Ad-free rankings · 5 HRT brands independently reviewed
Updated April 2026
WomenHormonesHRT

Hormone therapy designed for where you are

Estrogen, progesterone and testosterone therapy from five women's health platforms — compared on bioidentical vs. conventional, delivery format and menopause stage suitability.

Brands
5compared
From
$49/mo
Formats
Patch · Pill · Cream
70%
fewer hot flashes · 4 weeks
Independently compared · 5 providers reviewed
MIDIEvernowWinonaAlloyhers.menopause
Personal to you

Find the right HRT for your menopause stage

Where you are in your journey shapes what your body actually needs. Answer a few questions and we'll match you to providers who specialise in your stage — peri, menopausal, or post.

What's being prescribed

HRT medications explained. What each hormone actually does.

Not all hormone therapy is the same. Here's what the main components are, how they work, and what format they come in.

At a glanceEstradiolProgesteroneTestosteroneBi-Est / Tri-Est
Clinical evidenceHighestHighMidLower
FormatPatch · Gel · PillOral · CreamCream · TrochéCream · Troché
FDA-approved✓✓Off-labelCompounded only
Starting price$20/month$30/month$30/month$40/month
Best forEstrogen replacementUterine protectionLibido + energyCustom protocol

← Swipe to compare all four options →

Estradiol (E2)

Bioidentical estrogen · 17β-estradiol
Patch · Gel · Pill
From$20/moDosingDaily / WeeklyFDAApproved
What is it? The primary estrogen produced by the ovaries. As levels decline through perimenopause and menopause, replacing it with bioidentical estradiol directly addresses hot flashes, night sweats, vaginal dryness, sleep disruption and mood changes.
Ideal forMost women starting HRT — the foundation of estrogen replacement therapy.

How it works

Estradiol is the primary estrogen produced by the ovaries. During perimenopause and menopause, levels decline sharply — triggering hot flashes, night sweats, vaginal dryness, sleep disruption, and mood changes. Replacing it with bioidentical estradiol (chemically identical to what your body made) directly addresses these symptoms.

Available formats

  • Transdermal patch (twice-weekly or weekly) — lowest clotting risk; preferred for most clinical guidelines
  • Topical gel or cream (daily) — flexible dosing; similar safety to patch
  • Oral pill (daily) — convenient; slightly higher DVT/clot risk than transdermal
  • Vaginal ring (3-month) — local and/or systemic effect
  • Spray (daily) — applied to forearm

Price range

Generic estradiol patch: ~$20–60/month. Brand patch: $80–150/month. Compounded cream/troché: ~$30–100/month.

Key considerations

All major clinical bodies (NAMS, BMS, IMS) support use in healthy women under 60 or within 10 years of menopause onset. Transdermal is preferred over oral for women with cardiovascular risk factors. "Bioidentical" patch and gel products from major pharmacies ARE bioidentical — the term is sometimes misused to imply only compounded versions are natural.

Progesterone (Micronised)

Bioidentical progestogen
Oral · Cream
From$30/moDosingDaily (night)FDAApproved
What is it? Required alongside estrogen if you still have a uterus, to protect the uterine lining from overstimulation. Bioidentical micronised progesterone (Prometrium) is chemically identical to what your body produces.
Ideal forWomen on estrogen who still have a uterus — essential for endometrial protection.

How it works

If you still have a uterus, progesterone is required alongside estrogen to protect the uterine lining (endometrium) from overstimulation. Synthetic progestins (e.g., medroxyprogesterone in older Prempro) carry a different risk profile and are increasingly being replaced.

Available formats

  • Oral capsule (Prometrium) — taken at night; the sedating effect aids sleep
  • Compounded cream / troché — lower systemic absorption than oral
  • Vaginal suppository — sometimes used for targeted uterine protection

Price range

Prometrium (generic): ~$30–70/month. Compounded cream/troché: ~$20–60/month.

Key considerations

Essential if uterus is intact — "unopposed estrogen" significantly raises endometrial cancer risk. After hysterectomy: progesterone not required (estrogen-only HRT is appropriate). Bioidentical micronised progesterone has a more favourable breast and cardiovascular profile than synthetic progestins. Night-time oral dosing often helps sleep — a useful side effect.

Testosterone (low-dose)

Androgen · women's dosing
Compounded
From$30/moDosingDailyFDAOff-label
What is it? Low-dose testosterone (typically 1–2mg/day, far below male doses) addresses low libido, fatigue, reduced muscle tone and cognitive clarity. Increasingly offered by specialist women's health platforms.
Ideal forWomen with low libido, fatigue or reduced cognitive clarity alongside other menopausal symptoms.

How it works

Women naturally produce testosterone in the adrenal glands and ovaries — levels decline significantly around menopause. Low-dose testosterone (typically 1–2mg/day, far below male doses) addresses low libido, fatigue, reduced muscle tone, and cognitive clarity. It is not routinely included in standard HRT but is increasingly offered by specialist women's health platforms.

Available formats

  • Compounded cream (most common) — applied to inner arm or thigh; small measured dose
  • Troché lozenge — absorbed sublingually for consistency
  • Pellet (less common) — implanted subcutaneously, lasts 3–5 months

Price range

Compounded cream: ~$30–80/month. Often bundled into HRT packages by specialist providers.

Key considerations

All prescribing in the US is off-label (no FDA-approved female product). Doses are much lower than male TRT — typically 5–10% of male dosing. Monitoring recommended: total testosterone, free testosterone, SHBG at 6–12 weeks. Benefits: improved libido, energy, mood, and lean mass; evidence base growing but still maturing. Not for: active breast cancer; caution with family history.

Compounded Bi-Est / Tri-Est

Custom estrogen blend
Compounded
From$40/moDosingDailyFDACompounded
What is it? A compounded blend of estriol (E3) and estradiol (E2), typically 80:20. Tri-est adds estrone (E1). Promoted by some practitioners on the basis that estriol is a weaker, “protective” estrogen.
Ideal forWomen whose standard HRT has failed, exploring under specialist clinical guidance.

How it works

Bi-est is a compounded blend of estriol (E3) and estradiol (E2), typically in an 80:20 ratio. Tri-est adds estrone (E1). These formulations are promoted by some practitioners on the basis that estriol is a weaker, "protective" estrogen — however, there is no RCT evidence supporting superiority over standard estradiol-only products.

Format

Cream, troché, or gel — customised dosing based on individual prescription.

Price range

~$40–120/month, dependent on the compounding pharmacy.

Key considerations

Widely used in integrative and functional medicine practices. No published RCT evidence showing superiority over standard bioidentical estradiol. Estriol (E3) has very weak estrogenic activity and does not adequately protect the endometrium alone. Compounded products are not FDA-approved; quality is pharmacy-dependent. If standard HRT has failed, compounded may still be worth exploring under clinical guidance.

Why HRT works

Replace what's declining. Feel like yourself again.

Hormone replacement therapy restores estrogen (and sometimes progesterone and testosterone) to the levels your body needs to function well.

90%

By postmenopause, estrogen levels can fall by up to 90% from premenopause peak. The drop is rapid through perimenopause.

Estrogen levels through perimenopause
~10%100%75%50%25%3545505565Age

Menopause staging first

Peri, menopausal, or post-menopausal? Your stage determines the hormone mix your body actually needs — and which provider is best placed to prescribe it.

Estrogen + progesterone

If you still have your uterus, progesterone is required alongside estrogen to protect the uterine lining. Format choices — patch, pill, cream, troché, pellet — are matched to your preferences and health history.

Add testosterone for libido?

Low-dose testosterone is increasingly prescribed alongside E+P for libido, energy and cognitive clarity. Not all platforms offer it — our comparison flags which ones do.

What to expect

How HRT gets to work

Most women report a clear sequence of symptom relief — hot flashes typically improve first, with deeper benefits emerging over the following months.

  1. Week 2–4

    Hot flash relief often begins — the most rapidly responsive symptom and the earliest visible sign HRT is working.

  2. Week 4–8

    Sleep, mood and energy improvements typically follow as estrogen levels stabilise and the nervous system settles.

  3. Week 4–8 (with testosterone)

    Libido improvements often begin around this point if low-dose testosterone is part of your protocol.

  4. 3 months

    Vaginal symptoms — dryness, discomfort and GSM — fully resolve, particularly with combined systemic and local estrogen.

  5. 6 months and beyond

    Long-term benefits emerge: bone density preservation, cardiovascular protection, and stable cognitive function — particularly for women starting HRT within 10 years of menopause.

Is this right for you?

Common symptoms that bring women to HRT

Hot flashes & night sweats

The hallmark menopause symptom — caused by declining estrogen affecting the hypothalamus's temperature regulation. HRT is the most effective treatment.

Sleep disruption

Night sweats wake you, or you simply can't fall asleep. Progesterone at night has a natural sedating effect for many women.

Low libido

Loss of sexual desire is common in perimenopause and menopause. Low-dose testosterone alongside estrogen is an increasingly offered solution.

Mood changes & anxiety

Hormonal fluctuations directly affect serotonin and GABA — the neurotransmitters governing mood and anxiety. Stabilising hormones often stabilises mood.

Brain fog & memory

Difficulty concentrating or recalling words is widely reported but underdiagnosed. Estrogen plays a direct role in cognitive function.

Vaginal dryness

Genitourinary syndrome of menopause (GSM) affects up to 50% of women — responsive to both systemic HRT and local vaginal estrogen.

Weight redistribution

Hormonal changes shift fat storage to the abdomen. HRT doesn't directly cause weight loss but helps maintain pre-menopause body composition.

Joint aches & skin

Estrogen affects collagen in joints and skin. Loss accelerates collagen loss — leading to joint pain, dry skin and reduced elasticity.

Family history of breast cancer or blood clots?This is a flag, not a hard block. A history of breast cancer — particularly oestrogen receptor-positive — requires specialist discussion. Transdermal HRT carries a lower DVT risk than oral. All providers on this platform include a thorough health history assessment before prescribing.
Real results

What women actually say after starting HRT

“

I genuinely didn't recognise myself for two years — the anxiety, the sweats, the fog. Midi diagnosed me in one appointment and I was on a patch within a week. I felt like myself again within a month.

RB
Rachel B, 49
Midi
“

I'd been told by two GPs that I was too young for HRT at 44. Evernow's clinician took my symptoms seriously, checked my levels, and treated me. Life-changing.

SM
Sophie M, 44
Evernow
“

The testosterone piece was what nobody had told me about. Six weeks in and my libido was back for the first time in years. Winona did my full compounded protocol.

LT
Lisa T, 53
Winona
Our process

We do the research. You make the call.

01

Answer 8 short questions

Where you are in menopause, your most disruptive symptoms, format preferences and any health history. We use this to rank providers by fit — not by who pays us.

02

See your personalised shortlist

Up to five specialist women's health platforms, ranked by match — with real prices, format options, and whether testosterone add-on is available.

03

Compare, choose, and go

Pin up to three platforms to compare side by side. Click through to start your clinical intake with the provider that suits you best.

Questions, answered

Honest answers to common questions

The evidence on HRT safety has changed significantly since the early 2000s. For healthy women under 60, or within 10 years of menopause onset, the benefits of HRT for symptom relief typically outweigh the risks. The absolute risk increase for breast cancer with combined E+P HRT is small and is not seen with estrogen-only HRT (for women without a uterus). Discuss your individual risk profile with the prescribing clinician.
Bioidentical hormones are chemically identical to the hormones your body produces. Estradiol (the main estrogen in most patches and gels) and micronised progesterone (Prometrium) are both bioidentical and available as regulated pharmaceutical products. "Compounded bioidentical" refers to custom-mixed formulations from a compounding pharmacy — these are not FDA-approved but are widely prescribed.
No. If you don't have a uterus, you can safely take estrogen alone — without progesterone. Estrogen-only HRT actually has a slightly more favourable breast cancer risk profile than combined therapy.
Yes — perimenopause is often the ideal time to start. Symptoms can be severe before periods stop, and earlier initiation is associated with better long-term cardiovascular and bone outcomes. Not all GPs will prescribe this early; specialist telehealth platforms typically will.
HRT can be stopped at any time. Symptoms may return after stopping — the timing and rate of tapering can affect how pronounced the return is. Discuss a tapering plan with your clinician rather than stopping abruptly if you've been on HRT for more than a year.
Get your match

Find your HRT provider in 2 minutes

Answer a few short questions about your menopause stage, symptoms and preferences. We'll show you which platforms are best matched — with real prices, no email required.