Getting an HRT prescription can be like running across a battlefield and dodging landmines in enemy territory before finally reaching the safe zone. So pervasive and unnecessarily complex are the hurdles perimenopausal women face when they ultimately figure out that their hormones are in decline, and they try to take the next logistical step to help: replacing them.
Many women start at the first reasonable stop on this juncture – their primary care physician, family medicine doctor or gynecologist – often only to leave with bad advice (“dress in layers,” “start doing yoga,” and “drink herbal tea,” among them) or undesired prescriptions for antidepressants. And this frequently spells the end of what had previously been a pleasant, diplomatic patient-doctor relationship, as women feel minimalized, marginalized and made to feel absolutely crazy.
Sadly, far too many stop here. They give up and give in to all sorts of unproven antidotes for their hormonal symptoms of anxiety, insomnia, hot flashes, migraine headaches and more. They assemble a medicine cabinet full of tinctures, herbs and supplements like magnesium, chasteberry, St. John’s Wort and black cohosh. They order all sorts of lotions and creams that supposedly contain progesterone and estrogen from online retailers with absolutely no regulatory skin in the game.
And they continue to suffer.
Fortunately, the ubiquitous nature of online shopping has intersected with telemedicine. And this means that women can now shop around like a well-informed consumer with choices in obtaining a prescription for hormone replacement therapy (HRT). Here are some of the best-known virtual HRT providers, all staffed by actual physicians, nurse practitioners and registered nurses.
Defy Medical – Focuses on compounded, customized (not pre-packaged the ones you get off the shelf via prescription at the regular pharmacy) hormone therapy options, all intended to remediate perimenopause symptoms. These include estrogen in the form of capsules, creams, pellet implants, vaginal suppositories and injections, plus progesterone as capsules, creams, injections and vaginal suppositories. Unlike some other providers, Defy also prescribes testosterone to women and focuses on other hormones, like thyroid and pregnenolone, too.
Evernow – Offers perimenopausal treatment in the form of estradiol patches, pills and vaginal creams, as well as oral micronized progesterone. They also offer combined estradiol / norethindrone pills and ethinyl estradiol / norethindrone birth control pills (generic Loestrin 1/20). For those interested in non-hormonal options, Evernow has Brisdelle (generic paroxetine), which is a low-dose SSRI used for treating vasomotor systems like hot flashes and night sweats, with some potential benefit for low-level depression or anxiety, too. Finally, they also have venlafaxine, which is the generic for the SNRI antidepressant Effexor, which, too, treats hot flashes and night sweats. Evernow often runs a special promotion that allows women to try whichever treatment best suits them for free (paying only about $6 in shipping) for the first month.
Gennev – Provides virtual perimenopause care at a rate of $55 for a 20-minute appointment or $85 for a 30-minute appointment with a trained menopause specialist. Some online reviews suggest a level of dissatisfaction among women who wanted actual HRT but were prescribed standard birth control pills instead. However, Gennev claims to offer hormone replacement therapy, in addition to a range of supplements, like vitamin D, omega-3 and others.
HelloAlpha – Prescribes supplemental estrogen and progesterone in the form of capsules, patches and gels, offering name brand prescriptions and generics, with a fully transparent price list. They also offer combined pills and conventional birth control pills as options. For perimenopausal sleep problems, they have doxepin and Ramelteon. And if non-hormonal options are a need or preference, HelloAlpha offers brand name and generic Brisdelle (paroxetine) and Effexor (venlafaxine).
Winona - An emerging player in the HRT market, Winona offers the full panoply of hormone management options for women. They have estrogen in the form of tablets, patches and body creams, as well as vaginal estrogen. Progesterone is available as a combined cream with estrogen, as standalone oral capsules or as a body cream. Winona also has DHEA, which may help women who need a testosterone boost. Winona stands out in that they offer both FDA-approved, regulated hormone products as well as custom-compounded formulas.
Now, many people will wonder if these providers accept insurance? In most cases, the answer is likely “no.” Most providers require or expect out-of-pocket payment for HRT, though some may be willing to provide a statement developed for a patient’s potential insurance reimbursement. Some patients use HSA (health savings account) funds toward their HRT; some grapple with their insurance to cover at least part of it and, most, sadly, pay for it themselves – even if they have “good” insurance. The headaches of bickering with insurance administrators and going back and forth to doctor’s offices in person just isn’t worth it to them.
So, for those interested in HRT who have faced unreasonable hurdles with conventional, in-person doctors, there are alternatives available. The online HRT providers are staffed by medical personnel and most use FDA-approved body-identical hormone replacement products, not unscrupulous, questionable products from “the streets” or underground.
As with most things, buyer beware. Research online reviews, have an informational visit with a provider, check the doctors' credentials and history with the medical board in the state in which they are registered, ask as many questions as you need, comparison shop and even see how what they recommend corresponds with science and best practices. And then make a decision.
The Real Peri Meno is devoted to all things perimenopause - the science, treatments, care, understanding, personal experiences, relationships, culture and more. The brain child of Keisha D. Edwards, The Real Peri Meno developed out of her own shock-and-awe experience with perimenopause and navigating the disjointed U.S. medical system in search of answers, support and relief.
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