Estradiol + Progesterone
Bioidentical estradiol and progesterone for menopause symptoms like hot flashes and night sweats. Your clinician sets the dose from your symptoms and health history.
See if I qualifyFrom $71/mo$0 until a clinician approves · FSA/HSA eligible
$0 until a clinician approves.
- Clinician-reviewed in 24 hours
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- Pause or cancel anytime
To get a prescription, you need an online visit reviewed by a U.S.-licensed provider. Compounded medicines are made by licensed U.S. pharmacies and are not FDA-approved. Results vary from person to person.
Who it’s for
- Perimenopause or menopause symptoms (sleep, hot flashes, mood)
- PCOS, irregular cycles, or hormonal acne
- Want a clinician who checks your labs before prescribing
Most people are told it's stress long before anyone asks about menopause.
How it works
Estradiol is the main estrogen your ovaries make. Bioidentical estradiol (built the same as your own) helps with hot flashes, sleep, mood, and bone loss in perimenopause and menopause.
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What we can and can't tell you
Timing matters. The balance of benefit and risk is best when you start within 10 years of when menopause began. That is true across large groups of women. It isn't a promise for any one person. Your plan and how you take it depend on your symptoms and history. If you have a uterus, you need progesterone too.
- Who makes it A LegitScript-verified 503A compounding pharmacy makes it from your prescription. We never use gray-market or overseas suppliers.
- To what standard USP <797> standards for sterile compounding, and USP <800> standards for handling hazardous drugs, where they apply
Compounded medicines are not FDA-approved. The FDA does not review them for safety or effectiveness. They are not generic versions of any brand-name drug, and they are not equivalent to one.
What the first months look like
You start estradiol. Tender breasts can happen early as your body gets used to estrogen again. Tell your clinician about any bleeding so they can check it.
Hot flashes, night sweats, and broken sleep are usually the first to ease. Progesterone taken at bedtime can make you drowsy, which helps you sleep.
Your dose is adjusted based on your symptoms and how you respond, not a fixed schedule.
Your clinician reviews the benefits and risks of staying on therapy at each check-in, based on your own health.
Dosing, step by step
| Transdermal estradiol | 0.025–0.1 mg/day patch — skips a first pass through the liver; may carry a lower clot risk than pills |
|---|---|
| Oral estradiol | 0.5–2 mg/day — another option when it fits |
| Progesterone (continuous) | 100 mg/day at bedtime — taken at night, since it can make you drowsy |
| Progesterone (cyclic) | 200 mg/day, days 1–14 of each calendar month — cyclic or continuous both work; it's a matter of preference |
If you still have your uterus, estradiol always comes with progesterone (oral micronized). This protects the lining of your uterus. Your clinician decides how you take it and on what schedule. The ranges here come from the ingredient profile. They aren't a target.
And when it gets rough
Show what helps
- Breast tenderness or bloating Common early on. It usually settles once your dose is steady. If it doesn't go away, bring it up at your check-in so your dose can be reviewed.
- Spotting or bleeding Tell your clinician about any new or unexpected bleeding. They'll check it instead of assuming it's part of adjusting. Don't wait it out.
- Drowsiness or dizziness on standing (progesterone) Take progesterone at bedtime so the drowsiness works for you. Stand up slowly. Tell your clinician if it lasts into the day.
- Leg swelling, chest symptoms, or signs of a clot Venous thromboembolism (a blood clot in a vein) is uncommon but serious. The risk may be higher with pills than with a patch, but no form is risk-free. Do not manage this yourself. Get urgent care and contact your clinician right away.
Safety information
A U.S.-licensed clinician reviews every prescription and decides whether this medicine is right for you. During your visit, tell them if any of the following applies to you or your family.
Estradiol
- Common side effects
- Breast tenderness, Spotting (early on), Bloating, Mood changes
- Less common
- Headaches, Nausea
- Rare
- Blood clots in the veins (higher risk with pills), Liver effects that slow bile flow (cholestasis)
- Interactions
- CYP3A4 inducers (rifampin, St. John's Wort): may make it work less well
- Blood thinners: monitoring may need to change
- Thyroid hormone: your dose may need to change
Progesterone (micronized)
- Common side effects
- Sleepiness, Dizziness when you stand up
- Less common
- Headache, Breast tenderness
- Interactions
- Drugs that change CYP3A4 (a liver enzyme)
- Sedatives: even more drowsiness together
We choose menopause treatment based on your symptoms, health history, risks, and goals. Then we adjust it to how you respond. Most women don't need hormone tests for typical menopause symptoms. If you take estrogen and still have a uterus, you'll usually need progesterone to protect its lining. Low-dose vaginal estrogen is a different case. FDA-approved hormone products are available too, and they're worth asking about.
Three steps, no insurance hoops
Take the quiz
About 5 minutes. Tell us your symptoms, history, and goals.
Clinician reviews
A U.S.-licensed clinician looks at your answers within 24 hours. If it's right for you, they write your plan.
Care ships free
Your medication arrives in days. Refills come on their own, and check-ins are included.
Common questions
How much does Estradiol + Progesterone cost?
How is Estradiol + Progesterone taken?
What are the side effects of Estradiol + Progesterone?
Does Estradiol + Progesterone interact with other medications?
Is Estradiol + Progesterone FDA-approved?
Read before you start
From the Zappy clinical team, in plain language.
Read our women's health guides →
Care that shows up, and stays.
Ready when you are.
A licensed clinician reviews your visit within 24 hours.
See if I qualify · From $71/mo