Medications

How drugs cluster on this index

The medications women's hormonal telehealth prescribes fall into five major buckets. GLP-1 receptor agonists (semaglutide, tirzepatide, liraglutide) target weight and metabolic markers — the fastest-growing category since 2024. Estrogen formulations (transdermal estradiol, oral estradiol, conjugated equine) plus progestogens (micronized progesterone, medroxyprogesterone) carry the menopause/HRT side. PCOS management runs through metformin, spironolactone, and combination oral contraceptives. Mental-health adjuncts (paroxetine, escitalopram, gabapentin) cover hot-flash relief for women who can't take estrogen. The fifth bucket — compounded or branded specialty forms — varies by provider. Click any drug for evidence summary, dosing tiers, side effects, and which providers in our index will prescribe it.

• Bazedoxifene + Conjugated Estrogens

  bazedoxifene/CE

  SERM-estrogen combo for women with uterus. Provides endometrial protection without progesterone.

  FDA-approved~$215/mo

• Bioidentical Estradiol

  Estradiol

  Bioidentical estradiol, the primary form of estrogen, used to treat menopausal symptoms.

  FDA-approvedCompounded~$60/mo

• Compounded Estriol

  Weak estrogen frequently included in compounded "BiEst" preparations. Not FDA-approved as standalone in US.

  Compounded~$65/mo

• Conjugated Estrogens

  conjugated equine estrogens

  Original HRT formulation derived from pregnant mare urine. Largely replaced by bioidentical estradiol.

  FDA-approved~$95/mo

• Drospirenone + Ethinyl Estradiol

  drospirenone/EE

  Combined oral contraceptive with anti-androgenic progestin. First-line for PCOS-related acne and irregular periods.

  FDA-approved~$35/mo

• Estradiol Gel

  estradiol topical gel

  Topical estradiol gel applied daily to skin. Alternative to patches.

  FDA-approved~$80/mo

• Estradiol Patch

  estradiol transdermal

  Transdermal estrogen delivered through skin patch. Preferred over oral for lower clot risk.

  FDA-approved~$35/mo

• Estradiol Vaginal Cream

  estradiol vaginal cream

  Low-dose vaginal estrogen for genitourinary syndrome of menopause. Minimal systemic absorption.

  FDA-approved~$45/mo

• Estradiol Vaginal Ring

  estradiol vaginal ring

  Sustained-release vaginal estradiol ring replaced every 3 months. Set-and-forget option.

  FDA-approved~$145/mo

• Micronized Progesterone

  progesterone, micronized

  Bioidentical oral progesterone. Required alongside estrogen for women with uterus to prevent endometrial cancer.

  FDA-approved~$35/mo

• Compounded Semaglutide

  Semaglutide

  GLP-1 receptor agonist used for weight loss and type-2 diabetes. Available as compounded formulations and FDA-approved branded versions.

  FDA-approvedCompounded~$250/mo

• Compounded Tirzepatide

  Tirzepatide

  Dual GIP/GLP-1 receptor agonist with stronger weight loss outcomes than semaglutide in head-to-head trials.

  FDA-approvedCompounded~$350/mo

• GLP-1 (off-label PCOS)

  GLP-1 agonists prescribed off-label for PCOS-related weight management and metabolic dysfunction.

  ~$800/mo

• Mounjaro

  tirzepatide injection

  FDA-approved tirzepatide for type 2 diabetes. Off-label use for weight loss before Zepbound approval.

  FDA-approved~$1069/mo

• Ozempic

  semaglutide injection

  FDA-approved for type 2 diabetes — same molecule as Wegovy at lower max dose. Off-label for weight loss.

  FDA-approved~$970/mo

• Wegovy

  semaglutide injection

  FDA-approved semaglutide brand for chronic weight management at higher dose than Ozempic.

  FDA-approved~$1350/mo

• Zepbound

  tirzepatide injection

  FDA-approved tirzepatide formulation for weight management. Dual GIP/GLP-1 agonist.

  FDA-approved~$1059/mo

• Fezolinetant

  fezolinetant

  First neurokinin-3 receptor antagonist FDA-approved for hot flashes (2023). Non-hormonal mechanism.

  FDA-approved~$550/mo

• Gabapentin

  gabapentin

  Anticonvulsant with off-label use for night sweats and hot flashes. Often used when SSRIs not tolerated.

  FDA-approved~$18/mo

• Inositol

  Supplement (myo + d-chiro) with emerging evidence for insulin sensitivity in PCOS. OTC, not FDA-regulated.

  ~$25/mo

• Metformin

  Metformin

  Insulin-sensitizing medication commonly prescribed for insulin-resistant PCOS. Generic, inexpensive, well-studied.

  FDA-approved~$15/mo

• Paroxetine (low-dose)

  paroxetine 7.5mg

  First non-hormonal FDA-approved drug for hot flashes. Sub-antidepressant dose at 7.5mg.

  FDA-approved~$145/mo

• Venlafaxine

  venlafaxine extended-release

  SNRI with strong evidence for hot flashes and menopausal mood. Off-label for vasomotor symptoms.

  FDA-approved~$25/mo

• Spironolactone

  Spironolactone

  Anti-androgen often prescribed for hormonal acne, female pattern hair loss, and PCOS-driven androgen excess.

  FDA-approved~$20/mo

• Topical Minoxidil

  minoxidil topical

  OTC topical for androgenic alopecia in women. 5% formulation has strongest evidence; daily application required.

  FDA-approved~$35/mo

• Estradiol vs Estriol

  Estradiol is the strongest estrogen and FDA-approved standard for hormone therapy (transdermal patch, oral, vaginal ring). Estriol is a weaker estrogen used primarily for vaginal atrophy — only available via compounding pharmacies in the US.

• Wegovy vs Zepbound

  Wegovy (semaglutide) achieves 14-15% average body-weight loss at 68 weeks. Zepbound (tirzepatide) achieves 20-21% — Zepbound wins on efficacy. Costs similar ($1,000-1,350/mo retail). Side effects similar (mostly GI). Mounjaro and Ozempic contain the same molecules but are FDA-approved for diabetes rather than weight loss.

• Mounjaro vs Ozempic

  Both are FDA-approved for type 2 diabetes. Mounjaro (tirzepatide) lowers A1c more and produces more weight loss than Ozempic (semaglutide). Ozempic has longer real-world track record and broader insurance formulary coverage. Mounjaro has slightly more GI side effects in head-to-head trials (SURPASS-2).

• Semaglutide vs Tirzepatide

  Ingredient-level comparison. Semaglutide is a GLP-1 receptor agonist (single pathway). Tirzepatide is a dual GIP + GLP-1 receptor agonist. Tirzepatide produces ~6 percentage points more weight loss and slightly better A1c reduction in head-to-head trials. Both available as four FDA-approved brands (Ozempic/Wegovy = semaglutide; Mounjaro/Zepbound = tirzepatide).

• Paroxetine vs Escitalopram

  Paroxetine 7.5mg (Brisdelle) is FDA-approved for hot flashes — 30-40% reduction. Escitalopram off-label but similar efficacy and often better tolerated.

• Micronized progesterone vs Medroxyprogesterone

  Micronized progesterone (Prometrium) is bioidentical and evidence-preferred. Medroxyprogesterone (Provera) is synthetic — associated with slightly higher breast cancer risk in WHI data.

• Zepbound vs Ozempic

  Zepbound (tirzepatide) is FDA-approved for chronic weight management — average 22.5% weight loss at highest dose (SURMOUNT-1). Ozempic (semaglutide) is FDA-approved for type 2 diabetes — about 15% weight loss when used off-label. Both injectable weekly, similar side-effect profiles.

• Wegovy vs Ozempic

  Wegovy and Ozempic contain the same active ingredient — semaglutide — made by Novo Nordisk. Wegovy is FDA-approved for chronic weight management (max 2.4 mg weekly). Ozempic is FDA-approved for type 2 diabetes (max 2 mg weekly). Different brand, different indication, same molecule.

• Mounjaro vs Wegovy

  Mounjaro (tirzepatide) is FDA-approved for type 2 diabetes. Wegovy (semaglutide) is FDA-approved for chronic weight management. Different mechanisms (dual GIP/GLP-1 vs single GLP-1), different indications. For diabetes Mounjaro typical; for weight loss Wegovy or Mounjaro's weight-loss sibling Zepbound.

• Estradiol patch vs Estradiol gel

  Both deliver bioidentical estradiol transdermally, avoiding first-pass liver metabolism and both lower VTE risk vs oral estradiol. Patches (Climara, Vivelle-Dot) apply once or twice weekly. Gels (EstroGel, Divigel) require daily application. Choice usually comes down to skin tolerance and lifestyle preference.

• Compounded semaglutide vs FDA-approved semaglutide

  Compounded semaglutide is mixed by licensed compounding pharmacies, often with additives (B12, glycine) and at lower cash prices ($200-400/month). FDA-approved semaglutide (Ozempic, Wegovy) costs $935-1,349/month list but carries Novo Nordisk's quality, safety, and trial-data standards. FDA does not verify compounded products.

• Bioidentical HRT vs Synthetic HRT

  Bioidentical HRT (FDA-approved): estradiol patches/gels/pills + micronized progesterone (Prometrium) — molecularly identical to endogenous hormones. Synthetic HRT (historical): conjugated equine estrogens (Premarin) + medroxyprogesterone (Provera) — used in the original WHI trial. Modern guidelines favor FDA-approved bioidentical formulations.

• How to get HRT

  HRT requires a prescription. Three paths: (1) PCP if menopause-knowledgeable, (2) NAMS-certified specialist, (3) telehealth menopause clinics (Midi, Alloy, Evernow). Telehealth typically fastest — assessment to prescription in 2-7 days.

• How to get compounded semaglutide

  Compounded semaglutide is available via licensed telehealth providers with 503A pharmacy partnerships. Typical cost: $149-449/month. Verify FDA shortage status (ongoing as of 2026) determines legality.

• Progesterone for Perimenopause

  Micronized progesterone 100-200mg nightly is widely prescribed in perimenopause for sleep + cycle regulation + endometrial protection if pairing with estrogen. Off-label but evidence-supported usage in NAMS guidelines.

• Metformin for PCOS

  Metformin 500-2000mg/day reduces insulin resistance and often restores ovulation in PCOS. AACE 2026 guidelines reserve it for confirmed insulin resistance — not all PCOS phenotypes need it.

• Tirzepatide for PCOS

  Tirzepatide (Mounjaro/Zepbound) is FDA-approved for obesity, not PCOS specifically. Off-label use in PCOS gaining traction — addresses insulin resistance and weight, both central to PCOS metabolic phenotype.