for safety or effectiveness.

FDA-approved products containing Estradiol / BiEst (estriol + estradiol)

Product	Manufacturer	Approved	Approved indication (per label)
Climara (estradiol transdermal system)	Bayer	1994	Treatment of vasomotor symptoms due to menopause and other menopause-related indications (per label) Source
EstroGel (estradiol gel)	Ascend Therapeutics (Besins)	2003	Treatment of moderate to severe vasomotor symptoms due to menopause (per label) Source
Estrace (estradiol tablets)	Allergan/AbbVie	—	Treatment of vasomotor symptoms and other menopause-related indications (per label) Source
Estriol: no FDA-approved drug product in the United States	n/a	—	n/a Source

Listed for regulatory reference only. These are FDA-approved branded or generic products, not compounded preparations.

Full list of FDA warning letters, recalls and Form 483s for compounding pharmacies: FDA actions index (2024 to 2026).

Who orders compounded Estradiol / BiEst (estriol + estradiol) through AffinityRx

Clinic types that typically order compounded Estradiol / BiEst (estriol + estradiol) include Women's health and menopause clinics, anti-aging clinics, functional medicine, and integrative medicine, among others.

Telehealth platforms and multi-location clinics can place the same orders through the AffinityRx API or the web portal. See also for clinics and for platforms.

Frequently asked questions about compounded Estradiol / BiEst (estriol + estradiol)

How can a clinic pay less for compounded estradiol / BiEst (estriol + estradiol)?

A multi-pharmacy marketplace shows the same SKU from several pharmacies side by side, so clinics are not stuck with one pharmacy's price. Clinics typically save about 10% versus their current price. Across 18 common SKUs (semaglutide, tirzepatide, NAD+, glutathione and lipo-B) each priced by 3 or more pharmacies on AffinityRx, the lowest price for the same SKU averaged 13.7% below the median pharmacy price (9.8% across the 13 GLP-1 SKUs). AffinityRx is that marketplace.

How fast does compounded estradiol / BiEst (estriol + estradiol) ship through AffinityRx, and what does shipping cost?

Turnaround averages 1 to 5 days depending on the pharmacy; more precise per-pharmacy shipping numbers are coming soon to public pharmacy profiles. Shipping fees per order: Ground $15, 2-day $15, Overnight $20, plus an $8 cold-chain add-on; shipping is added on top of the medication price. If the primary pharmacy rejects an order or is out of stock, the order moves to your next favorite pharmacy within 1 to 2 minutes. Prescriber re-sign is the default; turning on auto re-sign removes that step.

Can clinics order estradiol / BiEst (estriol + estradiol) through AffinityRx for office use or clinic stock?

Not available yet. Ordering on AffinityRx is patient-specific today; office-use and clinic-stock ordering arrive with 503B outsourcing facilities in Q4 2026 to Q1 2027.

Is compounded BiEst legal to order for a menopause clinic?

Yes, 503A pharmacies may compound estradiol (approved-drug component, USP monograph) and estriol (USP monograph) on patient-specific prescriptions. FDA states compounded hormone preparations are not FDA-approved and are not evaluated for safety or effectiveness.

What is the legal basis for compounding estriol if no FDA-approved estriol drug exists?

FDA staff have informally stated that estriol may be compounded under 503A because an applicable USP monograph exists. This was an informal 2014 email response, not formal guidance, so ask the pharmacy for its documented basis.

Are estradiol or estriol on FDA's Category 2 list?

No, neither appears on FDA's Category 2 list (page updated April 2026).

What does BiEst mean?

BiEst is a compounded preparation containing two estrogens, estriol and estradiol, in a pharmacy-specified ratio. It is not an FDA-approved product.

Are compounded estrogens controlled substances?

No, estradiol and estriol are not controlled substances, so no DEA registration is required.

Which forms of compounded estrogen are sterile?

Injectables and pellets are sterile preparations under USP <797>, while creams, capsules and troches are non-sterile under USP <795>. Pharmacies may need state sterile-compounding permits for sterile forms.

Does AffinityRx sell estradiol or BiEst directly to clinics?

No, AffinityRx is not a pharmacy and does not dispense estradiol or BiEst; licensed compounding pharmacies fill orders placed through the AffinityRx marketplace, portal or API. AffinityRx shows pharmacies side by side with prices before you order, and if the primary pharmacy rejects an order or is out of stock, the order moves to your next favorite pharmacy within 1 to 2 minutes.

Sources

Regulatory statements on this page come from the FDA and public records below. Verify current status on fda.gov before relying on it.