New UCLA research on menopause and cognition — see what Dr. Voskuhl's team found.
PearlPAK®
- Neuroscientist designed, NIH research-backed, clinically tested
- Bioidentical menopause relief
- Improves brain fog, hot flashes, vaginal dryness
- Supports improved sleep
- Concierge care + prescription for $147/month
Product Description
PearlPAK® is designed to treat cognitive decline during perimenopause and menopause and improves other common menopause symptoms such as hot flashes, poor sleep and vaginal dryness.
Each PearlPAK® includes:
- 4 Weeks of treatment designed to mirror a woman’s cycle
- Bioidentical estriol (oral)
- Bioidentical progesterone (oral)
Recommended for:
Women in perimenopause and menopause (typically age 40–65) with an interest in maintaining cognitive functions like memory, focus, and concentration. PearlPAK® also relieves common menopause symptoms such as hot flashes, vaginal dryness, and poor sleep.
Directions
Each monthly dose contains 28 days of a combination of estriol and and progesterone in a ratio designed to resemble a woman’s menstrual cycle. PearlPAK® is delivered in 3-month quantities.
Timeline
Months 1–3: Improvement in hot flashes, night sweats, and sleep.
Months 4–6: Improvement in vaginal dryness, urinary urgency, and energy.
Month 12: Meaningful cognitive improvement with consistent treatment.
Our Standards
PearlPAK® was developed through decades of NIH funded research and has been clinically tested. Every PearlPAK® is formulated in partnership with nationally regulated pharmacies.
Made in the USA
Who this is for
PearlPAK® is designed for women in perimenopause and menopause who:
- Have difficulty concentrating, remembering words, or are experiencing brain fog
- Are experiencing hot flashes or night sweats
- Have difficulty sleeping
“Making a point at a high-stakes meeting and couldn’t remember where I was going with it. That’s just embarrassing.”
— Alice, 50s, Former Wellness Executive
Ingredients
Our formulation is simple:
- Bioidentical estriol (oral)
- Bioidentical progesterone (oral)
We use bioidentical hormones, structurally identical to the ones your body makes and delivered in a patented blister pack, designed to mirror a woman’s natural cycle.
What the research shows
Brain-First Menopause Care
Designed by a Neurologist, Not a Marketing Team.
PearlPAK® was developed by Dr. Rhonda Voskuhl, Professor of Neurology at UCLA and Director of the UCLA MS Program, based on over 30 years of NIH-funded research into estrogen and the brain. This isn't a repackaged hormone patch — it's what a physician-scientist built after decades studying the female brain.
Brain-First Menopause Care
Designed by a Neurologist, Not a Marketing Team.
PearlPAK® was developed by Dr. Rhonda Voskuhl, Professor of Neurology at UCLA and Director of the UCLA MS Program, based on over 30 years of NIH-funded research into estrogen and the brain. This isn't a repackaged hormone patch — it's what a physician-scientist built after decades studying the female brain.
Not All Estrogens Work the Same Way
When considering your options, it's important to understand the difference between estrogen types. Estradiol (patch) and oral estriol target different receptors that live in different parts of the body.
Estrogen Receptor Alpha
Abundant in reproductive tissues and breast. Estradiol binds strongly here. ERα activation drives the proliferative breast tissue effects associated with increased cancer risk in the Women's Health Initiative studies.
Estrogen Receptor Beta
Enriched in the hippocampus and prefrontal cortex — the brain regions responsible for verbal memory, processing speed, and executive function. These are the same regions that show measurable atrophy on MRI in menopausal women with untreated cognitive symptoms.
ERβ is enriched in the hippocampus and prefrontal cortex — the regions most affected by menopause-related cognitive decline.
70%
of menopausal women experience brain fog
40+
years of oral estriol safety data in Europe
Why Oral Estriol Changes Everything
Most hormone therapies use estradiol. PearlPAK® uses systemic estriol.
| Feature | CleopatraRx PearlPAK® — Oral Estriol (E3) Brain-first Menopause Care | Standard HRT Standard MHT — Estradiol (E2) Conventional hormone therapy |
|---|---|---|
| Primary Receptor | ✓ERβ — brain & nervous system | ~Broad — ERα + ERβ |
| Breast Tissue Exposure | ✓Weak — ERβ selective | ~Strong — ERα mediated |
| Converts to Estrone | ✓No | ~Yes — higher clotting risk with oral; lower with transdermal |
| Brain Fog Relief | ✓Primary indication | ~Unclear secondary / variable |
| Vasomotor Relief (Hot Flashes, Night Sweats) | ✓Very Good | ~Excellent |
| US Availability | ✓Compounded — licensed pharmacy | ~FDA-approved (patches in shortage 2026) |
| Safety Data | ✓40+ years (Asia & Europe) | ~Decades of use |
Want to speak to a licenced provider to learn more?
Why Estriol Changes Everything
Most hormone therapies use estradiol. PearlPAK® uses systemic estriol.
CleopatraRx
PearlPAK® — Oral Estriol (E3)
Brain-first Menopause Care
| Feature | PearlPAK® |
|---|---|
| Primary Receptor | ✓ERβ — brain & nervous system |
| Breast Tissue Exposure | ✓Weak — ERβ selective |
| Converts to Estrone | ✓No |
| Brain Fog Relief | ✓Primary indication |
| Vasomotor Relief (Hot Flashes, Night Sweats) | ✓Very Good |
| US Availability | ✓Compounded — licensed pharmacy |
| Safety Data | ✓40+ years (Asia & Europe) |
Standard HRT
Standard MHT — Estradiol (E2)
Conventional hormone therapy
| Feature | Standard MHT |
|---|---|
| Primary Receptor | ~Broad — ERα + ERβ |
| Breast Tissue Exposure | ~Strong — ERα mediated |
| Converts to Estrone | ~Yes — higher clotting risk with oral; lower with transdermal |
| Brain Fog Relief | ~Unclear secondary / variable |
| Vasomotor Relief (Hot Flashes, Night Sweats) | ~Excellent |
| US Availability | ~FDA-approved (patches in shortage 2026) |
| Safety Data | ~Decades of use |
Want to speak to a licenced provider to learn more?
12 MONTHS OF TAILORED CARE
Your Treatment Journey
Phase by Phase
Most women see relief at 3 months and meaningful
cognitive improvement 12 months of consistent treatment.
FAQ
Questions & Answers
Find answers to your most frequently asked questions about this product below.
Is estriol the same as the estradiol?
No. Estriol and estradiol are both estrogens, but they interact with estrogen receptors differently. Estradiol binds strongly to both ER-alpha and ER-beta receptors. Estriol is a weaker estrogen with relatively greater activity at ER-beta, the receptor subtype found in higher concentrations in regions of the brain involved in memory and attention.
PearlPAK uses estriol rather than estradiol because of this receptor profile and Dr. Voskuhl’s research on estriol and cognitive function in women.
If you have previously taken estradiol and had side effects, bring that history to your consultation. Your clinician will review what happened and determine whether PearlPAK is an appropriate option for you.
How much does PearlPAK cost?
PearlPAK is $147 per 28-day cycle. That price includes your medication, shipping, and ongoing support from the CleopatraRX care team.
PearlPAK ships every 12 weeks in a quantity covering three 28-day cycles. Billing follows the three-cycle schedule, so your payment dates will not always line up with calendar months or with the day a shipment arrives.
Is PearlPAK covered by insurance?
No. PearlPAK is a compounded medication, and compounded prescriptions are generally not covered by insurance plans. PearlPAK is cash-pay at $147 per 28-day cycle, which includes your medication and ongoing support through CleopatraRX.
Do I need a prescription for PearlPAK?
Yes. Estriol and progesterone are both prescription medications, so PearlPAK requires a prescription from a licensed clinician.
The process starts with an intake call with a CleopatraRX clinician, who takes your health history and reviews your symptoms. If you are a candidate and want to move forward, a board-certified physician reviews your case and, if appropriate, writes your prescription. A partner compounding pharmacy prepares and ships your prescription to your home.
Will PearlPAK® help with brain fog caused by dementia or Alzheimer’s disease?
No. PearlPAK is intended for women experiencing cognitive symptoms related to perimenopause and menopause. It is not a treatment for dementia, Alzheimer’s disease, or other neurological conditions, and it is not intended for individuals with advanced cognitive or memory impairment.
If you are concerned that your symptoms may reflect a neurological condition, talk with your primary care physician or a neurologist. Evaluating that possibility requires an in-person workup that an online visit cannot provide.
Prevention is Key
Cognitive difficulties at menopause and brain atrophy in the hippocampus occurs with gradual worsening during years of being without estrogen. Called the “timing hypothesis,” the benefits of estrogen are greater with earlier treatment. The key is to be proactive, not reactive when it comes to brain health.
If you’re watching a parent’s memory fade and wondering what that means for your own future, the choice you make at menopause is one of the few levers you actually control.
"I have the APOE4 gene. My grandmother had Alzheimer's. I'm actively trying to avoid that future — and my cognition is sharper than ever."
- CleopatraRX Patient
