Best Online HRT for Endometriosis
How we make money, up front:The links to Midi and Sesame are affiliate links — we earn a small commission if you start care. It’s never changed a recommendation or your price. We route some readers to in-person care because it’s the right call. Full disclosure.
For women with a stable endometriosis history and no new pelvic pain, unexplained bleeding, or suspected mass, the best online HRT for endometriosis starts with Midi Health: live video visits, FDA-approved options, the ability to order labs or imaging, and most PPO plans accepted (self-pay is $250 for the first visit and $150 for follow-ups). Prefer to choose your own clinician? Sesame’s menopause subscription is $59 a month. If your pelvic symptoms are new or active, see a doctor in person first.
One thing to clear up right away. “HRT for endometriosis” on this page means menopause hormone therapy for a woman who has, or once had, endometriosis. It does not mean using menopause hormones to treat endometriosis. Those are two different things, and the difference is the single most important idea on this page.
The 60-second answer
| Your situation | Where to start |
|---|---|
| Stable endometriosis history, no new pelvic symptoms, want coordinated menopause care | Midi Health — live visits, FDA-approved options, takes many PPO plans |
| You want to pick your own clinician or pay per visit | Sesame Care — $59/month menopause subscription, you choose the provider |
| New or worsening pelvic pain, bleeding after menopause, a suspected mass, or known active disease | An in-person doctor first— not a routine online subscription |
This guide is for you if: you’ve been diagnosed with endometriosis (now or in the past), you’re dealing with menopause or surgical-menopause symptoms, your pelvic symptoms are stable, and you want help choosing where to go.
Please don’t start with a routine online subscription if: your pelvic pain is new or getting worse, you have bleeding that isn’t explained or that happens after menopause, a mass or cyst is suspected, your past surgery or pathology is unclear, or you’ve been told you have residual or deep disease. Those situations need an exam first.
The HRT Index is the independent decision resource for online menopause and HRT care — comparing telehealth providers on clinical legitimacy, care quality, medication fit, price transparency, and access, with every claim verified and dated, so women can choose the path that fits their situation before their first consult.
The right online HRT provider isn’t the same for every woman. Because a general answer can’t resolve that for you, use The HRT Index’s Find My HRT Path tool to match your situation to the right provider — and to flag when online care isn’t the right starting point — before your first consult.
What’s the best online HRT for endometriosis?
For a woman with a stable endometriosis history and no red-flag symptoms, the strongest online starting point we found is Midi Health, because it offers a real live video visit, prescribes FDA-approved hormones, can order labs and imaging, and is in-network with most PPO plans. Sesame Care is the better fit if you want to choose your own clinician. New or active pelvic symptoms should be seen in person before any online prescription.
Let’s expand that into the three paths, because “best” depends entirely on which one you’re on.
Path 1 — Midi Health (most women with a stable history)
You get a 30-minute first visit with a clinician trained in midlife hormone health, not a questionnaire and an auto-prescription. They can order bloodwork or imaging if your history calls for it, they prescribe FDA-approved hormones, and they take many insurance plans. The trade-off — and it’s a real one — is that Midi is not an endometriosis specialist. More on that below.
Path 2 — Sesame Care (you want to pick the doctor)
Sesame is a marketplace. You search, you read clinician profiles, and you choose your own provider — and you can look for an OB-GYN or someone with gynecology experience where they’re available. That control matters if your case is complicated, or if you’ve been brushed off before. The trade-off is variability: price, experience, and follow-up depend on the individual you pick.
Path 3 — In-person care (anyone with red flags)
If you have new or worsening pelvic pain, bleeding you can’t explain, bleeding after menopause, or a suspected mass, no online subscription is the right first move. You need an exam. We’ll list the exact warning signs so you can tell which path you’re on.
Here, “best” means the best starting pointfor your situation — judged by our five pillars: clinical legitimacy, care quality, medication fit, price transparency, and access. It does not mean the cheapest monthly price, and it does not mean a cure for endometriosis. Menopause HRT doesn’t treat endometriosis, and we’re comparing these providers as menopause-care services, not endometriosis-treatment services.
Why does HRT work differently when you’ve had endometriosis?
Endometriosis is an estrogen-dependent disease — estrogen is the hormone that drives it. That one fact changes the HRT rules for you. After menopause the disease usually quiets down as estrogen falls, but HRT adds estrogen back, which can reactivate any leftover tissue in some women. So guidelines steer toward combined therapy — estrogen plus a progestogen — even if you no longer have a uterus, rather than estrogen alone.
Endometriosis is when tissue similar to the lining of the uterus grows outside the uterus — on the ovaries, the pelvic wall, the bowel, or the bladder. Because it feeds on estrogen, it tends to ease off after menopause when your estrogen naturally drops. (review of the literature)
Here’s where it gets counterintuitive. After a hysterectomy (removal of the uterus), women are normally given estrogen-onlyHRT, because the usual reason to add a progestogen — protecting the lining of the uterus — no longer applies. But with an endometriosis history, that shortcut can backfire. Endometriosis tissue can remain elsewhere in the pelvis even after the uterus is gone. So the usual guidance shifts: guidelines lean toward combined estrogen-plus-progestogen, even without a uterus, because adding a progestogen is thought to lower the chance that estrogen stirs up leftover disease. (British Menopause Society, 2026)
A quick term, defined: a progestogen is the umbrella word for progesterone (the hormone your body makes) and progestins (lab-made versions). For an endometriosis history, the job of the progestogen isn’t to protect a uterus you may not have — it’s to balance the estrogen so it’s less likely to feed any residual tissue.
One important nuance: combined therapy is the default, but it isn’t an absolute life sentence. The British Menopause Society says that for a woman with very little or no residual disease, a clinician mayconsider switching to estrogen-only later — after starting on combined — because it can carry a better safety profile past the natural age of menopause. That’s a judgment call your clinician makes with you, weighed against the risk of reactivating disease. It is not something to decide off a menu by yourself. (BMS, 2026)
The two big guidelines don’t agree on everything — here’s where they line up and split
Most pages quote one guideline and stop. Two bodies shape this conversation — Europe’s ESHRE and the UK’s British Menopause Society — and they agree on the core while differing on the edges. Knowing the difference tells you exactly what to ask.
| Question | ESHRE (2022) | British Menopause Society (2026) |
|---|---|---|
| Combined estrogen + progestogen for an endometriosis history | Can be considered; preferred over estrogen-only | Continuous combined is preferred, even after a hysterectomy |
| Estrogen-only systemic therapy | Advised against for menopause symptoms | Generally avoid — but a clinician may consider it later in women with little or no residual disease |
| Tibolone (a synthetic hormone) | Moved away from recommending it | Still listed as an option, especially for low libido |
| Reactivation / malignant change | Possible; more concern with estrogen-only; evidence is limited | Rare but possible; more likely with residual disease + estrogen-only; cases of malignant change reported, but absolute risk can’t be quantified |
The practical takeaway from both: combined therapy is the safer default for an endometriosis history, and the estrogen-only and tibolone questions are conversations to have with a clinician who knows your history — not settled rules you apply yourself.
Is online HRT a reasonable starting point with endometriosis?
Online menopause care can be a reasonable starting point when your endometriosis is diagnosed and stable, you have no new pelvic pain or unexplained bleeding, and the service can take a real history and refer you out if needed. It is not a substitute for a pelvic exam or imaging when your symptoms suggest active disease or something else going on.
Think of it as a simple gate. Some situations are fine to start online. Some need an exam first. Here’s how to tell.
Online may be a reasonable start when:
- •your endometriosis was diagnosed and prior treatment is documented,
- •you have no new or worsening pelvic pain,
- •you have no unexplained bleeding — and no bleeding at all after menopause,
- •there’s no suspected mass or cyst,
- •your main problem now is menopause symptoms (hot flashes, night sweats, sleep, mood, vaginal dryness),
- •and you have a clear way to get in-person care if something changes.
Start with in-person care instead when:
- •pelvic pain is new or getting worse,
- •you have bleeding that isn’t explained,
- •you have any bleeding after menopause,
- •a mass, cyst, or endometrioma is suspected,
- •you’re not sure what your past pathology or surgery actually found,
- •you’ve been told residual or deep disease remains,
- •or symptoms came back after a medication change.
Bleeding after menopause is the big one. It always deserves prompt evaluation rather than being treated as a routine “which product should I buy” question. (ESHRE guideline)
What online care simply can’t do: a pelvic exam, an in-person ultrasound on the spot, or reading your surgical anatomy without your records. A good online clinician knows this and will send you out when needed. That referral isn’t a failure — it’s the system working.
Not sure which gate you’re behind? Use The HRT Index’s Find My HRT Path tool to answer a few quick questions about your symptoms and history. It tells you whether online care is a reasonable starting point for you, or whether you should see someone in person first.
Find My HRT Path →Which situation are you actually in?
Whether menopause HRT is even the right tool depends on your situation. For a woman in surgical or natural menopause with a stable history, it can be appropriate — with a combined regimen. For a woman of reproductive age with active endometriosis, menopause HRT is the wrong tool entirely; that calls for a gynecologist. Use the table below to find yourself.
| Your situation | Is menopause HRT the right tool? | What guidelines support | Is online menopause care a reasonable start? |
|---|---|---|---|
| Reproductive age, active endometriosis, looking for relief | No.This is endometriosis treatment, not HRT. The usual approach is hormone suppression — combined birth control, progestins, a hormonal IUD, or GnRH medicines. | Suppression therapies, prescribed and monitored by a gynecologist (ESHRE) | No — see a gynecologist. |
| Surgical or early menopause after endometriosis surgery (ovaries removed) | Yes — and it often matters a lot. Early menopause raises long-term bone and heart risk, so HRT is frequently recommended at least until the usual age of menopause. | Combined estrogen + progestogen, even without a uterus; timing is individualized (review) | Sometimes — if your disease is stable and the provider prescribes a combined regimen with real follow-up. |
| Natural menopause, history of endometriosis | Yes — combined HRT can be considered for menopause symptoms. | Combined estrogen + progestogen; an honest conversation about reactivation (BMS, 2026) | Sometimes — same conditions, plus that conversation. |
| After menopause, but currently having pelvic pain or bleeding | Investigate first. Don’t reach for HRT yet. | Evaluation — sometimes a procedure — to find the cause before any hormone decision (ESHRE) | No — in-person evaluation first. |
How we built this: each row maps a situation to whether menopause HRT applies, what the major guidelines (ESHRE and the British Menopause Society) support for it, and whether starting online is reasonable. It’s a decision aid, not a prescription.
If you’re in row one, this is the most important sentence on the page for you: menopause HRT is not how endometriosis is treated, and online menopause care is the wrong door. Book a gynecologist. We’d rather lose you to the right care than keep you on the wrong path.
Can you take HRT if you have endometriosis?
A history of endometriosis is not an automatic “no” to menopause HRT, but it does change the conversation and can change the regimen a clinician recommends. Major menopause guidance supports considering HRT case by case, while flagging that the evidence is limited and that estrogen-only therapy deserves a specific discussion for women with possible residual disease.
So, can you? Often, yes — especially if you had your ovaries removed young and need the long-term protection HRT provides. But “yes” comes with conditions, and a careful clinician will walk through them with you instead of handing you a one-size package.
What the answer depends on:
- whether you’re actually in menopause yet,
- natural menopause versus surgical menopause,
- whether you still have a uterus and ovaries,
- whether any disease is known to remain,
- how severe your endometriosis was and what surgery you had,
- why you need HRT in the first place,
- and your other health risks (clotting, breast cancer history, and so on).
The estrogen-only question — ask it out loud
Even after a hysterectomy, the usual “no uterus, so estrogen only” logic can be incomplete when you’ve had endometriosis. The practical move is simple: ask your clinician, “Given my endometriosis history, does estrogen-only make sense for me, or should I be on a combined regimen?” If they can’t explain the reasoning, that’s a sign to slow down. (review)
Be honest with yourself about the evidence, too.The research here is thin and mostly observational. That means nobody — no provider, no website, no product — can promise you a specific outcome or guarantee your disease won’t flare. Anyone who does is overselling. (review)
HRT is not endometriosis treatment. Menopause HRT manages menopause symptoms. It does not treat or cure endometriosis. If your goal is relief from active endometriosis pain, that’s a gynecology conversation about suppression or surgery — not an online menopause subscription.
Which online providers fit an endometriosis history best?
The best provider for an endometriosis history isn’t the one with the lowest monthly medication price. What matters more is a real assessment, the ability to order tests and coordinate care, clear labeling of FDA-approved versus compounded products, honest follow-up, and a referral route if your case turns out to be complex.
We compared five U.S. online menopause providers. A few notes before the table:
- FDA-approved means a finished medication that went through the FDA’s approval process for safety, effectiveness, and manufacturing. Compoundedmeans a pharmacy mixes a custom formula for an individual. Compounded drugs are not FDA-approved — even when their ingredients also appear in FDA-approved drugs. (FDA)
- We do not assign numeric scores.
- “Confirm at checkout” means we can’t reliably verify it from the outside; you should confirm it before you pay.
Online menopause providers, for an endometriosis history (verified June 25, 2026)
| Provider | Visit type | FDA-approved options? | Can order labs / imaging? | Insurance | Fit for endo history |
|---|---|---|---|---|---|
| Midi Health | Live 30-min video | Yes | Yes (billed separately) | Most PPO plans; not Medicare/Medicaid | Best overall starting point — real visit, full history, can refer out |
| Sesame Care | Video visit; you choose clinician | Yes (depends on clinician) | Varies by clinician | Cash-pay subscription $59/mo; drug insurance may apply at pharmacy | Good if you want to pick your own OB-GYN; quality varies |
| Winona | Async (no live video) | Disputed — help center states treatments are not FDA-approved | No | None; HSA/FSA may apply | Lower fit — no live visit or imaging for complex history |
| Hers | Async; confirm at checkout | Yes | No | None | Lower fit — no live visit; not in all states |
| Oestra (Inner Balance) | No visit | No — compounded cream only | No | Confirm at checkout | Not suitable — no visit, no labs, compounded only |
Symptoms that mean “pause and check in with your clinician”
Returning or worsening pelvic pain, any new bleeding, bowel or bladder changes, pain during sex, a new sense of fullness or a mass, or unexplained symptoms after a medication change.
A good follow-up plan should include:
A named way to reach your clinician, an expected response time, a scheduled follow-up, clear instructions for what to do if symptoms change, and a route to in-person care. If a provider can’t describe that, it’s a reason to pause.
Want coordinated, insurance-friendly menopause care with a real live visit and the option to order labs or imaging? Check Midi’s coverage in your state.
Check Midi coverage and availability →Midi Health — affiliate link. You pay the same price.
Prefer to pick your own clinician? See Sesame’s $59/month menopause subscription and browse provider profiles before you book.
Browse Sesame menopause providers →Sesame Care — affiliate link. You pay the same price.
Are estradiol patches better than pills when you have endometriosis?
There isn’t enough endometriosis-specific evidence to say one route — patch, pill, or gel — prevents recurrence better than another. Route and regimen are two separate decisions: the route is how the estrogen is delivered, and the regimen is the full plan, including whether a progestogen is added. For an endometriosis history, the combined-versus-estrogen-only question usually matters more than patch-versus-pill.
A practical way to think about it: choosing a delivery method you’ll actually stick with is helpful, but it doesn’t settle the residual-disease question on its own. Transdermal estrogen (a patch or gel) bypasses the liver and is generally linked to a lower clot risk than oral estrogen, which is why many clinicians favor it — but that’s a general menopause consideration, not an endometriosis cure. (clinical overview)
What to ask about any route:
- Why this route for me?
- Is the exact product FDA-approved or compounded?
- Is a progestogen included, given my history?
- What symptoms should make me stop and call you?
- Are medication and follow-up included in the price I was quoted?
Can you use vaginal estrogen if you’ve had endometriosis?
Vaginal estrogen can usually be used for genitourinary symptoms — vaginal dryness, irritation, painful sex, urinary urgency — with or without systemic HRT, including in many women with an endometriosis history. As always, individual assessment matters, and any unexplained or post-menopausal bleeding should be evaluated before treatment.
A quick definition: genitourinary syndrome of menopause (GSM) is the cluster of vaginal and urinary symptoms caused by low estrogen in those tissues. Low-dose vaginal estrogen is a local treatment aimed right at GSM.
The British Menopause Society notes vaginal estrogen may be prescribed for these local symptoms with or without systemic HRT, including in women with a history of endometriosis. (BMS, 2026)
Local and systemic do different jobs. Low-dose vaginal estrogen mainly treats GSM. Systemic HRT (patch, pill, gel) treats whole-body symptoms like hot flashes. One isn’t an automatic stand-in for the other — and a product like Oestra is a compounded cream marketed for systemic effects, not the same thing as low-dose local vaginal estrogen.
Bleeding still gets evaluated.If you have unexplained bleeding — or any bleeding after menopause — that’s assessed before you treat, not waved through.
For more on this topic, see our guide to the best online vaginal estrogen options.
How much does online HRT cost, and which providers take insurance?
The real cost of online HRT with an endometriosis history is the full picture — the visit, the medication, follow-ups, labs, and any in-person referral — not just the advertised monthly price. A “cheaper” service can cost more if it can’t handle the assessment your history needs and you end up paying for a second appointment elsewhere. Only Midi bills insurance; the others are cash-pay.
| Provider | Visit / plan price | Medication | Insurance | Notes |
|---|---|---|---|---|
| Midi | $250 first visit, $150 follow-up (self-pay); ~$50 avg out-of-pocket with in-network PPO | Separate; varies by prescription | Most PPO plans; not Medicare/Medicaid | Can order labs/imaging (billed separately) (Midi) |
| Sesame | $59/month subscription (visits + labs when ordered + messaging) | Prescriptions filled at your pharmacy | No insurance for subscription; drug insurance may apply to meds | You choose the clinician (Sesame) |
| Winona | No membership fee | Cream from $89/mo; patch listed $149/mo; progesterone from $39/mo | None; HSA/FSA may apply | No video; no refund once medication is prepared (Winona refund policy) |
| Hers | Cash-pay subscription; confirm price at checkout | Varies | None | Not in all states; off-label for perimenopause |
| Oestra | $199/month for first 6 months, then ~$99.50 | Compounded cream (90-day shipments) | Confirm at checkout | No visit / no labs; 180-day guarantee |
The insurance-sensitive shortcut: if you want to use insurance, Midi is the clear pick — it’s the only one here that’s in-network with most PPO plans. If you’d rather pick your own clinician and pay a flat cash price, Sesame at $59/month is the straightforward option.
Costs the sticker price won’t show: a medication change, an extra follow-up, outside imaging, a pelvic exam, a specialist referral, pharmacy shipping, or a cancellation that lands after a refund window closes. Budget for the path, not just the first click.
Using insurance? Check Midi coverage in your state.
Check Midi coverage and availability →Midi Health — affiliate link.
Prefer to choose and pay a clinician directly? See Sesame’s $59/month menopause subscription.
Browse Sesame menopause providers →Sesame Care — affiliate link.
How to prepare for your consult
The most useful prep isn’t a symptom quiz — it’s a short, organized record of your endometriosis diagnosis, surgeries, pathology, current symptoms, prior hormones, and any known residual disease. Bring that, and your clinician can quickly tell what can be handled online and what needs an exam.
Endometriosis and surgery
- •operative reports and pathology results,
- •imaging (ultrasound/MRI) if you have it,
- •diagnosis date; whether you had excision or ablation,
- •hysterectomy and ovary-removal details,
- •any documented residual disease.
Menopause picture
- •last period (if relevant) and age at natural or surgical menopause,
- •your current symptoms, how severe, and when they hit,
- •vaginal/urinary symptoms,
- •any prior HRT and how you responded.
Health and meds
- •current medicines and allergies,
- •bleeding history,
- •breast cancer, clotting, stroke, liver, or migraine history,
- •smoking status and relevant family history.
This is preparation, not self-diagnosis — you’re not deciding your own regimen, you’re giving the clinician what they need to decide well with you.
Questions to ask before you accept any HRT plan
Before you pay, your clinician should be able to explain why the plan fits your symptoms, your surgical history, and any possible residual disease; whether each medication is FDA-approved or compounded; and what happens if symptoms come back. A vague answer, or no clear follow-up plan, is a reason to pause.
Copy these into your notes app and ask them out loud:
- How did my endometriosis history shape this recommendation?
- Have you reviewed my operative and pathology reports?
- Does known or possible residual disease change your reasoning?
- Is each medication you’re proposing FDA-approved or compounded?
- Why this route and this full regimen — and is it combined estrogen-plus-progestogen?
- What symptoms should make me stop and contact you?
- What’s the plan if pelvic pain or bleeding shows up?
- Can you order imaging or coordinate in-person care if I need it?
- When’s my first follow-up, and who answers questions between visits?
- What’s the total expected cost through the first three to six months?
Four warning signs in a provider’s answer:
- •they brush off your endometriosis history,
- •they call compounded hormones “safer” or “more natural” (no evidence supports that),
- •they won’t name the dispensing pharmacy,
- •they have no clear answer about new pain, bleeding, an exam, or imaging.
Before you click “start,” check these off:
- □I know whether each product is FDA-approved or compounded.
- □I know my full cost for the first three months.
- □I know when follow-up happens and how to reach my clinician.
- □I know what to do if my symptoms change.
- □I’m confident online care is still the right setting for me.
If all five are checked, you’re not guessing anymore — you’re deciding. That’s the whole point.
Frequently asked questions
Is endometriosis a reason you can’t take HRT?
Not automatically. A history of endometriosis doesn’t rule out menopause HRT, but it changes the conversation — most importantly, it pushes toward combined estrogen-plus-progestogen rather than estrogen-only, and toward individual assessment. Active disease or new pelvic symptoms, though, should be evaluated before starting.
Do I need progesterone after a hysterectomy if I had endometriosis?
There’s no universal yes or no, but the usual “no uterus, so estrogen only” rule often doesn’t apply cleanly to an endometriosis history, because residual tissue can remain. Guidance leans toward combined therapy even without a uterus, with estrogen-only considered only later and only in women with little or no residual disease. Ask your clinician to explain their reasoning for your case.
Can online HRT treat my endometriosis pain?
No. Menopause HRT is not a treatment for active endometriosis pain. New or worsening pelvic pain needs in-person evaluation, and endometriosis itself is usually managed with suppression therapy or surgery by a gynecologist — a different path from menopause care.
Can an online provider order an ultrasound?
Some can. Midi, for example, publishes that its clinicians can order labs and imaging. Other services vary, and no-video platforms generally don’t build imaging into their model. If imaging is likely, choose a provider that can order and coordinate it — or start in person.
Can endometriosis come back after both ovaries are removed?
Symptoms or residual disease can persist even after ovary removal, because tissue can remain elsewhere in the pelvis. The exact risk with HRT is uncertain and the evidence is limited, so there’s no reliable percentage. New pelvic pain or bleeding after surgery should be checked.
Are compounded “bioidentical” hormones safer for endometriosis?
No evidence supports calling compounded hormones safer, more natural, or equivalent to FDA-approved products. The FDA and The Menopause Society do not support those claims. “Bioidentical” describes molecular structure, not FDA approval, and several FDA-approved products are bioidentical too. A compounded finished product is not FDA-approved, even when made from approved ingredients.
Which provider takes insurance?
Among the options here, Midi is the one in-network with most PPO plans (not Medicare or Medicaid). Sesame, Winona, Hers, and Oestra are cash-pay, though some accept HSA/FSA and your drug insurance may apply to prescriptions filled at your pharmacy. Always confirm your specific plan and service.
Which provider lets me choose my own clinician?
Sesame Care’s marketplace gives you the clearest clinician choice — you read profiles and pick the provider, and you can look for an OB-GYN where one is available. The trade-off is that experience, price, and follow-up vary by who you select.
What if my pelvic pain comes back after starting HRT?
Contact your prescribing clinician and seek in-person evaluation rather than changing your regimen based on an article. Returning pain or new bleeding is a signal to reassess and rule out residual or active disease — not something to push through.
Should I see a menopause specialist or an endometriosis specialist?
For stable menopause symptoms with a quiet history, a menopause-focused clinician (online or in person) is a reasonable start. Active pelvic symptoms, complex surgery, or known residual disease make a strong case for gynecology or endometriosis expertise first.
The bottom line — where should you start?
Midi Health is the strongest online starting point for a stable endometriosis history, because its live, coordinated, FDA-approved, insurance-friendly model fits the uncertainty this history brings. Sesame Care is better when choosing your own clinician matters most. And new pain, bleeding, a mass, or suspected active disease belongs with an in-person doctor before any online prescription.
| Start with Midi | Start with Sesame | Start in person |
|---|---|---|
| Stable history | Want to choose your clinician | New or worsening pain |
| Want coordinated, insurance-friendly care | Prefer pay-per-visit, cash-pay | Bleeding after menopause |
| Want a real live visit | Want to read the clinician’s background first | Suspected mass or active disease |
You came here worried that HRT might wake up something you fought hard to get past. That worry is reasonable — and it’s exactly why the regimen and the clinician matter more than the brand or the monthly price. Get the combined-versus-estrogen-only question answered, bring your records, pick the right setting, and you can take care of your menopause without ignoring your history.
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This page was written by The HRT Index editorial team. We compared five U.S. online menopause providers by clinical legitimacy, care quality, medication fit, price transparency, and access. All provider prices, insurance details, and availability were verified in June 2026 and should be confirmed before you pay. We may earn a commission if you start care through our Midi or Sesame links — you pay the same price either way. No provider can pay to change their ranking, their editorial description, or our red-flag guidance. Questions: editors@thehrtindex.com.
For more on how we rank providers, see our methodology and affiliate disclosure.
Sources
Medical guidance
- ESHRE Endometriosis Guideline (2022): pmc.ncbi.nlm.nih.gov/articles/PMC8951218/
- British Menopause Society — Induced Menopause in Women with Endometriosis (Feb 2026): thebms.org.uk/…FEB2026-B.pdf
- Management of menopause in women with a history of endometriosis (review): pmc.ncbi.nlm.nih.gov/articles/PMC11576634/
- HRT in women undergoing pelvic clearance for endometriosis (case report + survey): ncbi.nlm.nih.gov/pmc/articles/PMC9821579/
- Hormone replacement therapy in menopausal women with a history of endometriosis (review): pmc.ncbi.nlm.nih.gov/articles/PMC6723930/
- FDA — Menopause / compounded “bioidentical” hormones: fda.gov/consumers/womens-health-topics/menopause
Provider facts (verified June 25, 2026)
- Midi Health — pricing & insurance: joinmidi.com/pricing-insurance · appointment cost: Midi Zendesk · HRT options: joinmidi.com/post/hrt-cost
- Sesame Care — menopause treatment: sesamecare.com/service/menopause-treatment
- Winona — product page: bywinona.com/hormone-replacement-therapy · FDA status: Winona Help Center · refund policy: cancellation and refund policy
- Inner Balance (Oestra) — compounded status and pricing: innerbalance.com/p/learn/winona-review
- Hers — perimenopause care: forhers.com/perimenopause