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Menopause hormone therapy guide

Menopause hormone therapy (systemic) online in Virginia and West Virginia

This guide is for starting or continuing systemic hormone therapy (HT) for bothersome hot flashes and night sweats — a transdermal estradiol patch, preferred for its lower blood-clot risk, plus micronized progesterone if the uterus is intact, or oral estradiol as an alternative. Only appropriate for women under 60 who are less than 10 years past their final period, with no history of breast/endometrial cancer, blood clots, stroke, heart attack, or unexplained bleeding, and no current postmenopausal bleeding. (Vaginal dryness or urinary symptoms without hot flashes are treated through the separate Menopause vaginal symptoms guide.)

Start online

Start a $59 online review for Menopause hormone therapy (systemic).

Systemic hormone therapy (HT) remains the most effective treatment for bothersome hot flashes and night sweats. For women who are under 60 and less than 10 years past their final period — the window in which the benefit-risk balance is most favorable — a transdermal estradiol patch is preferred because it carries a lower blood-clot risk than a pill, since it skips first-pass liver metabolism. If the uterus is still present, micronized progesterone is always added alongside the estrogen, because estrogen alone raises the risk of endometrial (uterine) cancer — this is never optional. An oral estradiol pill is available as an alternative for women who don't tolerate the patch. The safety rules are strict because online care cannot examine you: a history of breast or endometrial cancer, a blood clot, stroke, heart attack, or a clotting disorder, unexplained vaginal bleeding, or active liver disease all rule out this pathway, and ANY vaginal bleeding after menopause — whether or not you're already on hormone therapy — is always a hard stop to an in-person exam, not a routine online decision.

If treatment is appropriate, your physician can send a non-controlled prescription to your pharmacy and provide portal instructions for the next step.

Start this visitSee response windows

Quick facts

  • You must be physically in Virginia and West Virginia at the time of request
  • Starts at $59
  • No insurance needed
  • No app download
  • Physician review around the clock
  • Non-controlled prescriptions can be sent to your pharmacy when appropriate
  • A work or school note can be included when medically appropriate
  • Response windows: 24/7, every day

Common symptoms

  • Bothersome hot flashes
  • Night sweats disrupting sleep
  • Wanting to start systemic hormone therapy, or continue an existing stable regimen

May fit online care

  • Adults 18 and older
  • A woman under 60 who is less than 10 years past her final period
  • Bothersome hot flashes or night sweats as the main concern
  • No history of breast or endometrial cancer, blood clot, stroke, heart attack, thrombophilia, unexplained vaginal bleeding, or active liver disease
  • No current vaginal bleeding or spotting

Look for another care setting

  • Age 60 or older, or 10 years or more since your final period
  • ANY vaginal bleeding or spotting after menopause, on or off hormone therapy — this always needs an in-person exam first
  • A history of breast or endometrial cancer, a blood clot (DVT/PE), stroke, heart attack, a clotting disorder, unexplained vaginal bleeding, or active liver disease
  • Pregnant, possibly pregnant, or breastfeeding
  • Vaginal dryness or urinary symptoms without hot flashes as your main concern (use the Menopause vaginal symptoms guide instead)

What to have ready

  • When your final period was, and your current age
  • Whether you still have a uterus, or have had a hysterectomy
  • Any vaginal bleeding or spotting since menopause
  • Your history of breast/endometrial cancer, blood clots, stroke, heart attack, liver disease, migraine with aura, smoking, and gallbladder disease
  • When you last had a mammogram

What happens next

Standard

$59

Within 6 hours

Priority

$99

Within 3 hours

Rush

$149

Within 1 hour

Start the request on the website, answer the fit questions, and choose the response window you want. If the concern still fits this service, a physician reviews it and sends a secure update after sign-in. When appropriate, non-controlled prescriptions can be sent to your pharmacy, and a basic work or school note can be included at physician discretion.

Your physician

Every visit is personally reviewed by Ankur Fadia, MD — board-certified, cardiology-fellowship-trained, and Alpha Omega Alpha. Recognized with the Act Fast Award for the fastest physician stroke-treatment times (2019–2022) and as the most efficient, highest-rated physician in the HCA LewisGale Alleghany emergency department (2018). Licensed in Virginia and West Virginia — your care is never handed off.

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Why is the patch preferred over a pill?

Transdermal (patch) estrogen is absorbed through the skin and skips first-pass metabolism through the liver, which gives it a lower risk of blood clots (venous thromboembolism) compared to an oral estrogen pill. Because of this, the patch is the preferred starting option, with oral estradiol available as an alternative if the patch isn't tolerated.

Do I really need progesterone if I still have a uterus?

Yes — this is never optional. Estrogen on its own stimulates the lining of the uterus and meaningfully increases the risk of endometrial (uterine) cancer over time. Micronized progesterone taken nightly protects that lining. If you've had a hysterectomy and no longer have a uterus, progesterone isn't needed.

Why does any bleeding after menopause stop treatment?

Bleeding after menopause — even a small amount, even while already taking hormone therapy — is the most important warning sign of a problem in the lining of the uterus, including precancer or cancer, and needs an in-person exam and usually an ultrasound or biopsy. Because online care cannot examine you, any bleeding or spotting means we cannot prescribe or continue your prescription online until it's been checked in person.

Why am I only eligible if I'm under 60 and less than 10 years past my final period?

This is often called the 'timing hypothesis' — starting hormone therapy within this window is associated with a more favorable balance of benefits and risks, particularly for heart and blood-vessel health, compared with starting later. Starting hormone therapy outside this window needs a more individualized in-person risk discussion, so it isn't offered through this online pathway.

I get migraines with aura, or I smoke — can I still be treated?

Possibly, but only with the transdermal patch, never an oral pill — both migraine with aura and smoking over age 35 raise the stroke/clot risk of oral estrogen specifically, and the patch avoids that added risk. If you smoke, we'll also talk about quitting.

Can you also treat vaginal dryness?

This lane focuses on systemic hot flashes/night sweats. If vaginal dryness, irritation, or pain with sex without hot flashes is your main concern, low-dose vaginal estrogen — a separate, narrower treatment — is available through our Menopause vaginal symptoms guide.