Menopause treatment online: how hormone therapy is prescribed by telehealth

How online menopause treatment works

Online hormone therapy replaces the waiting room with a questionnaire, but not the clinician. At BaselineRx the four steps are the same ones an office visit covers, in a different order and on your schedule.

What can and cannot be prescribed online

Menopause hormone therapy is well suited to telehealth because prescribing is based on your symptoms and history, not on a physical examination or a hormone panel. Hormone levels swing from hour to hour during perimenopause, which is why the UK’s NICE guideline on menopause says that in otherwise healthy women over 45, perimenopause and menopause are diagnosed from symptoms and period history, and advises against estradiol and other hormone tests for that purpose. The BaselineRx protocol follows the same logic: no labs are needed to start.

What a BaselineRx clinician can prescribe online: bioidentical estradiol as a twice-weekly patch, a daily gel, a compounded cream, or (only for women who have reacted to topical estrogen and have no blood-clot risk factors) an oral tablet; micronized progesterone at 100 or 200 mg for women with a uterus; and low-dose estradiol vaginal cream for dryness, painful sex or recurrent urinary infections.

What the intake will not proceed with, and what needs in-person care instead: pregnancy or breastfeeding; regular menstrual cycles (hormone therapy is for perimenopause and menopause, not for cycling women); vaginal bleeding that has not been evaluated; an active estrogen-sensitive cancer or a history of breast or uterine cancer; a history of blood clots, stroke or heart attack; uncontrolled blood pressure or heart disease; active liver disease; or an unstable psychiatric illness. If you have reacted to topical estrogen and also have blood-clot risk factors, neither route is suitable and the questionnaire stops. In all of these cases the right next step is your own physician or gynecologist, and the intake says so rather than routing you to checkout.

Online care also has limits that are not about safety. If a patch, gel, cream or tablet does not fit your situation, if you need an endometrial evaluation for bleeding on therapy, or if you want to discuss options that BaselineRx does not offer, such as testosterone or non-hormonal prescription treatments for hot flashes, an in-person menopause specialist is the better route.

Where online menopause treatment is available

BaselineRx serves patients in all 50 states and the District of Columbia, through clinicians licensed in the state where you are located. In 44 states the whole process is asynchronous: the questionnaire is the visit, and the clinician reviews it without a live appointment. In seven jurisdictions state law requires a live (video or phone) consultation with a provider before treatment, which is arranged after your intake.

Asynchronous care is available in: Alaska, Alabama, Arkansas, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Idaho, Illinois, Indiana, Kentucky, Massachusetts, Maryland, Maine, Michigan, Minnesota, Missouri, Montana, North Carolina, North Dakota, Nebraska, New Hampshire, New Jersey, Nevada, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Vermont, Washington, Wisconsin and Wyoming. A live consultation is required first in the District of Columbia, Kansas, Louisiana, Mississippi, New Mexico, Rhode Island and West Virginia.

Availability of a specific medication can still vary by state, and your eligibility is confirmed during the intake.

What it costs and what is included

BaselineRx does not bill insurance. Pricing is a flat membership, billed monthly or quarterly, and hormone therapy plans start at $139 a month. The price covers the medication and the care around it; there is no separate visit fee, and you are not charged at all unless a provider approves treatment.

How online treatment compares to an in-person visit

An office visit with a gynecologist or menopause specialist and an online intake reach the same clinical decision by different routes. In person, you book, wait for the appointment, describe your symptoms, and leave with a prescription to fill at a pharmacy; follow-up means another appointment. Online, the questionnaire captures the same history up front, a clinician reviews it on their schedule rather than yours, the pharmacy ships the medication, and follow-up is built into the plan as check-ins and a dose review.

Where in-person care is stronger: anything that needs an examination or a procedure, such as evaluating abnormal bleeding, an endometrial biopsy, or a pelvic exam; complex histories that need a specialist’s judgment in the room; and treatments outside the BaselineRx protocol. Where online care is stronger: speed, access in areas without a menopause specialist nearby, and continuity, because the check-ins and the month-three review are part of the plan rather than appointments you have to remember to book.

The two are not exclusive. Many women use an online service for ongoing hormone therapy and keep their gynecologist for annual exams and screening; your clinician will tell you when something you report needs to be seen in person.

Who prescribes your treatment

BaselineRx is a technology platform, not a medical practice. The care comes from Arora Health & Aesthetics, an independent clinical network whose US-licensed providers review every intake, write every prescription and handle the follow-up. Its clinical team, led by Shannon Arora, MD, designed the menopause hormone-therapy protocol these pages describe: transdermal estradiol as the first-line form, micronized progesterone for women with a uterus, no labs to start, and a dose review around month three.

Prescriptions are filled by licensed US pharmacies that are accredited by the National Association of Boards of Pharmacy and LegitScript-approved. Compounded medications, where prescribed, are prepared by a registered 503A pharmacy and are not FDA-approved; the FDA does not review them for safety, effectiveness or quality.