Winona Reviews

Is Winona’s bioidentical hormone replacement therapy (BHRT) a good option for treating your menopause symptoms? We did the testing and research.

Last updated: Jun 5th, 2024
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Winona Review Lineup

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If you’re in the throes of menopause and experiencing the rollercoaster of changes that can come with it — like hot flashes, vaginal dryness, depression, urinary issues, or sexual dysfunction — then it may not be surprising to learn that these symptoms can have a significant impact on your quality of life. With 85% of menopausal people experiencing symptoms throughout the duration of this change, it seems only natural that demand would grow for a convenient and effective solution.

Online menopause care services, like Winona, aim to be just that. By offering a modest selection of bioidentical hormone replacement therapy (BHRT or BHT) treatments, Winona claims that it can help relieve a wide range of concerns, from hot flashes and low libido to hair changes, mood swings, fatigue, and more. But do the company’s claims hold up?

In our review of Winona, we cover the efficacy, safety, cost, and convenience of these treatments to help you determine if they’re the right choice for you.

Our Findings

Editor's Rating4.00


  • Treatment plans are personalized
  • Doctor visits are unlimited and free
  • Two treatments (the estrogen patch and estrogen tablets) are FDA-approved
  • Compounded treatments aren’t FDA-approved but are made with approved ingredients
  • Pay-per-month pricing structure can be more affordable for some people
  • Hormone-free treatment options available through partnership with Kindra
  • A lot of additional resources available for menopause support
  • HSA/FSA accepted at checkout and via reimbursement


  • “Bioidentical” HRT isn’t necessarily better or safer than traditional HRT (i.e., synthetic)
  • More information on DHEA risks, side effects, and interactions should be available to patients
  • All capsules contain gelatin, and progesterone capsules also contain peanut oil
  • HRT has inherent safety risks
  • Unavailable in 14 states

While it can be more expensive per month than some of its competitors, Winona offers a nice selection of hormone replacement therapies for menopause symptoms. We aren’t fans of the company’s reliance on the “bioidentical” buzzword, but that doesn’t detract from the potential benefits of the available prescriptions. And its additional resources (like webinars, Q&As, and peer support) can be great options for those seeking more support than just prescription treatment.

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Why you should trust us

Over the past two decades, Innerbody Research has helped tens of millions of readers make more informed decisions involving staying healthy and living healthier lifestyles.

For our review of Winona, we spent over 100 hours researching the benefits, drawbacks, and potential long-term risks associated with hormone replacement therapy. We also investigated claims surrounding “bioidentical” HRT to provide you with accurate information to help you make informed health decisions. We also used Winona’s platform to acquire hands-on experience, which included going through the intake process, discussing treatments with assigned doctors, purchasing prescriptions, speaking with customer service, and more.

Additionally, like all health-related content on this website, this review was thoroughly vetted by one or more members of our Medical Review Board for accuracy.

How we evaluated Winona

Helpfulness and safety were both highly important to us when evaluating Winona. If you’re interested in this service, you’re probably looking for relief from menopause symptoms, so finding something that actually helps while not putting your health at risk is paramount. Cost comes next; if the service is affordable, you’re more likely to stick with it and find relief. And finally, the convenience of Winona and its prescriptions, similar to cost, may be the deciding factor that helps you maintain a consistent treatment schedule.


Rating: 9.2 / 10

Winona’s primary offering is hormone replacement therapy (HRT) for menopause symptoms, which is typically either a prescription of just estrogen or a combination of estrogen and progesterone. Winona’s available HRT treatments include both estrogen and combination therapy in the form of pills, creams, and patches.

Whether from Winona or elsewhere, HRT has quite a bit of potential to help women experiencing a wide range of menopause symptoms, including but not limited to:

  • Hot flashes
  • Night sweats
  • Painful intercourse
  • Vaginal dryness
  • Vaginal itching

Estrogen and progesterone play significant roles in your body, and as their production changes during menopause, “supplementing” them with HRT can benefit your health in several ways outside of menopause symptom relief. For example, estrogen can help lower your cholesterol and promote glucose metabolism.

The remaining two Winona treatments, DHEA and Blossom (sildenafil and pentoxifylline), have mixed or very little evidence to support them at this time. DHEA may be able to improve vaginal atrophy, and topical sildenafil appeared to increase arousal in women versus a placebo cream in one small study.


Rating: 8.1 / 10

For most healthy adults, HRT should be a safe treatment option when used as directed. While there are potential risks with taking HRT — like an increased risk of certain cancers, blood clots, and stroke — some experts believe the benefits often outweigh them for healthy people seeking menopause relief. However, HRT shouldn’t be used by those who have a personal or immediate family history of cancer, heart disease, stroke, blood clots, or liver disease.

With Winona specifically, the company claims that bioidentical or “natural” HRT is safer than traditional forms (synthetic hormones). The term “bioidentical” basically means that the hormones have an identical chemical makeup to those made by the human body. But the claim that they’re safer than traditional treatments doesn’t have much, if any, evidence to support it at this time. “Bioidentical” is often used as a marketing buzzword to make a compounded hormone treatment sound superior to those approved by the FDA. However, some FDA-approved HRT treatments actually are bioidentical (and use the same or similar ingredients) but just aren’t marketed as such.

One of the major risks of compounded hormone treatments is that they aren’t subjected to the same manufacturing and purity standards as FDA-approved HRT. So companies that prescribe these compounded hormones must take extra precautions to ensure their treatments are safe.

We’ll delve further into the safety details of Winona’s pharmacy and prescriptions under the dedicated “Are Winona’s treatments safe?” section later on, but to summarize some of the most important parts:

  • Winona’s compounding pharmacy is located in Idaho, where the Board of Pharmacy requires all equipment to be cleaned, sanitized, or sterilized before use. Active ingredients must also be obtained from FDA-registered manufacturers.
  • Winona’s compounded treatments are made of FDA-approved ingredients. Once the ingredients are combined, the resulting treatment is no longer FDA-approved, but we can appreciate that Winona only uses approved ingredients (from FDA-registered manufacturers) at the outset.

Overall, Winona’s HRT treatments (like most other HRT prescriptions) should be safe for most healthy adults, but it’s important to understand the additional risks that can come with compounding. In comparison, Alloy only uses FDA-approved HRT; Gennev is similar, even stating that it doesn’t recommend compounded hormones; and the only compounded prescription that Evernow offers is a topical mixture of finasteride and minoxidil for hair loss.


Rating: 7.9 / 10

Comparing Winona's cost to its close competitors can be challenging, as they all have different pricing structures and policies. Here’s a quick breakdown of some of the ways the competition differs from Winona:

  • Alloy’s shipments always contain three months’ worth of your treatment, meaning you’re billed per quarter.
  • Evernow requires you to purchase a membership to its platform in addition to paying for the medication costs.
  • Gennev accepts a selection of insurance plans, but prescriptions can only be sent to your local pharmacy, so you may need to cover a variable copay.

Winona, in comparison, charges you monthly for your prescriptions, has no additional membership cost, and will ship your treatments to you for free, but it currently doesn’t accept insurance. Winona is also the only one of the mentioned services to offer compounded (customized) prescriptions.

If you look at monthly prices, Alloy is the least expensive option. However, instead of paying $39.99 for a month of estradiol pills, you’ll owe about $120 due to it being a three-month shipment. With Winona, a month of estradiol pills is $54. That’s quite a bit more expensive per month, but not everyone can swing a higher initial cost for eventual savings. If you can afford a higher upfront cost, however, Alloy may be a better option if it carries the treatment you’d like. And Gennev could be ideal if your insurance is accepted.

But Winona’s options (even the most expensive, like the $149 per month estradiol patch) are still more affordable than Evernow’s treatments. With a monthly Evernow membership of $49 plus the medication costs — $75 per month for pills and creams or $129 per month for patches — you’re looking at a monthly charge of $124 for pills and creams or $178 for patches. That’s about $30-$35 more than Winona for patches and creams and $75 more for pills.

For those with an HSA/FSA plan, Winona can either accept it as payment at checkout or provide you with the necessary information to submit for reimbursement. Alloy and Gennev will also give you the documents for reimbursement, and Evernow accepts HSA/FSA only for the membership costs, not the medications.


Rating: 9.2 / 10

Being a telehealth service, Winona can be more convenient than seeing a doctor in person, especially since getting an HRT appointment may be difficult with an increasing number of primary care physicians leaving the profession due to burnout.

With Winona, your initial “doctor’s appointment” can be whenever you want — all it takes is clicking the purple Get Started button at the top of the company’s website and filling out the questionnaire. This is pretty standard for a telehealth service, but it’s part of what can make telehealth a preferable option over in-person appointments for some people. Winona also offers unlimited consultations with your assigned physician, meaning you can speak with them whenever you need to, without the potential constraints of your insurance policy.

Regarding processing speed, our testers had about a four-day wait between submitting their information to Winona and the prescriptions being approved and sent out. Their orders arrived in discreet packaging after only a day’s wait for shipping (your experience may vary, however). Canceling or pausing a subscription from the patient portal was also fairly straightforward.

The treatments are easy to use, too, no matter the form. For example, the DHEA capsule only requires you to take one per day. However, opinions on treatment convenience can be subjective; one person may prefer using creams, while another may find them messy and a pain to use.

What is Winona?

Founded in 2020 and headquartered in Austin, TX, Winona — occasionally stylized as “by Winona” or “ByWinona” — is a telehealth menopause care service specializing in compounded HRT. As part of its goal to “take the confusion out of menopause and help women get the solutions they need,” the company notes that it only hires board-certified physicians (mainly OB/GYNs) who are “passionate about women’s healthcare.”

Outside of prescriptions, Winona also offers various avenues of support for menopause patients. Patients can access unlimited doctor consultations, a monthly Q&A, a private Facebook group, webinars, and more. Some of these resources, like a downloadable menopause symptom tracker kit, are available to everyone, even those who don’t use Winona’s prescription services.

Currently, Winona is available in 36 U.S. states (and Puerto Rico). The 14 states where service is currently unavailable due to “differing telehealth regulations” are:

  • Alabama
  • Arkansas
  • Delaware
  • Kansas
  • Kentucky
  • Louisiana
  • Mississippi
  • New Mexico
  • North Dakota
  • Rhode Island
  • South Dakota
  • Tennessee
  • Utah
  • Vermont

In comparison, competing platforms Gennev and Alloy are available in all 50 states, while Evernow is only available in 35 (several of which are different from those Winona is available in).

What is compounding?

The majority of Winona’s prescriptions are compounded, which means they’re customized to fit the needs of an individual patient. Generally speaking, compounding can take many forms, including but not limited to:

  • Modifying the delivery method (e.g., making a liquid for someone who can’t take pills)
  • Offering a dose of a medication not commercially available
  • Providing allergen-free forms of a drug (e.g., when someone is allergic to a dye present in the FDA-approved version of a medication)
  • Combining two or more drugs into one
  • Filling in the gap when a drug shortage occurs

In Winona’s case, compounding entails combining drugs and providing personalized doses of its available prescription treatments. Unlike your local compounding pharmacy, Winona won’t alter its pre-existing delivery methods, remove allergens (like the peanut oil in its progesterone capsules), or create brand-new combinations outside of what it already offers, but the company will try to customize the doses of what it has available to fit your needs.

When it comes to compounding drugs, there are two possible preparation methods: sterile and nonsterile. Winona’s pharmacy uses the latter. Now, the term “nonsterile” may raise a few concerned eyebrows, but this type of preparation still requires and utilizes a sanitary environment. Sterile compounding preparation is primarily reserved for implantable, injectable, and ophthalmic (eye) drugs. Capsules, tablets, creams, solutions, and others are compounded via nonsterile preparation.

Insider Tip: It’s important to mention that compounded drugs are not FDA-approved. Even if they’re made entirely of FDA-approved ingredients (like Winona’s treatments), the combination itself is not approved. That doesn’t mean the treatments are inherently unsafe, but using them may come with some additional risks due to the lack of FDA verification.

Winona’s online reputation

At the time of this writing, Winona doesn’t appear to have a Better Business Bureau (BBB) profile, but it does have a verified Trustpilot page. There are over 1,880 reviews, averaging 4.7 out of 5 stars, or an “Excellent” designation. Currently, 87% of the reviews are 5-star, with only 3% making up the 1- and 2-star reviews.

According to the “Company activity” section, Winona replied to 93% of negative reviews within a day (24 hours) of posting. Most of these negative reviews are from customers experiencing difficulty or confusion with the subscription model, while a few others are about order delays, side effects (like weight gain), or a lack of improvements from treatment.

Who is Winona for?

Winona can be a great menopause support platform for anyone looking to try HRT (as estrogen, progesterone, or a combination of both) as a potential treatment for their symptoms. Compared to many of its close competitors — such as Gennev, Evernow, and Alloy — Winona is the only one that offers extensive support outside of just prescriptions and doctor visits. The service provides menopause Q&As, webinars, ebooks, and more, all intended to try and make the natural transition a little less daunting. With a month-to-month subscription model, Winona might also be a good option for those who can’t afford to pay for multiple months in advance (as with Alloy).

According to the Mayo Clinic, HRT may be ideal for women or AFAB individuals who:

  • Have moderate to severe hot flashes
  • Experience vaginal symptoms, like dryness, itching, burning, or discomfort during intercourse
  • Are seeking osteoporosis prevention
  • Have an estrogen deficiency or are going through early menopause

Who should look elsewhere for menopause care?

If you’re not a fan of the idea of using HRT for your menopause symptoms, then Winona is probably not the service you’re looking for (unless you’re only interested in Blossom, the company’s “female Viagra”). And if you have a personal or close family history of cancer, heart disease, liver disease, stroke, or blood clots (like deep vein thrombosis, or DVT), then HRT may not be the safest to use, in general. In either of these circumstances, you might consider hormone-free solutions such as:

  • Menopause supplements
  • Cognitive behavioral therapy (CBT)
  • Low-dose antidepressants for mood symptoms
  • Gabapentin, clonidine, or fezolinetant (Veozah) for hot flashes and night sweats
  • A pH-balanced vaginal hormone-free moisturizer for dryness, painful intercourse, and other symptoms of vulvovaginal atrophy due to decreased estrogen production

Even if you are interested in HRT, other options may still be preferable to Winona, depending on your circumstances:

  • If you'd like to spend less money per month (and are comfortable with owing more upfront), then Alloy's HRT could be ideal.
  • Some competitors also offer HRT in forms not available through Winona (e.g., Evernow's vaginal estradiol tablets and Alloy's estradiol spray, estradiol gel, and low-dose birth control).
  • For those with health insurance through Aetna or United Healthcare, Gennev should be covered through your plan.
  • If you’d like to incorporate dietary changes into your menopause relief effort but aren’t sure where to start, Gennev offers consultations with registered dietitian nutritionists (RDNs).

Additionally, DHEA treatment — from Winona or elsewhere — can interact with a multitude of prescription drugs, including those for mental health, such as:

  • Antipsychotics
  • Lithium
  • SSRIs

What treatments does Winona offer?

Winona Review Estrogen Cream Bottle

Photo by Innerbody Research

Winona offers nine prescription treatments for women experiencing symptoms of menopause, and a majority of those treatments are HRT. There are various methods of delivery for the available treatments:

  • Estrogen: Cream (body or vaginal), tablet (oral), and patch (transdermal)
  • Progesterone: Capsule (oral) and cream (body)
  • Combination estrogen and progesterone: Cream (body)
  • Blossom (“female Viagra”): Cream (external vaginal area; vulva and clitoris)
  • DHEA: Capsule (oral)

The only non-hormonal treatment in the list above is Blossom. As for DHEA, it walks an interesting line; it’s a hormone produced by the adrenal glands that acts as a precursor to androgens and estrogens, but it's not typically housed under the umbrella of HRT in the traditional sense. Some research suggests that DHEA may be able to improve libido and vaginal dryness in older women, but results have been mixed, and the risks of supplementing DHEA may outweigh any potential benefits (more on that later).

If you have a uterus, then you’ll be prescribed combination therapy — estrogen and progesterone — as progesterone helps balance out the increased risk of uterine cancer that comes with taking estrogen. You can give your Winona doctor input as to how you’d prefer to take your treatment (e.g., the estrogen patch and progesterone pill). If you don’t have a preference, you’ll be prescribed the combination cream.

Those without a uterus are the only ones who can be safely prescribed an estrogen-only regimen.

And if the potential side effects of HRT concern you, transdermal application (topical) may reduce some of the risks — particularly the chance of blood clots. (More high-quality research comparing oral and topical HRT is necessary, however.)

Winona x Kindra

During Winona’s intake questionnaire, there’s a specific question to determine whether or not HRT is a safe treatment option for you. This question asks if you have (or ever had) one or more of a select set of medical conditions, including:

  • Uncontrolled/Untreated high blood pressure
  • Abnormal vaginal bleeding
  • Active liver disease
  • Stroke
  • Transient ischemic attack (TIA)
  • Heart attack and/or heart disease
  • Uterine, breast, ovarian, and/or cervical cancer
  • DVT, pulmonary embolism (PE), and/or a clotting disorder

It’s essential to be honest with this information, as omitting these details could put your health at serious risk if you end up being prescribed and using HRT.

If you select a condition unsafe for HRT, you’ll be redirected to the website for Kindra, a company that offers “non-hormonal menopause solutions” and has partnered with Winona. Products from Kindra include lotions, creams, serums, supplements, and other non-prescription products categorized by concern. These categories are:

  • Vaginal dryness
  • Low libido
  • Brain fog
  • Trouble sleeping
  • Hot flashes
  • Painful sex
  • Skin dryness
  • Stress

A couple of Winona’s competitors — Evernow and Alloy — offer non-hormonal alternatives on the same platform as their hormonal treatments. For example, both services have paroxetine as a non-hormonal prescription option for relief from vasomotor symptoms. And Evernow offers Veozah, an FDA-approved novel drug for treating moderate to severe hot flashes. While the partnership with Kindra is a nice option for some patients, it’d be nice to see Winona offer non-hormonal treatments of its own (besides Blossom) in the future.

Other menopause support

As a “menopause care service,” Winona offers support for individuals going through menopause in more ways than just prescription hormone replacement therapy. Some of the currently available online resources include:

  • Unlimited (free) physician consultations
  • Webinars on menopause
  • The Winona Women Facebook group for peer support
  • A monthly live physician Q&A
  • “Hormone-healthy” recipes in video and text formats
  • A blog (“The Winona Medical Journal”) with information on various health and wellness topics with a menopause focus, including sexual health, urinary health, skincare, nutrition, and more

A few downloadable resources are available as well, including:

  • The Ultimate Menopause Symptoms Guide: an ebook that covers how hormonal fluctuations and changes can cause a wide variety of symptoms
  • Navigating Menopause, Intimacy, & Pleasure: an ebook focusing on managing sexual dysfunction symptoms in menopause
  • The Menopause Tracking Guide: a document (sort of like a calendar) you can use to track your symptoms, menstrual cycle, sleep, exercise habits, and potential improvements from HRT

Winona’s close competitors don’t offer these kinds of resources, but Gennev does allow you to consult with an RDN as a way to potentially use dietary changes to combat your menopause symptoms. And that might be particularly helpful because certain diets — like a plant-based one — may have the potential to reduce vasomotor symptoms.

Do Winona’s treatments work?

The answer to whether or not the majority of Winona’s treatments work hinges on whether or not HRT works as a whole. (The only Winona treatment that doesn’t involve hormones is Blossom, a topical that contains sildenafil, the active ingredient in Viagra, and pentoxifylline, a vasodilator.)

Even though Winona boasts that its compounded HRT is “bioidentical,” current research does not indicate that this distinction really means much in terms of efficacy. That assessment may change someday, but for now, there isn’t sufficient evidence to say that bioidentical HRT is superior to traditional HRT treatments. And several FDA-approved HRTs are also bioidentical and use the same ingredients.

Because they’re extremely similar, information on the effectiveness of FDA-approved HRT medications can also be applied to Winona’s treatments.


If HRT is a suitable treatment for you, it can relieve symptoms like vaginal dryness or itching, hot flashes, and night sweats. It can also reduce your chance of developing osteoporosis. One study found that hormone therapy reduced the overall risk of bone fractures, regardless of fall risk.

Additionally, systemic HRT may improve libido and sexual responsiveness in menopausal women.


Research is limited and mixed, but DHEA may be able to help treat or prevent osteoporosis and improve vaginal atrophy in postmenopausal women.

Blossom (sildenafil and pentoxifylline)

Research on topical use of sildenafil or pentoxifylline is relatively scarce at this time. The only study on topical sildenafil for female arousal found that it increased “genital and self-reported measures of arousal compared to placebo cream” in six female patients. And pentoxifylline is a vasodilator that, when applied topically, may promote increased blood flow to the application site. So, based on the little research that exists, Blossom might be able to aid in dealing with certain sexual dysfunction symptoms.

Are Winona’s treatments safe?

For most healthy adults, using HRT should be a relatively safe option if used as directed. As with any prescription, there are some potential risks, including an increased risk for the following:

  • Heart disease
  • Stroke
  • Blood clots
  • Breast cancer
  • Uterine cancer
  • Gallbladder disease

Researchers are still investigating whether or not HRT can affect your risk for dementia, and they’re also not yet sure how it impacts conditions like diabetes. But even with these concerns, many experts assert that the benefits of HRT outweigh the risks for healthy populations suffering from menopause symptoms. If you’re concerned about using HRT, here are some factors that appear to lower the risks:

  • Being under 60 years old
  • Starting treatment within ten years of menopause
  • Having no personal or immediate family history of cancer, heart disease, stroke, blood clots, or liver disease
  • Taking progestin if you still have a uterus (i.e., haven’t had a hysterectomy)
  • Getting regular mammograms and gynecological or pelvic exams
  • Maintaining a healthy weight and getting regular physical activity
  • Choosing transdermal (topical) HRT over oral forms

Treatment safety

Winona explains that all of its compounded treatments are made of FDA-approved active ingredients. However, once you combine these ingredients, the resulting treatment is no longer FDA-approved. We do appreciate that Winona uses approved ingredients, though, especially since some less-than-trustworthy manufacturers, as Cleveland Clinic explains, may add additional, untested hormones that are not FDA-approved and are unsafe to use.

Insider Tip: Some of the treatments Winona uses are actually FDA-approved, such as the estrogen patches and estrogen tablets. However, these FDA-approved treatments aren’t made (compounded) by Winona. For example, the patch is from generic brands you could receive from your local pharmacy, like Dotti or Sandoz.

The following chart breaks down some of the risks associated with Winona’s available treatments or their active ingredients.

Estrogen therapy

This type of HRT — estrogen therapy, or ET — is only prescribed to those without a uterus (those who’ve had a hysterectomy) since it can increase the risk of uterine cancer. When used in this population, ET has fewer long-term risks than combination therapy. In fact, ET may “significantly” reduce the risk of developing breast cancer, though more research and trials are necessary before confirming this possibility.

Combination estrogen and progesterone

Combined hormone therapy (sometimes called estrogen-progestin therapy, or EPT) almost acts like ET’s opposite when it comes to cancer risk. Combination therapy reduces the risk of uterine cancer due to the inclusion of progesterone, but this addition may increase the chance of developing breast cancer. Combination therapy may also “slightly” increase the risk of ovarian cancer.


Even though it’s technically a synthetic form of a hormone, DHEA doesn’t require a prescription. Strangely enough, this has led Winona to summarize its potential side effects as “Non-rx should not have” when checked in the patient dashboard. However, this is far from the truth.

DHEA may increase the risk of mania in people with mood disorders, and it can interact with a wide range of prescription drugs, including those for mental health, like SSRIs and antipsychotics. DHEA might also increase the risk of hormone-sensitive cancers, and it can even interact with prescription estrogens, leading to nausea, headaches, and insomnia.

If you’re nursing or pregnant, you should avoid DHEA. And, according to the Mayo Clinic, it may be best to avoid this supplement entirely due to the safety risks.

Capsules (progesterone and DHEA)

While the capsule isn’t an active ingredient, it’s important to point out that Winona’s capsules all contain gelatin, and the progesterone ones contain peanut oil. That means none of Winona’s capsules are vegan-friendly, and the progesterone capsules should be avoided by those with peanut allergies.


Unfortunately, the research on topical sildenafil is very limited in terms of efficacy and safety. A lot of the available information pertains to wound healing. Because of these limitations, we can only base the risks on what’s known about oral sildenafil at this time.

Some side effects of oral sildenafil may include headaches, nausea, diarrhea, flushing or feeling warm, nosebleeds, and nasal congestion. Severe reactions can include loss of vision, blurred vision, fainting, chest pain, shortness of breath, or an allergic reaction (rash, itching, hives, swelling, and so on).


Perhaps the most significant risk of using pentoxifylline is the fact that it’s an FDA Pregnancy Category C ingredient. Category C ingredients “have shown an adverse effect on the fetus” in animal studies. Pentoxifylline should be avoided by those who are pregnant, breastfeeding, or planning to become pregnant — meaning that Blossom should be avoided, too.

Much of the same safety information applies to the prescriptions available through Winona’s close competitors, like Gennev, Evernow, and Alloy. While they may offer different forms of HRT delivery (Alloy, for instance, has an estradiol spray option), the active ingredients remain the same.

Winona’s pharmacy

Ultimately, our research into the applicable state (Idaho) and federal regulations that Winona’s compounding pharmacy follows indicate that it maintains a high safety standard.

One of the big reasons we dug particularly deep into the information surrounding Winona’s pharmacy is that compounded drugs are not verified or approved by the FDA. So, whether it’s Winona or another pharmacy entirely, it’s important to research the laws and regulations required by any compounding pharmacy you plan on using.

To start, the company’s compounding pharmacy is located in Idaho, where the state’s Board of Pharmacy lays out compounding drug preparation requirements in “Idaho Admin. Code r.” Here are some of the safety requirements:

  • All equipment must be cleaned, sanitized, or sterilized prior to use.
  • All active ingredients must be obtained from FDA-registered manufacturers.
  • Weighing and measuring need to be accurate; all ingredient amounts “must not vary” from the acceptable range listed in the United States Pharmacopeia and National Formulary (USP-NF).
  • A certificate of analysis (COA) must be obtained for all active pharmaceutical ingredients used in compounding.

Though Winona’s customer service never responded to our specific questions about the matter, its pharmacy falls under the FDA’s definition of a “503A” compounding pharmacy. This type of compounding pharmacy creates prescriptions specific to particular patients (a 503B one, in comparison, mass-produces compounded drugs for healthcare facilities or offices). As a 503A pharmacy, Winona must comply with applicable parts of the Federal Food, Drug, and Cosmetic Act (FD&C Act) that also apply to conventionally manufactured drugs.

Winona pricing and refunds

Before going into the pricing details, we should mention that all sales are final, and Winona does not accept returns. The same can be said for Winona’s close competitors. That’s pretty standard when it comes to medications from telehealth services.

Now, for pricing, Winona goes month-by-month for nearly all of its products, with the exception of DHEA, which is a 3-month supply.

  • DHEA: $27 for three months
  • Estrogen body cream: $89 per month
  • Estrogen and progesterone body cream: $89 per month
  • Estrogen patch: $149 per month
  • Estrogen tablet: $54 per month
  • Progesterone body cream: $89 per month
  • Progesterone capsule: $39 per month
  • Vaginal estrogen cream: $89 per month
  • Blossom: $79 per order

While these prices aren’t terrible compared to those of competitors, Alloy wins overall for the lowest prices per month. For instance, Alloy’s estrogen pill is only $39.99 per month — about $14 less than Winona's. Evernow’s prices are still the highest due to the company’s requirement of a paid monthly membership on top of medication costs.

Additionally, Winona accepts HSA/FSA at checkout and via reimbursement. Alloy and Gennev will also provide you with the necessary documentation for reimbursement.

Our experience with Winona

Our tester tried out the Winona platform to see things from a customer’s perspective. They took the initial questionnaire and were prescribed a combination estrogen and progesterone cream and a bottle of DHEA pills.

Processing and shipping were reasonably quick, taking about four days before the prescriptions were approved and sent in the mail. The orders arrived in discreet shipping materials and included paper copies of the potential treatment risks and side effects.

Our tester’s DHEA order actually only contained half of the ordered pills due to a shortage, but an included note informed them that they’d receive the rest as soon as the pills became available again. And, sure enough — even after canceling their subscription — our tester’s remaining pills arrived in the mail. It was nice to learn that Winona will provide what’s owed, even to someone who’s no longer an active customer.

Winona Review Estrogen Cream Texture

Photo by Innerbody Research

Regarding the treatments, the cream is on the thicker side, but it applies smoothly and dries nicely — it doesn’t “linger” like a heavy moisturizer. And the DHEA pills are about the “standard” size you might expect from a supplement; they’re not difficult to swallow.

Winona Review Dhea Pill

Photo by Innerbody Research

Alternatives to Winona

If you aren’t entirely sold on Winona, or you want to learn more about what else is available for telehealth HRT treatments, here are some details on a few of Winona’s close competitors.


The biggest difference between Gennev and Winona is that Gennev accepts certain insurance plans — currently, Aetna and United Healthcare plans. The coverage includes appointments with your assigned doctor, as well as consultation with an RDN. However, because Gennev accepts insurance, your prescriptions will likely require a copay.

While the Gennev platform doesn’t list exactly what medications are available, there is mention of FDA-approved hormonal medications, non-hormonal ones, and supplements for menopause.

Overall, Gennev may be worth a shot if you have an applicable healthcare plan. Otherwise, you might be better off with Winona, Alloy, or Evernow.


Unlike Winona, Alloy offers more than just treatments for menopause symptoms; it also offers a few options for skincare (like tretinoin) and gut health (a synbiotic). Focusing on just its menopause therapies, though, we find that most of them are fairly similar to the estrogen prescriptions offered by Winona, just at lower prices per month (though you need to pay for three months at a time). Alloy also has a couple of menopause treatment options you can’t get from Winona, including an estrogen spray and a gel.

Interestingly, Alloy doesn’t appear to offer progesterone or combination HRT at this time. However, it does have low-dose birth control pills and a non-hormonal treatment for hot flashes (Paroxetine).

Like Winona, Alloy will provide you with the necessary documentation to submit for HSA/FSA reimbursement.


Among the other competitors mentioned here, Evernow is the only one that requires a paid membership on top of fees for medication. The membership makes Evernow the most expensive option of the group — with a monthly membership fee of $49, you’ll be paying nearly $130 for pills or creams from this provider.

The available treatments for menopause symptoms are similar to those from Alloy and Winona, with the addition of vaginal estradiol tablets and a couple of non-hormonal options (Femistry, Veozah, and Paroxetine).

Similar to Alloy, Evernow has a couple of additional treatments for other concerns, namely hair loss. There are only two hair-loss treatments currently available: oral minoxidil and a topical finasteride and minoxidil solution. If you’re interested in hair loss treatments for women, we’d recommend a less expensive provider with more options, like Hers.

Additionally, while the company states that it accepts HSA/FSA, it does so only for the membership costs, not the medications.

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Innerbody uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Nappi, R. E., Siddiqui, E., Todorova, L., Rea, C., Gemmen, E., & Schultz, N. M. (2023). Prevalence and quality-of-life burden of vasomotor symptoms associated with menopause: A European cross-sectional survey. Maturitas, 167, 66-74.

  2. Mohamed, H., Lamadah, S., & Zamel, L. (2014). Quality of life among menopausal women. International Journal of Reproduction Contraception Obstetrics and Gynecology 3(3).

  3. Grant, M., Marbella, A., & Wang, A. (2015). Menopausal Symptoms: Comparative Effectiveness of Therapies. Comparative Effectiveness Reviews, No. 147.

  4. Manson, J. E., Crandall, C. J., Rossouw, J. E., Chlebowski, R. T., Anderson, G. L., Stefanick, M. L., Aragaki, A. K., Cauley, J. A., Wells, G. L., LaCroix, A. Z., Thomson, C. A., Neuhouser, M. L., Van Horn, L., Kooperberg, C., Howard, B. V., Tinker, L. F., Wactawski-Wende, J., Shumaker, S. A., & Prentice, R. L. (2024). The Women's Health Initiative Randomized Trials and Clinical Practice: A Review. JAMA.

  5. Cleveland Clinic. (2024). Hormone Therapy for Menopause Symptoms. Cleveland Clinic.

  6. Wetmore, K. (2023). Hormone Replacement Therapy: Is It Right for You? Cedars Sinai.

  7. Mayo Clinic. (2023). DHEA. Mayo Foundation for Medical Education and Research (MFMER).

  8. Goldstein, S., Kukkonen, T., Monsef, A., & Goldstein, I. (2020). 197 A Double-blind, Placebo-controlled, 2-Way Crossover Study Using Thermography to Assess the Pharmacodynamics of Sildenafil Cream, 3.6% in Healthy Women. The Journal of Sexual Medicine, 17(1), S69.

  9. National Health Service UK. (2023). Benefits and risks of hormone replacement therapy (HRT). NHS.

  10. Mayo Clinic. (2022). Bioidentical hormones: Are they safer? Mayo Foundation for Medical Education and Research (MFMER).

  11. Endocrine Society. (2019). Compounded Bioidentical Hormone Therapy: An Endocrine Society Position Statement. Endocrine Society.

  12. Santoro, N., Braunstein, G. D., Butts, C. L., Martin, K. A., McDermott, M., & Pinkerton, J. V. (2016). Compounded Bioidentical Hormones in Endocrinology Practice: An Endocrine Society Scientific Statement. The Journal of Clinical Endocrinology & Metabolism, 101(4), 1318-1343.

  13. Files, J. A., Ko, M. G., & Pruthi, S. (2011). Bioidentical Hormone Therapy. Mayo Clinic Proceedings, 86(7), 673-680.

  14. Harvey, B. & Spangler, M. (2020). Compounded Bioidentical Hormone Therapy. US Pharmacist, 2020, 45(9), 27-29.

  15. Idaho State Board of Pharmacy. (n.d.). Idaho Admin. Code r. - COMPOUNDING DRUG PREPARATIONS. Cornell Law School Legal Information Institute.

  16. U.S. Food and Drug Administration. (2022). Compounding and the FDA: Questions and Answers. FDA.

  17. Grinspoon, P. (2022). Why is it so challenging to find a primary care physician? Harvard Health Publishing.

  18. Andrews, M. (2010). Some Policies Restrict Coverage By Limiting Visits To The Doctor. The Kaiser Family Foundation, KFF Health News.

  19. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on the Clinical Utility of Treating Patients with Compounded Bioidentical Hormone Replacement Therapy; Jackson L., Parker R., & Mattison D. (2020). The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. National Academies Press.

  20. Mayo Clinic. (2022). Hormone therapy: Is it right for you? Mayo Foundation for Medical Education and Research (MFMER).

  21. Merz, B. (2017). Nonhormonal treatments for menopause. Harvard Health Publishing.

  22. National Health Service UK. (2022). Menopause - Treatment. NHS.

  23. U.S. Food and Drug Administration. (2023). FDA Approves Novel Drug to Treat Moderate to Severe Hot Flashes Caused by Menopause. FDA.

  24. Grüntkemeier, L., Häuser, M., May, T. W., Masur, C., & Stute, P. (2022). Vaginal hormone-free moisturising cream is not inferior to an estriol cream for treating symptoms of vulvovaginal atrophy: Prospective, randomised study. PLoS ONE, 17(5).

  25. Mount Sinai. (n.d.). Dehydroepiandrosterone (DHEA). Icahn School of Medicine at Mount Sinai.

  26. American Cancer Society. (2015). Menopausal Hormone Therapy and Cancer Risk. American Cancer Society.

  27. Barnard, N. D., Kahleova, H., Holtz, D. N., Neola, M., Crosby, L. M., & Holubkov, R. (2021). The Women's Study for the Alleviation of Vasomotor Symptoms (WAVS): A randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women. Menopause (New York, N.y.), 28(10), 1150-1156.

  28. Lorentzon, M., Johansson, H., Harvey, N. C., Liu, E., Vandenput, L., Crandall, C. J., Cauley, J. A., LeBoff, M. S., McCloskey, E. V., & Kanis, J. A. (2022). Menopausal hormone therapy reduces the risk of fracture regardless of falls risk or baseline FRAX probability—Results from the Women’s Health Initiative hormone therapy trials. Osteoporosis International, 33(11), 2297-2305.

  29. Heydari, A., Sharifi, H., & Bagheri Moghaddam, A. (2019). Topical Pentoxifylline for Pressure Injury Prevention: A Call for Clinical Research. Advances in Skin & Wound Care, 32(11), 486.

  30. Goldštajn, M. Š., Mikuš, M., Ferrari, F. A., Bosco, M., Uccella, S., Noventa, M., Török, P., Terzic, S., Laganà, A. S., & Garzon, S. (2023). Effects of transdermal versus oral hormone replacement therapy in postmenopause: A systematic review. Archives of Gynecology and Obstetrics, 307(6), 1727-1745.

  31. U.S. Food and Drug Administration. (2020). Compounding Laws and Policies. FDA.

  32. The FDA Group. (2021). 503A vs. 503B: A Quick-Guide to Compounding Pharmacy Designations & Regulations.The FDA Group, LLC.

  33. Cleveland Clinic. (2022). Bioidentical Hormones. Cleveland Clinic.

  34. Manyonda, I., Talaulikar, V. S., Pirhadi, R., Ward, J., Banerjee, D., & Onwude, J. (2022). Could Perimenopausal Estrogen Prevent Breast Cancer? Exploring the Differential Effects of Estrogen-Only Versus Combined Hormone Replacement Therapy. Journal of Clinical Medicine Research, 14(1), 1-7.

  35. Cancer Research UK. (2023). Does hormone replacement therapy (HRT) increase the risk of cancer? Cancer Research UK.

  36. National Library of Medicine. (2023). Sildenafil. MedlinePlus.

  37. U.S. Department of Health and Human Services & U.S. Food and Drug Administration. (2024). FDA Pregnancy Categories. Chemical Hazards Emergency Medical Management.

  38. Harvard Medical School. (2021). Yes, you can have better sex in midlife and in the years beyond. Harvard Health Publishing.