Best HRT online in 2026, with every score published

By our score, the top three for menopause HRT are Sesame Care at 8.0/10 (Not published, medication billed separately), Winona at 8.0/10 ($54 per 28 days, all-in), Wisp at 8.0/10 ($33/mo, medication billed separately). The public-information score adds five equal 0–2 criteria: product, price, care process, pharmacy and terms. It measures disclosed information rather than clinical quality or outcomes. Payment does not affect the calculation. 8 of the 8 providers we track are affiliate partners, they are labeled as partners in every table, and the ranking is sorted strictly by score.

For menopausal symptoms, estradiol is the molecule most hormone therapy uses, and the two decisions that follow it are the delivery route and whether you also need progesterone to protect the uterine lining. Route is the part with a real evidence difference behind it: oral estradiol passes through the liver before it reaches general circulation and transdermal estradiol does not, which is the mechanism behind the difference in venous thromboembolism risk reported in the BMJ 2019 nested case-control study. The Menopause Society's 2022 position statement supports hormone therapy for healthy symptomatic women under 60 or within 10 years of menopause. Which product suits you is a decision for a licensed clinician, not for a comparison table.

Two non-hormonal drugs are now FDA-approved specifically for moderate to severe menopausal hot flashes. Veozah (fezolinetant) is a neurokinin 3 receptor antagonist from Astellas, dosed at one 45 mg tablet daily, and it carries a boxed warning for hepatotoxicity added in December 2024. Lynkuet (elinzanetant) is a neurokinin 1 and 3 antagonist from Bayer, dosed at 120 mg once daily at bedtime, with no boxed warning but with warnings for hepatic transaminase elevations, daytime impairment and seizure risk. Both require baseline liver tests, and Veozah's label asks for five follow-up draws in the first nine months against Lynkuet's one. Both are indicated only for vasomotor symptoms, so they substitute for hormone therapy on hot flashes and not on bone loss or genitourinary symptoms.

Not for the visit. None of the 8 providers we currently track bills commercial insurance, so the consult is cash-pay everywhere on this roster. The medication is a separate question, and it is where an insured reader still wins: FDA-approved generic estradiol filled at your own pharmacy is often covered even when the telehealth visit is not. 2 providers send the prescription to a pharmacy you already use rather than shipping it themselves (Sesame Care and Wisp), so your plan or a discount card sets the drug price there rather than the platform. Price the visit and the drug separately before you book, because they are billed by different people.

The public-information score adds five equal 0–2 assessments of product, price, care process, pharmacy and terms. The total out of 10 is reproducible from the reasons and sources on our methodology page. A low score can reflect missing information and does not establish poor care. A–F grades are separate, dated legacy disclosure assessments; they are not recalculated from the new score. Affiliate status never changes points.

No. 50 sits inside the window the guidelines describe as favorable. The timing hypothesis, sometimes called the window of opportunity, holds that for women who begin hormone therapy before age 60 or within 10 years of their last period, the balance of benefits and risks is generally favorable. Starting more than 10 years after menopause, or after 60, shifts that balance because cardiovascular and stroke risk weigh more heavily. The 2002 Women's Health Initiative warnings that made a generation of women afraid of HRT came from a trial whose average participant was 63, a decade or more past menopause. The FDA removed the class-wide boxed warning on that basis, announced November 2025 with label changes approved February 2026.