Winona Reviews

Hormonal changes during menopause can lead to a wide range of symptoms — hot flashes, vaginal dryness, mood changes, sexual dysfunction — that can all have a meaningful impact on quality of life.1 2 With roughly 85% of menopausal individuals experiencing symptoms at some point during this transition, demand has steadily grown for accessible and effective treatment options.3

Online menopause care services, like Winona, aim to meet that demand by offering remote access to prescription treatments and ongoing clinical support. The company is best known for its use of bioidentical hormone replacement therapy (BHRT) to help manage common menopause symptoms, while also offering additional options for sexual health, skin concerns, and hair loss. But how well do these treatments actually work, and are they safe, cost-effective options?

In this review, we evaluate Winona’s treatments for effectiveness, safety, cost, and convenience to help determine whether the service is a worthwhile option for menopause care.

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 (webinars, Q&As, and peer support) can be great options for women seeking more than just prescription treatment.

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 120 hours researching the benefits, drawbacks, and potential long-term risks of HRT, as well as claims about “bioidentical” HRT. We also used Winona’s platform to gain practical knowledge by completing 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.

Effectiveness 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.

Effectiveness

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.5 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:4 5

• 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.6

Two of Winona’s other treatments — DHEA and Sildenafil Arousal Cream — have mixed or limited supporting evidence at this time.3 DHEA may help improve vaginal atrophy, while research on topical sildenafil suggests it may improve arousal in some women, particularly those with arousal-specific concerns, though results haven’t been consistent across larger studies.7 8 41

Safety

For most healthy adults, HRT should be a relatively safe and effective treatment option for menopause symptoms when prescribed appropriately.5 9 However, Winona’s approach deserves additional scrutiny because the company primarily uses compounded bioidentical hormone replacement therapy (HRT), an area that remains somewhat controversial within menopause care.

Unlike standard FDA-approved HRT products, compounded medications are customized formulations prepared by a compounding pharmacy.14 These treatments are not subjected to the same manufacturing, consistency, and purity standards as FDA-approved medications.

To its credit, Winona’s compounding pharmacy operates under Idaho Board of Pharmacy regulations requiring equipment to be cleaned, sanitized, or sterilized before use, and active ingredients must be sourced from FDA-registered manufacturers.15 Winona also states that its compounded treatments are made using FDA-approved ingredients, though the resulting customized medications are not FDA-approved themselves.16

Beyond the additional considerations surrounding compounded medications, HRT itself is not appropriate for everyone. Certain medical conditions and risk factors may increase the likelihood of complications, including:5 39 40

• Breast cancer
• Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Gallbladder disease
• Liver disease
• Coronary artery disease or heart disease
• Stroke
• Dementia (including those with a higher risk for dementia)
• Certain cancers

However, many experts believe the benefits of HRT can outweigh these risks for otherwise healthy people seeking relief from moderate to severe menopause symptoms.5 9

We should also note that Winona strongly markets its treatments as “bioidentical” or “natural,” meaning the hormones are chemically identical to those naturally produced by the human body.10 While this may sound inherently safer or more advanced, current evidence does not clearly show that compounded bioidentical HRT is safer than traditional FDA-approved hormone therapy.11 In fact, some FDA-approved HRT medications are also bioidentical and use similar or identical ingredients.10 12 13

Overall, Winona’s safety profile appears reasonably comparable to many other HRT providers, but its reliance on compounded hormone formulations differs from competitors like Alloy and Gennev, which primarily use FDA-approved medications instead.

Cost

Comparing Winona's cost to its close competitors can be challenging, as each uses a different pricing structure. Here’s a quick breakdown of how they differ:

• Alloy: Shipments always contain three months’ worth of treatment, so you’re billed per quarter.
• Evernow: Requires a membership in addition to medication costs, though it also offers one-time visits (around $150) as an alternative.
• 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 co-pay.

Winona, in comparison, charges monthly for prescriptions, has no membership fee, and includes free shipping, though it currently doesn’t accept insurance. It’s also the only service among these to offer compounded (customized) prescriptions.

If you look at effective monthly pricing, Alloy is often the least expensive option, though that comes with a higher up-front cost. Instead of paying $39.99 for a single month of estradiol pills, you’ll owe about $120 for a three-month supply. With Winona, a one-month supply of estradiol tablets costs $54. That’s more expensive per month, but it avoids the higher initial payment. If you can afford to pay more up front, Alloy may offer better long-term value, assuming it carries the treatment you need. Gennev could also be a strong option if your insurance is accepted.

Evernow’s pricing is more variable. In addition to a membership fee (typically about $35–$49 per month, depending on the plan), medications are priced separately. Tablets cost around $27.50 per month, while patches range from about $59.99 to $89.99 for a 30-day supply.

This means Evernow can be competitive with — or even less expensive than — Winona in some cases, particularly for tablet-based treatments. However, total costs depend on how you access care. With Evernow, using insurance may reduce medication costs if prescriptions are filled through a local pharmacy, while medications shipped directly to your home are typically cash-pay. Evernow’s membership fees aren’t covered by insurance, though the company’s one-time $150 visit may be eligible depending on your plan.

For those with an HSA/FSA plan, Winona can accept it at checkout or provide documentation for reimbursement. Alloy and Gennev offer similar support, while Evernow allows HSA/FSA use for membership costs, but not for medications unless they’re filled through a local pharmacy.

Convenience

As a telehealth service, Winona can be more convenient than seeing a doctor in person, particularly for those who prefer to avoid scheduling delays or in-office visits.

With Winona, your initial “doctor’s appointment” can happen on your own time — all it takes is clicking the “Get Started” button on the company’s website and completing a questionnaire. This is fairly standard for telehealth services, and it’s part of what makes them a practical alternative to in-person care.

Winona also provides ongoing messaging access to your assigned physician, allowing you to reach out with questions or concerns as needed, without the potential constraints of your insurance policy.18 This communication takes place through the patient portal rather than through scheduled live or video appointments.

In practice, that means you can:

• Complete your intake on your own schedule
• Message your provider without booking an appointment
• Manage subscriptions (pause or cancel) directly through the portal

In terms of processing speed, our testers experienced about a four-day wait between submitting their information and having prescriptions approved and sent out. Orders arrived in discreet packaging after roughly one day of shipping (though your experience may vary).

The treatments themselves are generally easy to use, regardless of form. For example, the DHEA capsule requires only one dose per day. That said, convenience can be subjective — some people may prefer creams, while others may find them messy or inconvenient.

Founded in 2020 and headquartered in Austin, TX, Winona — occasionally stylized as “by Winona” or “ByWinona” — is a telehealth menopause care service focused on hormone replacement therapy (HRT), including compounded bioidentical treatments. 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 works with board-certified physicians (primarily 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 ongoing messaging with their assigned physician, 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 37 U.S. states, plus Puerto Rico. The 13 states where service is currently unavailable, due to “differing telehealth regulations,” are:

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

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:16 19

• Modifying the delivery method (e.g., making a liquid for someone who can’t take pills)
• Offering a dose strength that isn’t 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 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 change how a medication is taken (such as turning a pill into a liquid), remove allergens (like the peanut oil in its progesterone capsules), or create brand-new combinations outside of what it already offers, but it will try to customize doses 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.19 The term “nonsterile” may raise a few concerned eyebrows, but this type of preparation still requires a sanitary environment. Capsules, tablets, creams, solutions, and similar medications are generally compounded using nonsterile preparation, whereas sterile compounding is typically reserved for implantable, injectable, and ophthalmic (eye) drugs.19

Winona’s online reputation

Winona holds a “B” rating from the Better Business Bureau (BBB) and is not BBB-accredited. The profile bears multiple complaints. Common themes include billing concerns, provider communication, and confusion around the platform’s asynchronous care model, which relies on intake questionnaires and messaging rather than live consultations.

While the company appears responsive in many cases, feedback is mixed, with many complaints tied to expectations of direct doctor interaction that the service doesn’t provide.

Winona also maintains a verified Trustpilot profile with thousands of reviews and an average rating of 4.6 out of 5 stars, earning an “Excellent” designation. Approximately 83% of reviews are 5-star, while about 9% fall between 1 and 3 stars.

According to Trustpilot’s “Company activity” section, Winona responds to nearly all negative reviews, often within a day. Lower-rated feedback most commonly reflects confusion around the subscription model, along with occasional concerns about order delays, side effects (such as weight gain), or a lack of noticeable results.

Winona can be a great support platform for anyone looking to try HRT (estrogen, progesterone, or a combination of both) as a potential treatment for menopause symptoms. According to the Mayo Clinic, HRT may be ideal for women and people assigned female at birth (AFAB) who:20

• 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

Among many of its close competitors — Gennev, Evernow, and Alloy — Winona is the only one that offers extensive support outside of just prescriptions and doctor visits. The service provides Q&As, webinars, ebooks, and more, all intended to try and make the menopause 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).

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 Sildenafil Arousal Cream, 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 (e.g., 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)21
• Low-dose antidepressants for mood symptoms22
• Gabapentin, clonidine, or fezolinetant (Veozah) for hot flashes and night sweats23
• A pH-balanced, hormone-free vaginal moisturizer for dryness, painful intercourse, and other symptoms of vulvovaginal atrophy due to decreased estrogen production24

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 up front), 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, Anthem Blue Cross Blue Shield, or Cigna 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:7

• Antipsychotics
• Lithium
• SSRIs

Winona offers eleven prescriptions for women experiencing symptoms of menopause, and a majority of those treatments are HRT. These medications are available in several forms:

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

The only nonhormonal treatment in the list above is the sildenafil-based arousal cream. As for DHEA, it occupies a bit of a gray area: it’s a hormone produced by the adrenal glands that acts as a precursor to androgens and estrogens, but it’s not typically classified as HRT in the traditional sense. Some research suggests that DHEA may help improve libido and vaginal dryness in older women, but results have been mixed, and the risks of supplementation may outweigh potential benefits (more on that later).7 25

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.26 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.5

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.)30

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

When presented with the substance of this portion of the questionnaire, one of our medical review board members — Matt Segar, MD — expressed some surprise.

“I’m surprised that they don’t ask about dementia or gallbladder disease,” Dr. Segar said, noting that HRT has been associated with an increased risk of gallbladder disease and may not be appropriate for some people with elevated dementia risk, depending on factors like age and medical history.

That’s part of why it’s so important to answer Winona’s intake questionnaire honestly and thoroughly, as omitting medical 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 “nonhormonal menopause solutions” and has partnered with Winona. Products from Kindra include lotions, creams, serums, supplements, and other nonprescription products categorized by concern. These categories are:

• Vaginal dryness
• Low libido
• Painful sex
• Postpartum
• Menopause

While the partnership with Kindra is a nice option for some patients, it’d still be nice to see Winona offer nonhormonal treatments of its own (besides Sildenafil Arousal Cream) in the future. That’s something competitors Evernow and Alloy already do. Both offer paroxetine as a nonhormonal prescription option for relief from vasomotor symptoms, and Evernow also provides Veozah, an FDA-approved treatment for moderate to severe hot flashes.23

Other menopause support

As a “menopause care service,” Winona offers menopause support beyond prescription HRT. Some of the currently available online resources include:

• Ongoing messaging access to a physician
• 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, skin care, and nutrition

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
• Menopause Intimate Wellness: an ebook focusing on managing sexual dysfunction symptoms in menopause
• The Menopause Tracker Kit: 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 (e.g., a plant-based one) may potentially reduce vasomotor symptoms.27

Whether Winona’s treatments are effective largely depends on how well HRT works overall. Most of the company’s offerings are hormone-based, with one exception: Sildenafil Arousal Cream, a topical formula containing sildenafil (commonly used in Viagra) and pentoxifylline, a vasodilator.

Even though Winona promotes its compounded HRT as “bioidentical,” there’s no clear evidence that this distinction improves efficacy over traditional HRT treatments.11 Several FDA-approved HRT medications are also bioidentical and use the same ingredients.10

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

For most healthy adults, HRT should be a relatively safe option when used as directed. As with any prescription, there are some potential risks, including an increased risk of the following:5

• Heart disease
• Stroke
• Blood clots
• Breast cancer
• Uterine cancer
• Gallbladder disease
• Dementia39

Risks like these are part of why it’s important to maintain open communication with your doctor when considering or undergoing HRT. But even with these concerns, many experts assert that the benefits of HRT outweigh the risks for healthy populations suffering from menopause symptoms.9 If you’re concerned about using HRT, here are some factors that appear to lower the risks:5 20

• 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 forms30

Treatment safety

Winona explains that all its compounded treatments are made with FDA-approved active ingredients. However, once you combine these ingredients, the resulting treatment is no longer FDA-approved.16 We do appreciate that Winona uses approved ingredients, though, especially since some less-than-trustworthy manufacturers, as the Cleveland Clinic explains, may add untested hormones that are not FDA-approved and are unsafe to use.33

Below, we break down some of the risks associated with Winona’s available treatments or their active ingredients.

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

Based on our review of both state and federal regulations, along with information provided directly by the company, Winona’s compounding pharmacies appear to follow a strong set of safety standards.

A key distinction is that compounded medications are not reviewed or approved by the FDA.16 Because of this, it’s especially important to understand the regulatory framework these pharmacies operate under, whether you’re using Winona or another provider.

Winona states that it owns and operates two 503A compounding pharmacies, which create prescriptions on a patient-specific basis rather than mass-producing medications.31 32 These types of pharmacies are primarily regulated at the state level, though they must still comply with applicable portions of the Federal Food, Drug, and Cosmetic Act (FD&C Act).31

According to Winona, its pharmacies are subject to oversight from state Boards of Pharmacy and must follow United States Pharmacopeia (USP) compounding standards for quality, purity, strength, and identity. The company also notes that all compounded prescriptions are made using FDA-approved active ingredients, even though the final formulations themselves are not FDA-approved.

More specifically, Winona’s compounding pharmacy is located in Idaho, where the Board of Pharmacy outlines preparation requirements under “Idaho Admin. Code r. 24.36.01.700.” These include:15

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

Overall, while compounded medications carry additional considerations compared to FDA-approved drugs, the available regulatory information suggests that Winona’s pharmacy operates within established safety guidelines.

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.

When it comes to pricing, Winona structures most of its treatments on a monthly basis. Only a few products — including DHEA, the estriol face cream with tretinoin, and the minoxidil hair serum — are sold in three-month supplies.

• DHEA: $27 for three months
• Estriol Face Cream with Tretinoin: $150 for three months
• Estrogen Body Cream: $89 per month
• Estrogen Body Cream (with Progesterone): $89 per month
• Estrogen Patch: $149 per month
• Estrogen Tablet: $54 per month
• Minoxidil Hair Serum: $150 for three months
• Progesterone Body Cream: $89 per month
• Progesterone Capsule: $39 per month
• Vaginal Estrogen Cream: $89 per month
• Sildenafil Arousal Cream: $79 per order

While these prices are generally in line with 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 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.

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.

If you aren’t entirely sold on Winona, or you want to learn more about other telehealth HRT treatment options, here are some details on a few of Winona’s close competitors.

Gennev

The biggest difference between Gennev and Winona is that Gennev accepts certain insurance plans — currently, Aetna, Anthem Blue Cross Blue Shield, and Cigna Healthcare plans. The coverage includes appointments with your assigned doctor, as well as consultations with an RDN. However, because Gennev accepts insurance, your prescriptions will likely require a co-pay.

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

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

Alloy

Unlike Winona, Alloy offers more than just treatments for menopause symptoms; it also includes options for skin care (like tretinoin), gut health (a synbiotic), and weight loss, including prescription medications such as Wegovy.

In terms of its menopause therapies, many of Alloy’s offerings are similar to the estrogen and progesterone treatments available through Winona, often at a lower monthly cost (though Alloy typically requires a three-month commitment). Alloy also provides a few routes of administration that Winona doesn’t, including an estrogen spray and gel.

Beyond hormone therapy, Alloy offers options like low-dose birth control pills and a nonhormonal treatment for hot flashes (paroxetine), which may appeal to those looking for alternatives to traditional HRT. Like Winona, Alloy will provide you with the necessary documentation to submit for HSA/FSA reimbursement.

Evernow

Among the competitors mentioned here, Evernow is the only one that requires a paid membership in addition to medication costs. While this adds complexity compared to other services, its overall pricing has become more competitive in recent months, and the company has begun accepting some insurance plans, though coverage remains limited and situation-dependent.

Here’s how Evernow’s pricing works:

• Membership plans: start at about $49 per month, with discounted options like $129 for three months (about $43/month) and $420 for a year (about $35/month)
• One-time visits: available for around $150 per appointment and may be covered by insurance, depending on your plan
• Medication costs: charged separately, with tablets around $27.50 per month and patches ranging from about $59.99 to $89.99 for a 30-day supply
• Insurance usage: can be applied to medications only if they’re filled through a local pharmacy
• Home delivery: prescriptions shipped directly to your home are typically cash-pay
• Membership coverage: membership fees are not covered by insurance
• HSA/FSA: can be used for membership costs, but not for delivered medications

With this structure, Evernow can be competitive with — or even less expensive than — other providers in some cases, particularly for tablet-based treatments. However, total costs still depend on how you choose to access care, whether you use insurance, and how prescriptions are filled.

The available treatments for menopause symptoms are similar to those from Alloy and Winona, with the addition of vaginal estradiol tablets and a few nonhormonal options (Femistry, Veozah, and paroxetine).

Like Alloy, Evernow also offers treatments outside of menopause care, including hair-loss options such as oral minoxidil and a topical finasteride/minoxidil solution. However, the selection is relatively limited, and there are often more cost-effective providers with broader offerings in this category, such as Hers.