Online menopause care has expanded quickly, and the services vary more than the marketing suggests — in who sees you, what they can prescribe, what it costs after the first month, and how easy it is to stop. Here is what to check before signing up to anything.

Where we stand: Menova is an independent publication. We sell no consultations and no hormones. Some pages on this site carry affiliate links to services, disclosed where they appear, and we do not rank by commission rate — see our affiliate disclosure. Apply the checks below to us as well as to them.

The seven questions

1. Who actually sees you? A doctor, a nurse practitioner, a physician associate? What menopause-specific training do they have? Some services are led by clinicians with menopause qualifications; others use general prescribers working from a questionnaire.

2. Is there a real consultation? A form you fill in, reviewed asynchronously, is different from a video appointment where you can ask questions and be asked them back. Both exist; the price is often similar.

3. What can they prescribe? Specifically:

  • Regulated, approved products, or compounded ones? This is the question that matters most — see compounded versus regulated HRT and bioidentical hormones explained
  • Transdermal options, not just oral — the route affects clot risk and matters for migraine, blood pressure and thyroid medication; see HRT types and forms
  • Micronized progesterone or an IUD referral, if you have a uterus
  • Local vaginal estrogen, which is frequently the most useful prescription and is sometimes not offered
  • Testosterone, where indicated, with monitoring — see testosterone for women
  • Non-hormonal options, for women who cannot or prefer not to take hormones — see non-hormonal prescription options

A service that only offers one thing is selling that thing.

4. What does it cost after the first month? Introductory pricing is common. Ask for the annual total, including medication, and check whether cancelling is a click or an email — see HRT cost and insurance.

5. Do they order tests, and why? Routine hormone panels to diagnose the transition are advised against for women over 45, and routine estradiol monitoring on treatment is generally not recommended. A service that sells testing as essential is selling testing — see do you need blood tests on HRT and was that my last period.

6. What happens if it does not work? Titration is normal. Ask how dose changes are handled, how quickly, and whether follow-up costs extra — see is my dose too high or too low.

7. How does it connect to the rest of your care? Will they write to your regular clinician? Who monitors your blood pressure and screening? Who investigates unexpected bleeding? Fragmented care is the main risk with telehealth, and the answer should not be "you" by default — see keep your own health record.

Signals to walk away from

  • Prescribing without any assessment of contraindications — clot history, breast cancer, migraine with aura, liver disease. A service that does not ask is not assessing
  • Compounded hormones presented as safer or more natural
  • Pellets, which cannot be adjusted or removed — see hormone pellets
  • "Optimising" hormone levels to a target, which is a marketing frame rather than a clinical one
  • Estrogen without adequate progestogen for a woman with a uterus, or progesterone cream offered as endometrial protection
  • Subscription lock-in, or cancellation that requires a phone call
  • No named clinician anywhere on the site
  • Testing bundled with the treatment from the same provider
  • Pressure and countdown timers

Our general guide to reading claims is how to tell good menopause information from bad.

Where telehealth is genuinely better

Not a second-best option in several situations:

  • Access. Waiting lists, rural areas, no local clinician with menopause training — see finding a clinician who knows menopause
  • Speed, when symptoms are affecting work and the alternative is a three-month wait
  • Being taken seriously. Women who have been dismissed repeatedly often find a menopause-specific service simply starts from a different place — see not being dismissed
  • Convenience, which matters when you are exhausted

Where it is not

  • Anything needing examination — abnormal bleeding, a lump, pelvic pain
  • Complex history — cancer, clots, significant cardiovascular disease. These need a clinician with your full record
  • Continuity. Screening, blood pressure, and everything else in this decade still needs an owner
  • Emergencies

Any bleeding after twelve months without periods needs assessment in person, regardless of who prescribes your hormones — see bleeding after menopause.

Before your first appointment

Whatever you choose, the preparation is the same and it determines what you get:

  • Your cycle record — dates, heaviness, three months if you have them
  • Symptom counts, not adjectives. "Twelve hot flashes a day, waking four times a night, for eight months"
  • Full medication and supplement list
  • History: clots, migraine with aura, cancer, liver disease, blood pressure
  • Family history, with ages
  • Pregnancy history, including pre-eclampsia and gestational diabetes
  • What you want from it, in one sentence

Our free 30-day symptom tracker produces the record, and the free printable visit prep sheet turns it into one page. See your first telehealth visit.

Comparing services

Our independent comparisons are in the best menopause telehealth in 2026, with individual reviews of Midi, Alloy, Evernow and Gennev, and a head-to-head in Midi versus Alloy.

Whether telehealth or your own clinician makes more sense for you is covered in telehealth versus your own doctor.

The one test

Does the service ever tell you that you do not need something?

A clinician who says "you do not need that test," "your dose is fine," or "this is not the right treatment for you" is practising. A service where every path leads to a purchase is a shop.

The free 2-minute Menova self-check organizes your symptoms into something you can take to any of them — no account, not a diagnosis, and your answers never leave your device.

This article is general education, not medical advice. Prescribing rules, service availability and licensing differ by country and state. Discuss treatment with a licensed clinician, and seek in-person assessment for bleeding, lumps or pain.

Sources: The Menopause Society, NICE NG23 — Menopause, ACOG — The Menopause Years, and NHS — HRT.