Hormone replacement therapy for menopause has moved significantly online in the last three years. Platforms like Alloy, Winona, and Midi Health now serve hundreds of thousands of women who previously would have needed an in-person OB/GYN appointment to access estradiol prescriptions.

Here is how they compare on the things that actually matter: cost, clinical model, and who each one is built for.

The clinical basics

Standard HRT for menopause typically involves estradiol (in patch, gel, or pill form) with or without progesterone (for women with a uterus, to protect the uterine lining). Some women also benefit from testosterone supplementation. All require a prescription from a licensed physician.

Online HRT platforms provide the virtual consultation, the prescription, and in many cases the medication itself via direct-to-patient pharmacy.

Midi Health

Midi is the premium option — menopause-specialist physicians only, no generalists. The care model is the most clinically robust of the three. Consultations are typically 45 minutes. Ongoing care includes regular check-ins.

Cost: $95/month membership plus medication costs. Medication costs vary. Total monthly cost typically $120–200 depending on your protocol.

Best for: women who want specialist-level menopause care and are willing to pay for it. Midi scores 9.1 on ClinicLayer — highest in the HRT category.

Alloy

Alloy focuses on simplicity and lower cost. The platform is designed to get women from assessment to prescription as quickly as possible with minimal friction.

Cost: $49/month including medication (oral estradiol). Patches and other formulations cost more. One of the lowest all-in HRT costs available.

Best for: women who want to start treatment quickly at a reasonable price and are comfortable with a lighter-touch care model.

Winona

Winona focuses on bioidentical hormones specifically and positions as a more personalized alternative to synthetic HRT. The platform is somewhat more expensive but has strong patient satisfaction scores.

Cost: $82–149/month depending on protocol.

Best for: women specifically seeking bioidentical hormone protocols and who want ongoing personalized attention to their treatment plan.

The bottom line on platform choice

If cost is the primary driver: Alloy at $49/month all-in is hard to beat for basic estradiol therapy. If specialist-level care is the priority: Midi is worth the premium. If bioidentical protocols matter to you: Winona. All three are significantly more accessible than trying to get a menopause specialist appointment in-person, which has a 6–8 month waitlist in most US cities.