Best HRT online in 2026, with every score published

By our score, the top three for menopause HRT are Alloy at 8.9/10 ($40/mo, all-in), Winona at 8.4/10 ($54/mo, all-in), Midi Health at 7.7/10 ($150 per visit, medication billed separately). The score combines cost at 25%, formulary at 20%, clinical depth at 20%, patient experience at 20% and transparency at 15%, and it is computed from verified prices and published disclosure rather than from who pays us. 6 of the 16 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.

Rarely on the platforms that advertise online. 3 of the 16 providers we track bill commercial insurance (Midi Health, Gennev and Elektra Health), and all 3 charge per visit rather than a monthly subscription. Everything else on the roster is cash-pay. The medication itself is a separate question: generic estradiol filled at your own pharmacy is often covered even when the telehealth visit is not, which is why the providers that send a prescription to your pharmacy rather than shipping it themselves can end up cheaper for an insured reader. On government coverage, Midi Health states on its own pricing page that it does not take Medicare, Medicare Advantage or Medicaid. Check the same with the others before you book.

Five weighted dimensions: cost 25%, formulary breadth 20%, clinical depth 20%, patient experience 20%, transparency 15%. On top of that sits a separate A-F Price Transparency Grade, which is not a component of the score. It grades five things a provider either discloses before intake or does not: pricing, named clinicians with credentials, a published cancellation policy, corporate disclosure, and accessible third-party reviews. The current distribution across 16 providers is 1 A, 6 B, 5 C, 4 D. An unanswered BBB F or a corroborated billing-surprise pattern caps the grade at D regardless of what is disclosed. Affiliate status is excluded from both axes, and the rankings table is sorted by score alone.

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.