Sesame HRT vs Winona: Who Takes You, What You Pay, and Who Ships the Medicine

Affiliate disclosure: We may earn a commission if you use a sponsored provider link, at no added cost to you. Read our affiliate disclosure. Sesame HRT vs Winona is a choice between clinician-first care and bundled medication delivery. Sesame is the better default if you want video visits, provider choice, and prescriptions sent to your pharmacy from $59 a month. Winona fits better if you are 35–59, live in its service area, and want medication, messaging, and shipping in one published price.^[1][2]

The part almost nobody tells you before you fill out the intake: eligibility can end this comparison before price matters. Winona limits HRT treatment to women ages 35–59 and serves 37 states plus Puerto Rico. Sesame accepts adults 18 and older, but its Terms require users to certify that they are not Medicare, Medicaid, or TRICARE beneficiaries.^[3][4]

Best for you / not for you

Winona fits better if you…	Sesame fits better if you…
Are 35–59 and live in one of Winona’s 37 states or Puerto Rico	Are 60 or older, provided Sesame’s federal-program restriction does not exclude you
Want one published product price that includes clinician messaging and standard shipping	Want a $59 monthly care program and the freedom to price the medication at your own pharmacy
Prefer asynchronous portal messaging over scheduled calls	Want video visits and to choose from available clinicians
Do not want to coordinate with a retail pharmacy	Want the prescription sent to a pharmacy you choose
Want one of Winona’s listed pills, patches, or compounded creams	Want a wider publicly listed medication menu, including hormonal and nonhormonal options

Neither is the right first stop if you…
Have bleeding after menopause that has not been evaluated
Need emergency or urgent in-person care
Want testosterone: neither provider offers it
Need Sesame but are a Medicare, Medicaid, or TRICARE beneficiary
Need Winona but are outside its 35–59 age range or service area

The 30-second comparison

Every commercial fact below was checked against the providers’ own pages on August 13, 2026. When a provider does not publish an answer, we leave the gap visible instead of turning it into an estimate.

Decision fact	Winona	Sesame
What the published price buys	Medication + clinician messaging + standard shipping	Clinical care; medication is separate
Published price	$39–$149 per product	From $59/month; $49/month for eligible Costco members
Billing timing	30-day supplies process every 28 days; 90-day supplies every 84 days	Monthly
First 90 days	Four processing dates for a 30-day product: day 0, 28, 56, and 84	Three monthly care charges
Age	HRT only for women 35–59	Adults 18+; no upper limit published
States	37 states + Puerto Rico	No menopause-specific public state list found; availability depends on clinicians licensed in your state
Medicare / Medicaid / TRICARE	No insurance billing; no equivalent beneficiary exclusion found	Terms require you to certify that you are not a federal-program beneficiary
Clinician contact	Secure portal messaging only; no phone or video	Video visits, provider choice, and unlimited messaging
FDA-approved lane	Winona states that its estrogen tablets, progesterone capsules, and patches are FDA-approved; verify the manufacturer and NDC on the dispensed package	Public menu includes examples of FDA-approved brand and generic products; verify the exact dispensed product at your pharmacy
Compounded lane	Several body and vaginal creams are compounded and not FDA-approved	Compounded BHRT may be prescribed; Sesame says it is outside FDA standardization and has not been shown safer or more effective
Labs	No bloodwork or hormone testing required	Five basic tests included if ordered; direct-pay exceptions in NY, NJ, RI, and ND
Testosterone	No	No
Refund deadline	Only within Winona’s 24-hour processing window	Full first-month refund only if cancelled at least 3 hours before the initial visit
Pause	30, 60, or 90 days	No menopause-specific pause policy published

Start where you actually are

I want medication and shipping in one published price — check Winona’s eligibility and current products → (Sponsored)

I want video care and my own pharmacy — check Sesame’s current menopause availability → (Sponsored)

If age, state, insurance status, symptoms, or medication route could change the answer, use The HRT Index's Find My HRT Path tool before you pay. It also flags when online care isn't the right starting point.

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 — it depends on your symptoms, your age and whether you have a uterus, your medication route preference (patch, pill, gel, or vaginal estrogen), your risk history, your insurance or cash-pay situation, and your state. Some situations belong with an in-person clinician first. Because a general answer can't resolve those 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.

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Sesame HRT vs Winona: what is the actual difference?

Winona is built around a prescribed product that its pharmacy operation dispenses and ships. Sesame is a marketplace and care program: you choose an available clinician, meet by video, and take any prescription to your preferred pharmacy. Cost, convenience, FDA status, insurance handling, and cancellation all flow from that one structural difference.

Here is the mistake almost every quick comparison makes: it puts Sesame’s $59 beside Winona’s $89 or $149 as if the numbers buy the same thing.

They do not.

Winona’s listed price covers the product, clinician messaging, dose-change conversations, and standard shipping. Sesame’s $59 is for the care program. Medication costs are explicitly separate and depend on the prescription, pharmacy, insurance, and discounts available to you.^[1][2]

Comparing $59 with $89 without saying that is like comparing a hotel room with a whole trip package and pretending the lower number settles it.

What Winona actually is

Winona focuses on menopause care. Its FAQ says more than 30 board-certified physicians review intakes and prescribe for women who qualify. You complete the intake online, get matched to a physician licensed in your state, and communicate through the portal. If you submit a question in the onboarding questionnaire, Winona says the physician will answer it before prescribing. If you leave the question field blank and qualify, the prescription may move directly to fulfillment.^[3]

Winona ships prescriptions from two 503A compounding pharmacies in El Dorado Hills, California, and Twin Falls, Idaho. Its creams are compounded there. Its tablets, capsules, and patches are presented by Winona as FDA-approved products dispensed through the same operation—not as compounded versions.^[3][5]

Standard shipping is free. Winona says a new order has a mandatory 24-hour hold, usually takes another 1–2 business days to prepare, and is expected to arrive in 3–5 business days depending on location and carrier timing.^[3]

What Sesame actually is

Sesame is not the pharmacy and does not make the medication. Its menopause program currently advertises care from $59 per month, provider choice, video visits, unlimited messaging, and prescriptions sent to your preferred local pharmacy if a clinician decides treatment is appropriate.^[1]

That means the drug can still run through the pharmacy system you already use. Depending on the product and plan, insurance may apply to the medication even though Sesame does not bill insurance for the care program. A prescription savings card is also available when a medication is prescribed.^[1]

The tradeoff is simple: more control, more moving parts. You may have one Sesame charge and a separate pharmacy price. With Winona, those pieces are bundled into the listed product price.

The one-sentence test

Do you want the medicine delivered as part of the service, or do you want the prescription sent to a pharmacy you control?

If you never want to think about a pharmacy, Winona has the cleaner model. If you want video care, provider choice, and the ability to compare pharmacy prices, Sesame has the stronger model.

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Will Winona or Sesame actually accept you?

Winona’s public HRT gate is narrow and explicit: women ages 35–59 in 37 states plus Puerto Rico. Sesame is open to adults 18 and older and does not publish an upper age limit, but its Terms require users to certify that they are not Medicare, Medicaid, or TRICARE beneficiaries. Those are different exclusions, and they should not be blurred together.^[3][4]

This section can save you twenty minutes of intake and a rejected application.

Eligibility gate	Winona	Sesame
Minimum age	35 for HRT	18
Maximum age	59 for HRT	None published
Geographic rule	Must be in a listed service state or Puerto Rico	Must have an available clinician licensed for your location
Medicare / Medicaid / TRICARE	Does not bill insurance, but no blanket beneficiary prohibition was found	Terms require certification that you are not a beneficiary
Clinical approval	Physician reviews medical history and may decline treatment	Independent clinician decides whether care and any prescription are appropriate

Winona’s 37 states, by name

Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, Wisconsin, and Wyoming — plus Puerto Rico.^[3]

Not listed: Alabama, Alaska, Arkansas, Kansas, Louisiana, Mississippi, New Mexico, North Dakota, Rhode Island, South Dakota, Utah, Vermont, West Virginia, and Washington, DC.

Coverage changes. The list above was counted directly from Winona’s FAQ on August 13, 2026. Check it again before onboarding.

Why Winona stops at 59

Winona says its age rule aligns with the generally more favorable benefit-risk profile when hormone therapy is started before age 60 or within ten years of the final menstrual period.^[3]

That is a real clinical timing concept. The cutoff is still Winona’s business rule—not a universal medical verdict on every woman who turns 60. The Menopause Society supports individualized decisions, including continued treatment beyond 65 for some women after counseling and risk assessment. Starting systemic therapy later can require a more cautious, individualized evaluation.^[6]

If you are 61 with disruptive symptoms, one platform’s age gate is not the end of the medical conversation. It means that platform is not the place to start it.

If you have Medicare, Medicaid, or TRICARE

Sesame’s Terms say two separate things: it does not accept Medicare, Medicaid, or third-party insurance, and users certify that they are not federal health care program beneficiaries. That is stronger than “we do not bill your plan.” It is an eligibility problem, not just a payment preference.^[4]

Winona also does not bill insurance, but we did not find an equivalent beneficiary certification in Winona’s public materials. An age-eligible Medicare beneficiary should confirm directly with Winona before onboarding rather than assume she is excluded solely because Winona is cash-pay.

If neither one can take you

You are not out of options. You are out of these options.

• Ask your current primary-care or gynecology practice whether someone there manages menopause care.
• Use The Menopause Society’s practitioner directory.
• Use Find My HRT Path to screen for age, state, insurance, medication route, and situations that need in-person care first.

We are not putting a provider button in this section. If the eligibility gate closes, pushing you back into the same funnel would be useless.

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Which is cheaper, Winona or Sesame?

Sesame has the lower published starting care fee, but it is not automatically the lower all-in cost because medication is separate. Winona’s $39–$149 product prices include the medication and standard shipping, but 30-day products process every 28 days. That produces four Winona charges inside the first 90 days, versus three monthly Sesame care charges.^[1][2][3]

Two facts have to land before the numbers mean anything.

Fact one: Winona does not bill a 30-day product once per calendar month. It says payment and prescription processing occur every 28 days. Starting on day 0, the first 90 days contain processing dates on days 0, 28, 56, and 84.^[3]

Fact two: Sesame’s published starting price of $59 buys care, not medication. The pharmacy total remains unknown until you know the product, strength, quantity, insurance status, and pharmacy.^[1]

Winona’s first 90 days: the four-cycle math

These are editorial calculations using Winona’s current published product prices and its current 28-day processing rule. They assume a 30-day product begins on day 0 and is not paused or cancelled.

Winona route	Published price per 28-day processing cycle	Charges in first 90 days	First-90-day total
Progesterone capsules	$39	4	$156
Estrogen tablets	$54	4	$216
Estrogen tablets + progesterone capsules	$93	4	$372
Estrogen body cream	$89	4	$356
Estrogen + progesterone body cream	$89	4	$356
Estrogen patch	$149	4	$596
Estrogen patch + progesterone capsules	$188	4	$752
Vaginal estrogen cream	$89 per order	Request-only	No automatic 90-day total

Winona’s vaginal estrogen cream is an exception to its auto-refill system. The FAQ says it must be requested as needed, so the honest number is $89 per order, not “$89 every month” and not an invented annual total.^[2][3]

Sesame’s first 90 days: care plus an unknown pharmacy bill

Sesame care path	Monthly care fee	Three-month care total	Medication cost
Published starting price	$59	$177	Separate; confirm at pharmacy
Eligible Costco member price	$49	$147	Separate; confirm at pharmacy

The Costco row assumes you already have an eligible Costco membership and successfully verify it through Sesame. The membership cost is not included.^[7]

The break-even table nobody else gives you

This table answers the only useful cost question: How much room does Sesame leave for pharmacy costs before it becomes more expensive than the comparable Winona route over the first 90 days?

Potential route	Winona first 90 days	Sesame care at the published $59 starting rate	Pharmacy-cost room before Sesame exceeds Winona	Sesame care at the $49 Costco rate	Pharmacy-cost room before Sesame exceeds Winona
Progesterone capsules	$156	$177	None — Sesame care is already $21 higher before medication	$147	$9
Estrogen tablets	$216	$177	$39	$147	$69
Estrogen tablets + progesterone capsules	$372	$177	$195	$147	$225
Estrogen patch	$596	$177	$419	$147	$449
Estrogen patch + progesterone capsules	$752	$177	$575	$147	$605

This is not a treatment recommendation. A clinician decides whether any product—or combination—is appropriate. It is simply the published-fee math on the same 90-day clock.

What you still cannot know before intake or pharmacy checkout

Any comparison that gives one guaranteed all-in total is guessing about at least one of these:

• Whether a clinician prescribes anything
• Which product and route are selected
• Whether you need one prescription or more than one
• Strength, quantity, and 30-day versus 90-day fills
• Your insurance formulary, copay, prior-authorization rules, and deductible
• Your pharmacy’s cash price and stock on the day of filling
• Whether a dose change leaves unused medication
• Whether Sesame’s $49 Costco price applies to your account
• Whether state-specific lab payment rules add a direct charge

Compare the part each company can actually quote

See Winona’s current product prices and eligibility → (Sponsored)

Check Sesame’s current care price and provider availability → (Sponsored)

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What does Sesame’s menopause subscription from $59 actually include?

Sesame currently advertises its menopause program from $59 per month. The fee covers ongoing clinician care, provider choice, video visits, unlimited messaging, prescription management, and five basic lab tests if ordered. It does not include medication, and it does not guarantee that a clinician will prescribe HRT or any specific product.^[1]

That is the corrected version of Sesame’s price story. The number is no longer hidden on the menopause page.

Included in the published care fee

• A menopause intake and access to available clinicians
• The ability to choose among available provider profiles
• Video visits as needed with the provider
• Unlimited messaging for ongoing guidance
• Prescription management and refills when clinically appropriate
• Five basic lab categories if the provider orders them, subject to state payment exceptions
• Prescriptions sent to your preferred pharmacy

Not included in the published care fee

• The medication itself
• A guarantee of HRT or any prescription
• A guarantee that a particular brand, route, or dose will be prescribed
• A guarantee that your preferred clinician will remain available forever
• Direct payment of labs in New York, New Jersey, Rhode Island, or North Dakota

The price is cleaner than the old draft made it look. The total cost is still not one number because the pharmacy sits outside the subscription.

The question to ask before entering a card

“What is the exact recurring price for the menopause subscription on my account, does the Costco price apply, and are there any provider-specific charges not included?”

Screenshot the answer. That turns a price page into a receipt.

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Is Winona FDA approved? Is Sesame?

Neither company is “FDA approved,” because the FDA approves specific finished drug products—not telehealth companies. Winona separates provider-stated FDA-approved tablets, capsules, and patches from compounded creams that are not FDA-approved. Sesame lists examples of FDA-approved products and also permits compounded BHRT, which it clearly describes as outside FDA standardization.^[1][3][8]

Two ideas stop most of the confusion.

One: FDA approval belongs to a finished product. It does not attach to a website, clinic, ingredient list, or marketing category.

Two: compounded is not generic. An FDA-approved generic has gone through an FDA review pathway showing it meets approval requirements for the reference product. A compounded medication is prepared for an individual prescription and is not FDA-approved as a finished product.^[8]

“Bioidentical” and “FDA-approved” are not opposites

“Bioidentical” describes molecular structure. It does not tell you whether the finished product is FDA-approved, compounded, safer, more natural, or better.

The FDA says some FDA-approved drugs contain hormones identical to hormones produced naturally by women. It also says compounded products marketed as “bioidentical” are not FDA-approved and have not been shown safer or more effective than FDA-approved hormone therapy.^[8]

The provider-stated versus independently verifiable table

Medication lane	What Winona publishes	What Sesame publishes	What you should verify
Manufactured estrogen tablet	Winona calls its estrogen tablets FDA-approved	Sesame lists estradiol examples including generic forms associated with Estrace	Manufacturer, NDC, strength, and pharmacy label
Manufactured estrogen patch	Winona calls its patch FDA-approved and lists five strengths	Sesame lists estradiol examples associated with Climara and other products	Manufacturer, NDC, once- or twice-weekly schedule, and exact product
Manufactured progesterone capsule	Winona calls its progesterone capsules FDA-approved	Sesame lists progesterone examples associated with Prometrium	Manufacturer, NDC, dose, and directions
FDA-approved combination products	No manufactured combined pill is listed by Winona	Sesame lists Prempro, Bijuva, and Mimvey as examples	Whether the chosen clinician prescribes it and whether your pharmacy stocks it
Compounded body creams	Winona sells estrogen, progesterone, and combination body creams; final products are compounded and not FDA-approved	Not a default product list, but compounded BHRT may be prescribed	Exact ingredients, strengths, pharmacy, directions, and reason for compounding
Compounded vaginal cream	Winona sells a compounded vaginal estrogen cream	Sesame may prescribe local therapies; exact product depends on clinician and pharmacy	Whether the dispensed product is FDA-approved or compounded

Winona’s current FDA wording—and the contradiction that remains

Winona’s FAQ now says the clean version: its estrogen tablets, progesterone capsules, and estrogen patches are FDA-approved, while compounded creams are not.^[3]

But another answer on the same FAQ says all HRT treatment options “are compounded by a licensed pharmacist.” Those two statements cannot both describe the tablets, capsules, and patches literally.

That does not justify declaring the manufactured products fake. It just gives you one very good pre-pay question:

“For the exact patch, tablet, or capsule you plan to dispense, what is the manufacturer and NDC on the finished package?”

An NDC identifies the marketed drug package. The package and label—not a generic “FDA-approved ingredients” badge—settle the product question.

One Winona claim you should not use as proof

Some Winona cream pages say the cream’s “active ingredients” are FDA-approved. That does not make the finished compounded cream FDA-approved. The FDA also states there are no FDA-approved drugs containing estriol, one of the ingredients named on some Winona cream pages.^[8]

The correct reader-facing label is simple:

Winona’s compounded creams are not FDA-approved finished products.

Sesame’s strongest compliance sentence

Sesame says compounded BHRT is prescribed and dispensed outside formal FDA regulation and standardization, and that studies have not shown it safer or more effective than traditional hormone therapy.^[1]

That is the right separation. Keep it.

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Do you actually talk to a doctor at Winona or Sesame?

Winona offers no phone or video calls with physicians; communication is through secure portal messaging, with replies typically within 24–48 hours. Sesame is built around video care and lets you choose from available clinician profiles. For many women, that—not price—is the deciding fact.^[1][3]

Winona: messaging only

Winona is asynchronous. You can send messages at any time, but the physician does not join you on a scheduled phone or video visit. Winona says replies typically arrive within 24–48 hours, though some may take longer.^[3]

For some women, that is a feature. You can write the whole story once, add questions when they occur to you, and avoid arranging privacy for a video call about hot flashes, sleep, bleeding patterns, or painful sex.

For others, it is the dealbreaker. If you process medical decisions out loud, have a complicated history, or know you will not feel settled without a face-to-face conversation, messaging-only care can feel like talking through a keyhole.

Sesame: video and provider choice

Sesame shows available clinician profiles with names, credentials, and appointment options. You choose the available provider and meet by video. Afterward, ongoing guidance can continue through video care and messaging.^[1]

Provider choice is not a guarantee of permanent continuity. Availability can change, and Sesame’s Terms say provider listings may not always be complete or current. Still, choosing from profiles before the first visit is more control than being assigned without a live conversation.^[4]

Does video care sound like the part you have been missing?

See which Sesame menopause clinicians are currently available in your state → (Sponsored)

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What can Winona and Sesame actually prescribe?

Winona’s public catalog is narrower and product-based: estrogen tablets, an estradiol patch, progesterone capsules, compounded body and vaginal creams, and prescription DHEA. Sesame publishes a broader menu spanning hormonal, nonhormonal, vaginal, bone, hair, and supplement categories. Neither list guarantees that a clinician will prescribe a particular item.^[1][2]

A product page is a menu, not a promise.

Treatment category	Winona	Sesame’s published examples
Estrogen tablet	Estrogen tablets — $54 per 28-day processing cycle	Estradiol examples associated with Estrace
Estrogen patch	Estradiol patch — $149 per 28-day processing cycle; five published strengths	Estradiol examples associated with Climara
Estrogen gel	Not listed	Estradiol examples associated with Divigel
Progesterone capsule	Progesterone capsules — $39 per 28-day processing cycle	Progesterone examples associated with Prometrium
Combination oral products	No manufactured combined oral product listed	Prempro, Bijuva, Mimvey
Compounded body cream	Estrogen, progesterone, or combined — $89 per 28-day processing cycle	May be prescribed, but not presented as Sesame’s default finished-product list
Vaginal therapy	Compounded vaginal estrogen cream — $89 per requested order	Intrarosa is named; other local options depend on clinician and pharmacy
Nonhormonal options	No hot-flash prescription drug shown in the HRT catalog	Gabapentin, clonidine, paroxetine, sertraline, trazodone, ospemifene
Bone-health products	Not listed in HRT catalog	Alendronate, risedronate, vitamin D, calcium
Testosterone	No	No

The Bijuva fork

Bijuva is an FDA-approved single capsule containing estradiol and progesterone. Sesame names it on the public menopause medication menu. Winona does not list a manufactured combination capsule; its one-product estrogen-plus-progesterone route is a compounded body cream, which belongs in a different regulatory category.^[1][9]

That is a clean, checkable difference. It does not mean a Sesame clinician will prescribe Bijuva to you. It means the product appears on Sesame’s public menu and not on Winona’s.

If vaginal dryness or painful sex is the whole problem

Do not pay for systemic care before asking whether a local treatment is enough.

Systemic hormone therapy is used when treatment needs to reach the whole body—for symptoms such as hot flashes. Low-dose local vaginal therapies act primarily in vaginal tissue and may fit women whose problem is limited to genitourinary symptoms. The right choice still depends on medical history and a clinician’s evaluation.^[6]

Winona’s local option is a compounded vaginal estrogen cream at $89 per order. Sesame’s broader pharmacy model can support prescriptions for FDA-approved local products when the clinician chooses one, with the actual pharmacy price confirmed after prescribing.

Read our vaginal estrogen guide before turning a local symptom into the most expensive route on the page.

Testosterone: neither one

Sesame says its online providers cannot prescribe controlled substances. Winona says it does not prescribe testosterone. Testosterone is a Schedule III controlled substance in the United States, so it requires a prescription and must be handled under federal and state controlled-substance rules.^[1][3][10]

DHEA is not a disguised testosterone prescription and should not be presented as equivalent. If testosterone is the reason you are searching, neither provider solves that request.

Check whether Winona’s current product menu and age/state rules fit you → (Sponsored)

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If you have a uterus, which route protects the uterine lining?

If you use systemic estrogen and still have a uterus, an adequate progestogen is generally needed to reduce the risk of endometrial overgrowth and cancer. FDA kept the endometrial-cancer boxed warning for systemic estrogen-alone products in its 2026 labeling changes. Evidence does not support relying on transdermal progesterone cream for endometrial protection.^[8][11][12]

This is the highest-stakes decision criterion on the page, and it is not a place for fuzzy “hormone balance” copy.

Estrogen stimulates the uterine lining. A progestogen is used to oppose that effect when systemic estrogen is prescribed to a woman with a uterus. The exact dose and schedule belong to the prescribing clinician.^[8][11]

The oral capsule and the compounded cream are not interchangeable evidence lanes

A systematic review on micronized progesterone concluded that oral micronized progesterone can provide endometrial protection in supported regimens, while transdermal micronized progesterone does not provide adequate protection.^[12]

That has a direct practical meaning inside Winona’s catalog:

Winona’s $39 oral progesterone capsule is in the better-supported route for endometrial protection. Its compounded progesterone-containing body cream should not be assumed to do the same job.

If a clinician proposes a systemic estrogen patch or tablet and you have a uterus, ask the question plainly:

“What is protecting my uterine lining, and what evidence supports this dose and route?”

The corrected Winona patch cost

Winona’s patch is $149 per processing cycle. If the clinician also prescribes the $39 progesterone capsule, the published combined total is $188 per 28-day cycle and $752 across the first 90 days under Winona’s current billing schedule.

That is not a recommendation that everyone needs those two products. It is the honest price when the route requires both.

At Sesame

Sesame’s published menu includes generic progesterone examples and Bijuva, an FDA-approved estradiol/progesterone capsule. The clinician still decides the regimen, and the pharmacy—not the Sesame care fee—determines the medication price.

Bleeding after menopause is not a telehealth shopping problem

Bleeding after menopause needs medical evaluation. The FDA tells women to report any vaginal bleeding after menopause because it may signal an urgent problem. Do not use an online subscription as a substitute for getting unexplained bleeding evaluated.^[8]

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What happens to your money if it goes wrong?

Winona offers a full refund only inside its 24-hour order-processing window; after that, processing orders cannot be cancelled, returned, or refunded. Sesame refunds the first month only when you cancel at least three hours before the initial visit. Sesame’s Terms also require cancellation at least 48 hours before renewal to stop the next membership charge.^[3][4]

Most people asking “which is better?” are also asking, “What happens if I hate this?”

Policy	Winona	Sesame
First cancellation/refund deadline	Within the 24-hour processing window	At least 3 hours before initial visit for a full first-month refund
After the initial deadline	Processing order cannot be cancelled, refunded, or returned	No first-month refund once the initial visit has happened
Ongoing cancellation	Self-serve in Account Settings	Self-cancel available; Terms say cancel at least 48 hours before renewal
Previous payments	No money-back guarantee after processing deadline	Previous months are not refundable
No prescription issued	Public refund FAQ does not state a separate promise	Terms say no refund for not receiving a prescription or disagreeing with the clinical outcome
Pause	30, 60, or 90 days	No menopause-specific pause rule published

The Winona intake box that changes the whole interaction

Winona says that if you submit questions in the onboarding questionnaire, the physician will address them before prescribing. If you submit no questions and qualify, the prescription may be sent directly for fulfillment.^[3]

Read that twice.

Typing one real question into the intake box is the difference between creating a pause for a reply and letting the process move straight toward fulfillment.

Ask about the product, strength, NDC, uterine protection, tube size, refill timing, or anything else that would change your decision. It costs nothing and gives you a written record before the order starts moving.

The Sesame version

Sesame’s service page says you can self-cancel before the next billing cycle. Its Terms use the stricter rule: at least 48 hours before renewal. Follow the stricter rule and give yourself a buffer.^[4]

Our house rule for subscriptions is not glamorous:

Cancel early, cancel in writing when possible, and keep the confirmation.

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Does either provider include lab work?

Winona does not require bloodwork or hormone testing before prescribing. Sesame includes five basic lab categories if the clinician orders them, but none is an estradiol or FSH panel. Patients in New York, New Jersey, Rhode Island, and North Dakota pay the laboratory directly under Sesame’s published state exceptions.^[1][3]

Lab question	Winona	Sesame
Required to start?	No bloodwork or hormone testing required	Not automatically; clinician may order
Included panel	None	CBC, HbA1c, thyroid function, lipid panel, comprehensive metabolic panel
Hormone panel included?	No	No
Main lab network	Not applicable	Quest in most states
Network exceptions	Not applicable	LabCorp in AZ, OK, SD, WI; Clinical Labs of Hawaii in HI
Direct-pay exceptions	Not applicable	NY, NJ, RI pay Quest directly; ND uses any lab and pays directly
Existing lab work	Not applicable	Can be uploaded; clinician decides whether it is sufficient

“Labs included” does not mean hormone testing

No estradiol. No FSH. No progesterone panel.

That is not automatically a flaw. During perimenopause, hormone levels can fluctuate, and major menopause guidance emphasizes symptoms and clinical context rather than requiring routine hormone testing for every woman.^[6]

Sesame’s five tests are aimed at broader health screening—anemia, blood sugar, thyroid function, lipids, kidney and liver function, and electrolytes. That can be valuable if those questions have not been checked. It may add little if the same work was done recently and your clinician accepts it.

Would basic screening plus video follow-up solve a real gap in your care?

See Sesame’s current menopause program and lab rules → (Sponsored)

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How do insurance, HSA, and FSA work?

Neither provider bills health insurance for the care itself. Winona accepts HSA/FSA payment methods and provides receipts, but the medication is bundled into Winona’s cash-pay model. Sesame’s care fee is self-pay; prescriptions go to your pharmacy, where insurance or a savings card may still apply to the medication.^[1][3][13]

The structural difference matters more than the phrase “takes insurance.”

Winona controls the dispensing path. You pay Winona’s published product price. Winona does not send a normal pharmacy claim to your insurer on your behalf, though it provides receipts and NDC documentation for possible reimbursement.^[13]

Sesame controls the care path, not the drug sale. If prescribed, the medication goes to your pharmacy. That creates the possibility of using your drug benefit, a savings card, or a cash price—depending on the exact product and plan.^[1]

Payment question	Winona	Sesame
Bills health insurance for care	No	No
Medication included in provider fee	Yes	No
Pharmacy insurance can potentially apply	Not through Winona’s bundled dispensing model	Yes, depending on product and plan
HSA/FSA	Winona accepts HSA/FSA methods and provides receipts	Sesame’s service page and Terms are not perfectly aligned; confirm eligibility with your plan before assuming reimbursement
Prescription savings card	Not the core model	Provided when a prescription is written

Five questions to ask your plan or pharmacy

1. Is the exact drug, strength, and quantity on my formulary?
2. Does it require prior authorization or step therapy?
3. Is a 90-day fill cheaper than three 30-day fills?
4. Does my plan reimburse any compounded medication or telehealth subscription fee?
5. What is the cash price if I do not run the prescription through insurance?

Do not ask, “Do you cover HRT?” That question is too broad to produce a useful answer. Ask about the exact finished product.

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What is the one honest problem with Winona?

Winona’s convenience can be expensive on its patch route. Its public price is $149 per processing cycle at every listed patch strength, before adding progesterone when needed. Sesame lets the pharmacy price the exact manufactured product instead. If lowest total cost is your priority, that local-pharmacy route has more room to win.^[2]

That is the damaging admission, and it is real.

Winona’s flat patch price does not fall when the prescribed strength is lower. The first-90-day total is $596 for the patch alone and $752 when the $39 progesterone capsule is also prescribed. Sesame’s first-90-day care fee is $177 at the public rate or $147 for an eligible Costco member, leaving hundreds of dollars for the pharmacy bill before reaching Winona’s published total.

Winona does NOT win on unbundled patch price. If that is your priority, Sesame is the better route to investigate.

But Winona is not selling only a box of patches. Because it controls the prescribing workflow, portal, dispensing, and shipment, it can put the product, clinician messaging, refill processing, dose-change conversations, and standard delivery into one predictable charge. You do not have to call pharmacies, compare stock, or manage a separate medication bill.^[3]

That is the pivot. Winona costs more on the patch route because it bundles more of the process. Whether the bundle is worth it depends on how much friction you are paying to remove.

The Winona route almost nobody knows about

Winona’s help center says it can send a prescription to an outside pharmacy for a $50 monthly platform fee, plus the pharmacy’s medication cost. The fee covers continued care with the Winona physician.^[5]

For a manufactured pill or patch, this can create a middle path: Winona physician continuity plus local pharmacy pricing. It can also be a bad deal on a low-cost product, because the $50 platform fee may exceed the difference between Winona’s bundled price and the local drug price.

One key detail remains unpublished: whether that $50 “monthly” fee follows a calendar month or Winona’s 28-day processing rhythm. Ask before switching.

Also ignore the help-center claim that retail “synthetic” versions are less safe or effective than “bioidentical” products. That broad statement is not supported by the FDA’s description of FDA-approved versus compounded hormones and should not drive the decision.^[5][8]

If Winona is still your answer

That is not a contradiction. You may reasonably value one charge, direct shipping, asynchronous care, and fewer pharmacy calls more than the lowest unbundled price.

If the bundled model is the part you want, check the exact Winona product, eligibility, and refill timing before the 24-hour clock starts →

See Winona’s current options → (Sponsored)

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What do customer reviews actually tell you?

Reviews can reveal whether onboarding worked, messages were answered, a shipment arrived, or a refund became difficult. They cannot prove that a hormone regimen is safe, appropriate, or effective for you. Provider-selected quotes and changing star ratings should be treated as service evidence—not clinical evidence.

We did not reproduce individual Trustpilot quotes because we could not reverify them from an accessible primary record on August 13, 2026. A quote that cannot be checked does not belong on a health decision page.

That does not mean reviews are useless. It means you read them for the right things:

• Did the portal work?
• Did the clinician reply within the stated window?
• Did the pharmacy ship when promised?
• Was a refill processed before a requested change?
• Did cancellation happen before or after the provider’s deadline?
• Did the reviewer understand whether medication was included?

Do not use reviews to answer:

• Is HRT safe for me?
• Is this dose right?
• Will this cure my symptoms?
• Is a compounded cream equivalent to an FDA-approved product?

Winona and Sesame both display ratings or selected patient feedback on their own pages. Those pools are not independent, do not use the same collection method, and change over time. We do not average them into a fake score.

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When should neither provider be your first stop?

Online menopause care can work for common, stable concerns that do not require an exam. It is a poor first stop when unexplained bleeding, an urgent symptom, pregnancy, a major contraindication, or a condition needing physical examination must be evaluated. A platform’s willingness to accept an intake does not replace that judgment.^[8]

Start with an in-person clinician or the appropriate existing specialist when:

• You have bleeding after menopause or unexplained bleeding. This needs evaluation, not a subscription guess.
• You may be pregnant, are recently postpartum, or are breastfeeding. Treatment decisions require context that goes beyond a standard menopause funnel.
• You have a history of certain hormone-sensitive cancers, blood clots, stroke, heart attack, or liver disease. The FDA lists these among situations that require careful medical consideration and may make hormone therapy inappropriate.^[8]
• Symptoms are sudden, one-sided, severe, or rapidly worsening. The first job is diagnosis.
• A physical exam is needed. Telehealth cannot examine tissue, measure a mass, or investigate bleeding.
• You need emergency care. Chest pain, trouble breathing, stroke symptoms, or heavy uncontrolled bleeding belongs with emergency services—not a portal message.

This is not anti-telehealth. It is the line that makes the rest of the telehealth recommendation trustworthy.

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How did The HRT Index compare Sesame HRT and Winona?

We read the providers’ current service pages, product catalogs, FAQs, help-center policies, and Terms; normalized their prices onto the same 90-day clock; separated provider-stated facts from independently verifiable regulatory facts; and left unknowns visible. We did not use a numeric provider score or turn missing data into estimates.

This comparison follows The HRT Index Verification Standard: read every published price, separate FDA-approved from compounded, verify state availability and insurance, and re-check on a fixed schedule—top providers monthly and the full roster quarterly.

We evaluate providers on five pillars, always in this order: clinical legitimacy, care quality, medication fit, price transparency, access.

What we actually verified on August 13, 2026

• Sesame’s current menopause page shows care from $59/month.
• Sesame’s medication cost is separate from the subscription.
• Sesame publishes video care, provider choice, unlimited messaging, pharmacy delivery of prescriptions, five included lab categories if ordered, and state lab exceptions.
• Sesame’s Terms contain the federal-program beneficiary certification, age requirement, membership cancellation timing, and no-controlled-substance rule.
• Winona’s current product prices are $39, $54, $89, and $149 across its listed HRT routes.
• Winona processes 30-day products every 28 days and 90-day products every 84 days.
• Winona limits HRT to women 35–59 and lists 37 states plus Puerto Rico.
• Winona offers messaging only, with no phone or video physician visits.
• Winona’s refund window, auto-refill exception, pause options, shipping timing, HSA/FSA documentation, and outside-pharmacy fee.
• FDA’s current separation of FDA-approved and compounded hormone therapy.
• DEA’s current Schedule III classification of testosterone.
• FDA’s February 2026 labeling changes and retained endometrial-cancer warning for systemic estrogen alone.

What remains unknown until intake, dispensing, or direct confirmation

• Sesame’s complete menopause-specific state availability list
• The exact Sesame price shown to every user and whether Costco verification succeeds
• The medication, dose, quantity, and pharmacy total for a Sesame patient
• The manufacturer and NDC of the exact Winona tablet, capsule, or patch you will receive
• Whether Winona’s $50 outside-pharmacy fee runs on a calendar month or every 28 days
• The exact compounded strength and quantity a Winona physician would prescribe
• Whether either platform will accept your clinical history and write a prescription
• Whether you will retain the same clinician over time

Found something that changed? Email partners@thehrtindex.com. We will check the primary source, correct the page, and update the verification date.

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If neither fits, what are the next options?

The right alternative depends on the gate that stopped you: insurance, age, state, subscription preference, medication route, or the need for in-person evaluation. Do not replace one wrong-fit funnel with another. Fix the actual constraint first.

What stopped you	Better next place to look	The catch to verify
You need insurance to cover the visit	Midi Health or an in-network local clinician	Verify your exact plan; Midi says most PPO plans are in-network, Medicaid/Medi-Cal are excluded, and Medicare beneficiaries may use self-pay without Medicare claims[14]
You are 60 or older	Sesame if its federal-program rule does not exclude you; Midi self-pay; or your own clinician	Starting systemic therapy later needs individualized risk assessment
Your state is not on Winona’s list	Sesame, Midi, or a licensed local clinician	Confirm availability by state or ZIP before payment
You hate ongoing subscriptions	Wisp’s menopause consult or your own clinician	Wisp currently lists a $99 consult with follow-ups and three months of care-team access; pharmacy medication is separate[15]
You want published pharmacy-delivered FDA-approved products	Alloy or a local clinician/pharmacy route	Alloy publishes product-level prices for FDA-approved HRT options; verify the exact product, dose, consult fee, and recurring terms[16]
You need Medicare, Medicaid, or TRICARE compatibility	Your plan directory, current clinician, or a verified program that accepts your status	Sesame’s Terms exclude beneficiaries; do not assume a cash-pay platform accepts you
You want the lowest total cost	Existing clinician + local pharmacy	Access to a willing, qualified prescriber is the bottleneck

That last row deserves to sit in the open. If you already have a clinician who will evaluate and prescribe appropriately, you may not need a subscription company between you and the pharmacy.

Telehealth exists because many women cannot get that conversation. If you can, use the simplest route that gives you safe, competent care.

Not sure which gate applies to you?

Get your personalized starting-point plan with Find My HRT Path →

Compare the online menopause providers we track →

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Related HRT provider comparisons

Compare the care model, medication route, price exposure, and eligibility before you choose:

• Read the full Sesame HRT review
• Read the full Winona HRT review
• Compare Wisp and Sesame HRT
• Compare Winona and Wisp
• Compare Winona and Evernow
• Review the best online HRT providers
• See which providers prescribe which HRT products
• Read the vaginal estrogen guide
• Find your best-fit HRT path

Sesame HRT vs Winona: frequently asked questions

Which is cheaper, Sesame HRT or Winona?

Sesame has the lower published starting care fee: $59 monthly, or $49 for an eligible Costco member, with medication separate. Winona’s published product prices range from $39 to $149 and include medication and standard shipping. Because Winona processes 30-day products every 28 days, it can charge four times in the first 90 days. The cheaper all-in route depends on the prescribed medication and pharmacy price.

Is Winona FDA approved?

Winona the company is not FDA-approved; the FDA approves specific finished drug products. Winona says its estrogen tablets, progesterone capsules, and estrogen patches are FDA-approved. Its body and vaginal creams are compounded and are not FDA-approved. Confirm the manufacturer and NDC of any tablet, capsule, or patch on the dispensed package.

Is Sesame FDA approved?

Sesame is a marketplace and care platform, not an FDA-approved drug. Its public medication menu includes examples of FDA-approved products, but the actual product depends on the clinician and pharmacy. Sesame also allows compounded BHRT and states that compounded BHRT is outside FDA standardization and has not been shown safer or more effective.

Does Sesame take insurance?

Sesame does not bill insurance for the menopause care program. If a prescription is sent to your pharmacy, your drug coverage may apply to the medication depending on the product and plan. Sesame’s Terms also require users to certify that they are not Medicare, Medicaid, or TRICARE beneficiaries.

What states does Winona serve?

Winona lists 37 states plus Puerto Rico: Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, Wisconsin, and Wyoming.

Can you talk to a doctor at Winona?

Yes, but not by phone or video. Winona says all physician communication happens through secure portal messaging. Typical replies are 24–48 hours, though some can take longer.

Does Sesame include lab work?

Five basic lab categories are included if the clinician orders them: CBC, HbA1c, thyroid function, lipid panel, and comprehensive metabolic panel. They are not a hormone panel. New York, New Jersey, Rhode Island, and North Dakota have direct-pay exceptions.

Does Winona require blood tests?

No. Winona says it does not require bloodwork or hormone testing for HRT. Its physicians use symptoms, history, risk factors, and medication use to decide whether treatment is appropriate.

Can you cancel Winona at any time?

You can cancel the subscription in Account Settings, but “cancel anytime” does not mean “refund anytime.” Winona offers a full refund only within its 24-hour processing window. Once that window passes, the processing order cannot be cancelled, refunded, or returned.

Can you pause Winona?

Yes. Winona allows pauses of 30, 60, or 90 days through account settings. The prescription resumes on the selected date unless you make another change.

Does either provider prescribe testosterone?

No. Sesame says providers cannot prescribe controlled substances online, and Winona says it does not prescribe testosterone. Testosterone is a Schedule III controlled substance in the United States and requires a prescription under federal and state rules.

What is the difference between compounded and FDA-approved hormone therapy?

An FDA-approved finished drug has gone through FDA review for its approved use, manufacturing, labeling, and quality requirements. A compounded medication is prepared for an individual prescription and is not FDA-approved as a finished product. A compounded drug is not the same regulatory category as an FDA-approved generic.

Can I use an HSA or FSA?

Winona accepts HSA/FSA payment methods and provides receipts and NDC documents for possible reimbursement. Sesame’s materials do not provide one clean universal promise for its subscription fee, so confirm with your plan before assuming eligibility. Medication purchased at a pharmacy may have separate HSA/FSA or insurance treatment.

How long does Winona shipping take?

Winona says new orders have a mandatory 24-hour waiting period, are usually prepared and shipped within 1–2 business days, and should arrive within 3–5 business days depending on state and USPS timing. Standard shipping is free.

Do I need progesterone if I have a uterus?

If you use systemic estrogen and have a uterus, an adequate progestogen is generally used to protect the uterine lining. The exact product, dose, and schedule are clinical decisions. Do not assume a compounded transdermal progesterone cream provides the same protection as an evidence-supported oral regimen.

What happens if Sesame’s clinician does not prescribe?

Sesame does not guarantee a prescription. Its Terms say disagreement with the clinical outcome or not receiving a prescription is not a basis for a refund. The first-month refund applies only when cancellation occurs at least three hours before the initial visit.

Does Winona use discreet packaging?

No. Winona’s FAQ says it cannot offer alternate or more discreet packaging. Sesame sends prescriptions to the pharmacy you choose, which may suit someone who prefers pickup instead of a branded shipment at home.

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Still not sure which HRT program is right for you? Take our free about-90-second matching tool.

Find My HRT Path →

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This page is educational and is not medical advice. It has not been reviewed by a clinician. Talk with a licensed healthcare professional who knows your history before starting, stopping, or changing treatment. Prices, formularies, state availability, product labels, and provider terms can change; verify the dated commercial facts before paying.

Primary sources

¹ Sesame, Online menopause treatment, accessed August 13, 2026.

² Winona, Menopause treatments and HRT options, accessed August 13, 2026.

³ Winona, Frequently asked questions, accessed August 13, 2026.

⁴ Sesame, Terms of Service, last updated August 11, 2026; accessed August 13, 2026.

⁵ Winona Help Center, Winona’s compounding pharmacies, accessed August 13, 2026.

⁶ The Menopause Society, Hormone therapy and ongoing individualized hormone therapy appears to have no age limit, accessed August 13, 2026.

⁷ Sesame, Costco membership perks, accessed August 13, 2026.

⁸ U.S. Food and Drug Administration, Menopause, accessed August 13, 2026.

⁹ DailyMed, Bijuva—estradiol and progesterone capsule, accessed August 13, 2026.

¹⁰ U.S. Drug Enforcement Administration, Drug scheduling, accessed August 13, 2026.

¹¹ U.S. Food and Drug Administration, FDA approves labeling changes to menopausal hormone therapy products, February 12, 2026.

¹² Stute P, et al. The impact of micronized progesterone on the endometrium: a systematic review. Climacteric. 2016.

¹³ Winona Help Center, Payment methods, HSA/FSA funds, and insurance documents, accessed August 13, 2026.

¹⁴ Midi Health, Pricing and insurance, accessed August 13, 2026.

¹⁵ Wisp, Menopause consult online, accessed August 13, 2026.

¹⁶ Alloy, Menopause treatment solutions, accessed August 13, 2026.