FAQ

Evernow 101

Start here for answers to essential questions about Evernow—what we do and how we do it. If you’ve got a query you don’t see addressed on this page, feel free to contact us!

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Will estradiol or progesterone make me gain weight?

Several studies over the past several years have shown that hormone replacement therapy can slow the creep of menopausal weight gain and abdominal fat redistribution in many women.

Where to apply the estradiol patch?

The patch is very easy to use. The packaging insert has a guide for you to reference, but here are the basics: You just place it on your skin like a bandaid. The most common sites of application are the lower abdomen and upper buttocks. To avoid irritation, it helps to change the site of application each time (i.e., rotate between the sides of the abdomen or buttocks). The patch should be changed every 3 and 4 days (e.g., Monday & Thursday or Tuesday & Friday). If you forget to change your patch, it’s no big deal, but the medication will decrease over time, so you may get some resurgence of symptoms, like hot flashes or night sweats. This will also happen if the patch falls off on accident. The adhesive is durable and it is rare that a patch dislodges by accident. If you are a regular swimmer, you may consider covering the patch with a waterproof bandaid when you swim, but you won’t need to for regular bathing/showering. Pro tip: Set a reminder in your calendar or a recurring alarm on your phone to help you remember to swap your patch!

How to keep the estradiol patch on?

Make sure that the site of application is free of any lotion, oil, and powder.

Position your patch in an area that won’t be irritated by clothing or crease from movement (ideal areas for patch placement are lower abdomen and on the upper buttocks below the panty line)

Press and spread the patch out firmly with the palm of your hand

How long does it take the estradiol patch to start working?

By 2 weeks, most women start to really feel the benefits of the treatment, including a reduction in hot flashes and night sweats, better sleep, and decreased vaginal dryness. This is normal, and will even out over time. Full relief is expected between 1-3 months. We will check in with you a little more often while you are getting started and then monthly, but please reach out to our providers any time if you have questions.

How long does it take for vaginal estradiol cream to work?

Initial improvement in symptoms may be seen as early as 2-4 weeks after initiating treatment. However, full relief is typically experienced after 2-3 months.

What is the vaginal estradiol cream prescribed for?

Vaginal estradiol cream helps with menopause symptoms specifically affecting the genitourinary system (eg, vulva, vagina, urethra and bladder): vulvar irritation, vaginal dryness, painful sex, frequent urination, frequent UTIs.

Can I insert the vaginal estradiol cream without an applicator?

No, do not insert the cream without the applicator. This may cause you to use too little or too much of the medication, both of which can have negative consequences.

How long after placing the estradiol vaginal cream can you engage in vaginal intercourse?

Although there aren’t scientifically-backed guidelines around this specific question, we recommend that you avoid penetrative vaginal activities for 8 hours after the placement of the cream to ensure that it does not get pushed out of the vagina. We recommend that you engage in sexual activity before placing the vaginal estradiol cream in the vagina.

Are estradiol patches safe?

The estradiol patch is typically well tolerated, but there are some common side effects to be aware of. Nausea, headache, abdominal bloating, breast pain, vaginal spotting, and irritation at the placement site can occur. These side effects are typically time-limited and go away in the first few months of use.

Use of estrogen may be associated with an increased risk of heart attack, stroke, blood clots in the legs or lungs, breast cancer, uterine cancer, or dementia. Evernow prescribes the generic equivalent of Vivelle-Dot. Be sure to check out the safety information for Vivelle-Dot, and talk to your Evernow medical provider about possible contraindications, especially if you have a history of estrogen-sensitive cancer, undiagnosed vaginal bleeding, coronary heart disease, blood clots, or stroke.

Do you need a prescription for vaginal estradiol cream?

Yes. Once you complete your health profile, our NAMS-certified medical providers will review your health history and current symptoms and determine, in consultation with you, whether vaginal estradiol cream is appropriate.

Does vaginal estradiol cream carry the same risks as systemic estrogen therapy?

Low-dose vaginal estradiol cream carries less of a risk than systemic estrogen therapy because the level of estrogen in the vaginal cream is significantly lower. As a result, levels of estrogen in the blood with the use of low-dose vaginal estrogen remain within the postmenopausal range.

How do you use the vaginal estradiol cream?

When first getting started, the cream is placed with an applicator in the vagina nightly for 2 weeks. After that, it is used only 2 nights a week.

What are vaginal estradiol tablets prescribed for?

Vaginal estradiol tablets help with menopause symptoms specifically affecting the genitourinary system (eg, vulva, vagina, urethra and bladder): vulvar irritation, vaginal dryness, painful sex, frequent urination, frequent UTIs.

Do vaginal estradiol tablets carry the same risks as systemic estrogen therapy?

Low-dose vaginal estradiol tablets carry less of a risk than systemic estrogen therapy because the level of estrogen in the vaginal tablets are significantly lower. As a result, levels of estrogen in the blood with the use of low-dose vaginal estrogen remains within the postmenopausal range.

How long does it take for vaginal estradiol tablets to work?

Initial improvement in symptoms may be seen as early as 2-4 weeks after initiating treatment. However, full relief is typically experienced after 2-3 months.

How do you use the vaginal estradiol tablet?

When first getting started, the tablet is placed in the vagina nightly for 2 weeks. After that, it is used only 2 nights a week.

How long after placing the estradiol vaginal tablet can you engage in vaginal intercourse?

Although there aren’t scientifically-backed guidelines around this specific question, we recommend that you avoid penetrative vaginal activities for 8 hours after placement of the tablet to ensure that it does not get pushed out of the vagina. We recommend that you engage in sexual activity before placing the vaginal estradiol tablet in the vagina.

Do you need a prescription for vaginal estradiol tablets?

Yes. Once you complete your health profile, our NAMS-certified medical providers will review your health history and current symptoms and determine, in consultation with you, whether vaginal estradiol pills are appropriate.

How soon can I expect to see results when using minoxidil?

Growing hair takes a long time! Most women note seeing results within six months. In order to maintain the results you achieve, you will have to continue to take this medication indefinitely.

Am I an ideal candidate for Minoxidil?

You're an ideal candidate if you want to slow the rate of hair loss and prefer to put a topical treatment on their scalp rather than take a pill.

What benefits can I expect with Minoxidil?

You can expect increase in hair thickness as well as volume. Additionally the treatment will slow your rate of hair loss.

When should I expect to see results with oral minoxidil?

Minoxidil takes a few months to produce noticeable results to your crown and hairline. Results are usually seen within 6 months but can be seen as early as 3 months. Shedding of hair is common in the first two to eight weeks of treatment. This is likely due to hair follicles releasing hair that is no longer growing in order to start up new growth. In order to maintain the results you achieve, you will have to continue to take this medication indefinitely. Your provider will follow your treatment closely to help ensure optimal outcomes and minimize side effects.

What is the typical dosage of oral minoxidil for female hair loss?

Oral minoxidil is typically prescribed in lower doses when treating hair loss in women – ideally obtaining positive outcomes with fewer side effects. Oral minoxidil is made in 2.5mg tablets. Patients will start with taking a half of a tablet, 1.25mg per day. If after six months, you do not see results at this dose, your provider may recommend increasing to a full table. If you experience side effects, your provider may recommend reducing your dose or stopping the use of oral minoxidil.

What are the common side effects of oral minoxidil?

Taking oral minoxidil can result in certain risks. One of these risks involves hypertrichosis, which is the term for unusual hair growth on other parts of the body. This happens because oral minoxidil affects the whole body systemically, and can thus lead to hair growth in places other than the scalp. However, it's important to note that this condition usually resolves itself within four months of stopping the treatment.

Another potential side effect is lower extremity edema, a condition characterized by the swelling of legs, ankles, and feet. Some women may also experience headaches, palpitations, and nausea when taking this medication.

While they are less likely to occur, there are other risks associated with oral minoxidil usage. These include pleural effusion, which is the buildup of fluid between the layers of tissue lining the lungs and chest cavity. Also, some women may experience hypotension, a condition marked by lower-than-normal blood pressure. This can lead to feeling light-headed.

Read through important safety information.

Why should I try Evernow?

At Evernow, we're doing telemedicine a little differently. Our membership provides access to medical providers through a practice called "asynchronous telemedicine." This means you don't need a specific appointment date or time—when you have a question, you message your provider through your account and they reply to you within a business day. We're excited about our approach because it gets you on the path to feeling better ASAP.

Over time, 80% of our members have complete relief from symptoms like hot flashes, night sweats, and vaginal dryness. And while no medical provider can promise that every single symptom will go away completely, we do promise to walk hand-in-hand with you while we work to bring you the relief you’re looking for.

What is oral minoxidil?

Oral minoxidil contains the same active ingredient as topical minoxidil, the main ingredient in many over the counter hair growth products. Oral minoxidil was first prescribed in the 1970s to treat hypertension, or high blood pressure, by allowing more blood flow through the body. A frequent side effect of this initial use was hypertrichosis, or excessive hair growth. Unlike topical minoxidil, which is FDA-approved and available without a prescription, oral minoxidil is considered “off-label” and requires a prescription. Learn more about off-label treatment.

What is minoxidil?

Topical minoxidil stimulates the flow of blood rich with nutrients and oxygen to hair follicles. This increased circulation prolongs the growth of current hair, shortens the resting time of follicles, and increases the size of follicles, helping them grow terminal rather than miniaturized hairs. 

How do Evernow providers determine my treatment plan?
  • First, you’ll complete our online health profile. We’ll ask about your age, blood pressure, symptoms, and other medical information relevant to your treatment. 
  • Because every woman has a unique medical history, and because some of these histories require greater care and scrutiny (such as if you’ve had a hysterectomy or have an underlying medical condition), this virtual consultation collects the details our medical team needs to determine whether you are a good candidate for hormonal treatments.
  • Our health profile incorporates guidelines of professional medical societies such as ACOG (American College of Obstetricians and Gynecologists) and NAMS (North American Menopause Society).
  • Once you've signed up, we'll connect you with an Evernow clinician who will review your health profile answers in-depth and create a detailed treatment plan for you. She'll be by your side to help find the perfect solution for you—prescription treatment, delivery to your door, and unlimited messaging. You don't have to wait for your treatment plan to ask questions, either. You can message your provider immediately after you're signed up.
Who is oral minoxidil for?

Oral minoxidil can be effective at addressing symptoms of hair loss including women in perimenopause and menopause. Some patients find it easier to take a single oral pill a day instead of applying topical treatments. Simple routines can help improve adherence and outcomes, leading to better results. Specific treatment recommendations are at the discretion of healthcare providers based on an individual’s medical history, contraindications and potential side effects. 

What is finasteride?

Finasteride blocks the chemical conversion of testosterone to dihydrotestosterone (DHT) - a hormone that slows down the growth of hair within the hair follicles. By inhibiting DHT, finasteride helps to maintain the growth phase of the hair cycle, preventing further hair loss.

Does Evernow require bloodwork?

Bloodwork is unnecessary for treatment of menopausal symptoms. Guidelines from The American College of Obstetricians and Gynecologists (ACOG) and The North American Menopause Society (NAMS) recommend treating patient symptoms rather than hormone levels in the blood. For more information, please read our article about why we are able to treat menopausal symptoms without blood testing.

What is the difference between topical and oral minoxidil?

While topical minoxidil is FDA-approved to treat hair loss and is available without a prescription, oral minoxidil is considered “off-label” and requires a prescription. “Off-label” means a product is not FDA-approved for that particular use, but it can still be prescribed to patients at their provider’s discretion. Learn more about off-label treatment. 

What is the minoxidil and finasteride topical solution?

This solution takes two ingredients and combines them into a single formula. The result is an easy topical treatment for hair loss that provides a compelling alternative to pills or multiple, messy drops. Simple routines can help improve adherence and outcomes, leading to better results. Specific treatment recommendations are at the discretion of healthcare providers based on an individual’s medical history, contraindications and potential side effects.

Where is Evernow available?

We are currently available in Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New York, Nevada, North Carolina, North Dakota, South Dakota Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Tennessee, Virginia, Washington, Wisconsin, and Wyoming.

When should I expect to see results with topical minoxidil and finasteride for female hair loss?

Results may vary, but are generally seen within 6 months. In order to maintain the results you achieve, you will have to continue to take this medication indefinitely. Your provider will follow your treatment closely to help ensure optimal outcomes and minimize side effects.

What should I expect in my first few months of Evernow?

Week 1: Once you have your prescription, you can begin treatment right away. Depending on your medical history and needs, you’ll be receiving estrogen in the form of an estradiol patch, pill, or cream, along with progesterone if needed. Instructions are included on your treatment plan.

Week 2: Breast tenderness, bloating, or sleep changes? These are normal, temporary side effects. Your Evernow provider will check in again this week, and if at any point you experience something you want to ask about, please ask.

Week 3: The third week of treatment is when most women begin to experience noticeable relief from hot flashes, night sweats, and vaginal dryness. We expect that as these hormonal symptoms diminish, you’ll begin to experience better sleep and increased energy. If you’re not yet experiencing relief at 3-4 weeks, let your provider know so your treatment can be adjusted.

Looking ahead: By the end of the 3rd month of your treatment, we expect that you will have fully adjusted to the hormones and experienced continuous relief from your symptoms. Our hormone-based treatment plans are clinically proven to eliminate hot flashes, night sweats, and vaginal dryness in 80% of women, along with other symptoms.

How should I use the topical minoxidil and finasteride formulation for female hair loss?

This formulation contains 5.6% minoxidil and 0.3% finasteride in a propylene glycol base. Apply 5 drops once a day to full scalp. To do so, partition your hair in 5 sections from ear to ear and place one drop where you part each section. Massage the topical into the scalp with your fingers. Wash hands with soap and water after application. Let dry for one hour before lying down.

What medications does Evernow prescribe?

Our doctors and nurse practitioners prescribe estradiol, progesterone, venlafaxine, and paroxetine. We offer several forms of estradiol: Estradiol patch, Estradiol pill and Estradiol cream.

  • Estradiol (Estrogen): Evernow prescribes bio-identical estradiol, is effective at addressing menopause symptoms including hot flashes, night sweats, and vaginal dryness.
  • Progestin (Progesterone): Progesterone is prescribed to women with a uterus who are taking estradiol during menopause. This is because estrogen promotes the continuous growth of cells in the uterus. When you’re menstruating, those cells are shed every month through your period. Once menstruation stops (through menopause, for example), estrogen alone can make the the cells build up, thickening your uterus and leading to abnormal growths, which can then lead to uterine cancers. Progestin helps prevent this by keeping the uterine lining thin. 
  • Venlafaxine: Venlafaxine is an SSRI that is prescribed off-label to treat menopausal symptoms. As a treatment in menopause it is prescribed in very low doses. Venlafaxine is a non-hormonal treatment.
  • Paroxetine: Paroxetine is an SSRI that is FDA-approved to treat menopausal symptoms. As a treatment in menopause it is prescribed in very low doses. This is a non-hormonal treatment.
  • Topical and oral Minoxidil. The topical is a 5.6% minoxidil and 0.3% finasteride compound applied to the scalp, while oral minoxidil is a daily pill. Minoxidil stimulates hair growth, while finasteride increases the amount of hair that's growing. Both prescriptions improve hair growth and reduce hair shedding.
What are the common side effects of topical minoxidil & finasteride?

Taking minoxidil and finasteride has certain risks. The most common side effect is local scalp irritation. This is potentially caused by the propylene glycol base, which the minoxidil and finasteride are dissolved in. Additionally, shedding of hair is common in the first two to eight weeks of treatment. This is likely due to hair follicles releasing hair that is no longer growing in order to start up new growth. Additionally, the topical minoxidil and finasteride solution may cause facial hypertrichosis or the growth of excessive hair on the face. This normally resolves within 4 months of ceasing treatment. Facial hypertrichosis can be managed in a number of ways, including using a razor, waxing, nair, laser hair removal or threading. Some women may also experience headaches, metallic taste in mouth, metallic taste in mouth, breathlessness, palpitations and tachycardia when taking this medication.

Review important safety information.

Off-label Prescribing

The FDA approval process requires a rigorous clinical testing process to ensure a drug is safe and effective to treat a particular condition or indication. “Off-label” use is when a provider prescribes an FDA approved drug for an unapproved use (conditions that go beyond its approved indications). Such “off-label” prescribing is legal and commonly practiced. Healthcare providers have the discretion to prescribe drugs off-label if deemed appropriate for a patient based on their medical history, symptoms and preferences.

What are compounded products?

The topical minoxidil and finasteride solution, like most other compounded products, is not FDA approved. This means that the FDA has not evaluated the safety or effectiveness of the topical minoxidil and finasteride solution. Instead, licensed pharmacies in the United States “compound” the topical minoxidil and finasteride solution based on your unique needs as prescribed by your doctor.

Who is a good candidate for hormone therapy?

Hormone therapy has been shown to be the most effective treatment for many of the most troublesome symptoms of menopause, but deciding whether to try hormone therapy is a decision only you can make, based on your symptoms, needs, quality of life, and personal health history.

When prescribing treatment, our medical team takes your unique health profile into account and will prescribe hormonal treatment if indicated, or non-hormonal treatment if you are not a candidate for MHT.

If you’re considering the estradiol patch or the estradiol pill, be sure to talk to your Evernow medical provider about possible contraindications, especially if you have a history of an estrogen-sensitive cancers, liver disease, undiagnosed vaginal bleeding, coronary heart disease, a history of blood clots, or stroke.

The most common reasons people don't qualify for menopausal hormone therapy is because of health condition that contraindicates the treatment (like high blood pressure or breast cancer) or because the symptoms reported do not include hot flashes, night sweats, or sleep disturbances. If you have specific questions about why you may not have qualified after completing our health profile, please email support@evernow.com for help.

What are the ingredients in Evernow's hormone therapy treatments?

The only ingredient in our Estradiol patch and pill is bioidentical estrogen.

Bioidentical hormones are hormones that are structurally the same as hormones produced naturally in the body. As you age, your body produces less estradiol and other estrogens. Taking estradiol helps address the symptoms of these changes in hormones.

Are there non-hormonal treatment options for my symptoms?

Hormone replacement therapy is the most effective treatment for menopausal symptoms including hot flashes, night sweats, and sleep disruptions.

For women who are unable to take hormone replacement, we offer paroxetine and venlafaxine, which are both considered effective for the treatment of menopause symptoms.

What are bioidentical hormones?

Bioidentical hormones are hormones that are structurally the same as hormones produced naturally in the body. As you age, your body produces less estradiol and other estrogens. Taking estradiol helps address the symptoms of these changes in hormones.

What are common side effects of hormone therapy?

Breast tenderness, bloating, vaginal spotting, or headache are common and temporary side effects. In the first few weeks, as your body adjusts to your treatment, it’s normal to experience some side effects like breast tenderness, headaches, bloating, spotting, or mood changes.

Can I use hormone therapy if I have a history of breast cancer?

If you have or have had breast cancer, you are not a candidate for menopausal hormone therapy. However, we also offer effective, non-hormonal options to treat menopause symptoms. These can be used by people who have recovered from breast cancer.

In the health profile you create during sign-up, we ask about personal history of breast cancer and leave a space for a message to your provider where you can mention family history. This will help your provider understand which treatment is most appropriate for you.

Can I use hormone therapy if I have had a hysterectomy?

Many people who have had a hysterectomy benefit from menopausal hormone therapy. If you've had your uterus removed, only estrogen is needed and not progesterone. The Women’s Health Initiative (WHI) study showed that estrogen, taken alone, had a lower risk for breast cancer than postmenopausal women who took estrogen plus progesterone.

Whether you are taking menopausal hormone therapy or not, maintaining an accurate record of surgeries and procedures will help you and your doctor ensure you get the most appropriate treatment.

How much does Evernow cost?

An Evernow membership price varies by plan, but all plans include unlimited messages with a board certified menopause specialist, access to our app with our symptom tracker, and premium member's only content. Our current membership options include:

  • Month-to-month plan: $49 a month
  • 3-month plan: $129 for 3 months of Evernow ($43 a month)
  • 12-month plan: $348 for 12 months of Evernow ($29 a month)

If prescribed, medication is an additional cost. If you fill your Rx at your personal pharmacy, you can use insurance to pay for it (most plans have coverage) and/or your pharmacist may be able to use a discount code If you fill your Rx at the Evernow delivery pharmacy, you'll pay below market negotiated cash prices.

Can I use insurance to pay for Evernow?

Yes. You can use your insurance for your medication (most plans offer coverage). Simply select "Your Local or Online Pharmacy" when approving your Care Plan or update your fulfillment method in your account settings. You can use your insurance to pay for your prescription when you check out at the pharmacy. Insurance does not cover the membership fee; however, you can use your FSA or HSA card for membership.

Can I use my FSA or HSA to pay for Evernow?

Yes, we accept FSA and HSA cards. Most insurance plans also cover hormone therapies.

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Top Questions

Why should I try Evernow?

At Evernow, we're doing telemedicine a little differently. Our membership provides access to medical providers through a practice called "asynchronous telemedicine." This means you don't need a specific appointment date or time—when you have a question, you message your provider through your account and they reply to you within a business day. We're excited about our approach because it gets you on the path to feeling better ASAP.

Over time, 80% of our members have complete relief from symptoms like hot flashes, night sweats, and vaginal dryness. And while no medical provider can promise that every single symptom will go away completely, we do promise to walk hand-in-hand with you while we work to bring you the relief you’re looking for.

Does Evernow require bloodwork?

Bloodwork is unnecessary for treatment of menopausal symptoms. Guidelines from The American College of Obstetricians and Gynecologists (ACOG) and The North American Menopause Society (NAMS) recommend treating patient symptoms rather than hormone levels in the blood. For more information, please read our article about why we are able to treat menopausal symptoms without blood testing.

Who is a good candidate for hormone therapy?

Hormone therapy has been shown to be the most effective treatment for many of the most troublesome symptoms of menopause, but deciding whether to try hormone therapy is a decision only you can make, based on your symptoms, needs, quality of life, and personal health history.

When prescribing treatment, our medical team takes your unique health profile into account and will prescribe hormonal treatment if indicated, or non-hormonal treatment if you are not a candidate for MHT.

If you’re considering the estradiol patch or the estradiol pill, be sure to talk to your Evernow medical provider about possible contraindications, especially if you have a history of an estrogen-sensitive cancers, liver disease, undiagnosed vaginal bleeding, coronary heart disease, a history of blood clots, or stroke.

The most common reasons people don't qualify for menopausal hormone therapy is because of health condition that contraindicates the treatment (like high blood pressure or breast cancer) or because the symptoms reported do not include hot flashes, night sweats, or sleep disturbances. If you have specific questions about why you may not have qualified after completing our health profile, please email support@evernow.com for help.

What are the ingredients in Evernow's hormone therapy treatments?

The only ingredient in our Estradiol patch and pill is bioidentical estrogen.

Bioidentical hormones are hormones that are structurally the same as hormones produced naturally in the body. As you age, your body produces less estradiol and other estrogens. Taking estradiol helps address the symptoms of these changes in hormones.

How much does Evernow cost?

An Evernow membership price varies by plan, but all plans include unlimited messages with a board certified menopause specialist, access to our app with our symptom tracker, and premium member's only content. Our current membership options include:

  • Month-to-month plan: $49 a month
  • 3-month plan: $129 for 3 months of Evernow ($43 a month)
  • 12-month plan: $348 for 12 months of Evernow ($29 a month)

If prescribed, medication is an additional cost. If you fill your Rx at your personal pharmacy, you can use insurance to pay for it (most plans have coverage) and/or your pharmacist may be able to use a discount code If you fill your Rx at the Evernow delivery pharmacy, you'll pay below market negotiated cash prices.

Getting started

Why should I try Evernow?

At Evernow, we're doing telemedicine a little differently. Our membership provides access to medical providers through a practice called "asynchronous telemedicine." This means you don't need a specific appointment date or time—when you have a question, you message your provider through your account and they reply to you within a business day. We're excited about our approach because it gets you on the path to feeling better ASAP.

Over time, 80% of our members have complete relief from symptoms like hot flashes, night sweats, and vaginal dryness. And while no medical provider can promise that every single symptom will go away completely, we do promise to walk hand-in-hand with you while we work to bring you the relief you’re looking for.

How do Evernow providers determine my treatment plan?
  • First, you’ll complete our online health profile. We’ll ask about your age, blood pressure, symptoms, and other medical information relevant to your treatment. 
  • Because every woman has a unique medical history, and because some of these histories require greater care and scrutiny (such as if you’ve had a hysterectomy or have an underlying medical condition), this virtual consultation collects the details our medical team needs to determine whether you are a good candidate for hormonal treatments.
  • Our health profile incorporates guidelines of professional medical societies such as ACOG (American College of Obstetricians and Gynecologists) and NAMS (North American Menopause Society).
  • Once you've signed up, we'll connect you with an Evernow clinician who will review your health profile answers in-depth and create a detailed treatment plan for you. She'll be by your side to help find the perfect solution for you—prescription treatment, delivery to your door, and unlimited messaging. You don't have to wait for your treatment plan to ask questions, either. You can message your provider immediately after you're signed up.
Does Evernow require bloodwork?

Bloodwork is unnecessary for treatment of menopausal symptoms. Guidelines from The American College of Obstetricians and Gynecologists (ACOG) and The North American Menopause Society (NAMS) recommend treating patient symptoms rather than hormone levels in the blood. For more information, please read our article about why we are able to treat menopausal symptoms without blood testing.

Where is Evernow available?

We are currently available in Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New York, Nevada, North Carolina, North Dakota, South Dakota Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Tennessee, Virginia, Washington, Wisconsin, and Wyoming.

What should I expect in my first few months of Evernow?

Week 1: Once you have your prescription, you can begin treatment right away. Depending on your medical history and needs, you’ll be receiving estrogen in the form of an estradiol patch, pill, or cream, along with progesterone if needed. Instructions are included on your treatment plan.

Week 2: Breast tenderness, bloating, or sleep changes? These are normal, temporary side effects. Your Evernow provider will check in again this week, and if at any point you experience something you want to ask about, please ask.

Week 3: The third week of treatment is when most women begin to experience noticeable relief from hot flashes, night sweats, and vaginal dryness. We expect that as these hormonal symptoms diminish, you’ll begin to experience better sleep and increased energy. If you’re not yet experiencing relief at 3-4 weeks, let your provider know so your treatment can be adjusted.

Looking ahead: By the end of the 3rd month of your treatment, we expect that you will have fully adjusted to the hormones and experienced continuous relief from your symptoms. Our hormone-based treatment plans are clinically proven to eliminate hot flashes, night sweats, and vaginal dryness in 80% of women, along with other symptoms.

Medications & Treatments

Will estradiol or progesterone make me gain weight?

Several studies over the past several years have shown that hormone replacement therapy can slow the creep of menopausal weight gain and abdominal fat redistribution in many women.

Where to apply the estradiol patch?

The patch is very easy to use. The packaging insert has a guide for you to reference, but here are the basics: You just place it on your skin like a bandaid. The most common sites of application are the lower abdomen and upper buttocks. To avoid irritation, it helps to change the site of application each time (i.e., rotate between the sides of the abdomen or buttocks). The patch should be changed every 3 and 4 days (e.g., Monday & Thursday or Tuesday & Friday). If you forget to change your patch, it’s no big deal, but the medication will decrease over time, so you may get some resurgence of symptoms, like hot flashes or night sweats. This will also happen if the patch falls off on accident. The adhesive is durable and it is rare that a patch dislodges by accident. If you are a regular swimmer, you may consider covering the patch with a waterproof bandaid when you swim, but you won’t need to for regular bathing/showering. Pro tip: Set a reminder in your calendar or a recurring alarm on your phone to help you remember to swap your patch!

How to keep the estradiol patch on?

Make sure that the site of application is free of any lotion, oil, and powder.

Position your patch in an area that won’t be irritated by clothing or crease from movement (ideal areas for patch placement are lower abdomen and on the upper buttocks below the panty line)

Press and spread the patch out firmly with the palm of your hand

How long does it take the estradiol patch to start working?

By 2 weeks, most women start to really feel the benefits of the treatment, including a reduction in hot flashes and night sweats, better sleep, and decreased vaginal dryness. This is normal, and will even out over time. Full relief is expected between 1-3 months. We will check in with you a little more often while you are getting started and then monthly, but please reach out to our providers any time if you have questions.

How long does it take for vaginal estradiol cream to work?

Initial improvement in symptoms may be seen as early as 2-4 weeks after initiating treatment. However, full relief is typically experienced after 2-3 months.

Can I insert the vaginal estradiol cream without an applicator?

No, do not insert the cream without the applicator. This may cause you to use too little or too much of the medication, both of which can have negative consequences.

How long after placing the estradiol vaginal cream can you engage in vaginal intercourse?

Although there aren’t scientifically-backed guidelines around this specific question, we recommend that you avoid penetrative vaginal activities for 8 hours after the placement of the cream to ensure that it does not get pushed out of the vagina. We recommend that you engage in sexual activity before placing the vaginal estradiol cream in the vagina.

Are estradiol patches safe?

The estradiol patch is typically well tolerated, but there are some common side effects to be aware of. Nausea, headache, abdominal bloating, breast pain, vaginal spotting, and irritation at the placement site can occur. These side effects are typically time-limited and go away in the first few months of use.

Use of estrogen may be associated with an increased risk of heart attack, stroke, blood clots in the legs or lungs, breast cancer, uterine cancer, or dementia. Evernow prescribes the generic equivalent of Vivelle-Dot. Be sure to check out the safety information for Vivelle-Dot, and talk to your Evernow medical provider about possible contraindications, especially if you have a history of estrogen-sensitive cancer, undiagnosed vaginal bleeding, coronary heart disease, blood clots, or stroke.

What are vaginal estradiol tablets prescribed for?

Vaginal estradiol tablets help with menopause symptoms specifically affecting the genitourinary system (eg, vulva, vagina, urethra and bladder): vulvar irritation, vaginal dryness, painful sex, frequent urination, frequent UTIs.

Do vaginal estradiol tablets carry the same risks as systemic estrogen therapy?

Low-dose vaginal estradiol tablets carry less of a risk than systemic estrogen therapy because the level of estrogen in the vaginal tablets are significantly lower. As a result, levels of estrogen in the blood with the use of low-dose vaginal estrogen remains within the postmenopausal range.

How long does it take for vaginal estradiol tablets to work?

Initial improvement in symptoms may be seen as early as 2-4 weeks after initiating treatment. However, full relief is typically experienced after 2-3 months.

How long after placing the estradiol vaginal tablet can you engage in vaginal intercourse?

Although there aren’t scientifically-backed guidelines around this specific question, we recommend that you avoid penetrative vaginal activities for 8 hours after placement of the tablet to ensure that it does not get pushed out of the vagina. We recommend that you engage in sexual activity before placing the vaginal estradiol tablet in the vagina.

How soon can I expect to see results when using minoxidil?

Growing hair takes a long time! Most women note seeing results within six months. In order to maintain the results you achieve, you will have to continue to take this medication indefinitely.

Am I an ideal candidate for Minoxidil?

You're an ideal candidate if you want to slow the rate of hair loss and prefer to put a topical treatment on their scalp rather than take a pill.

What benefits can I expect with Minoxidil?

You can expect increase in hair thickness as well as volume. Additionally the treatment will slow your rate of hair loss.

When should I expect to see results with oral minoxidil?

Minoxidil takes a few months to produce noticeable results to your crown and hairline. Results are usually seen within 6 months but can be seen as early as 3 months. Shedding of hair is common in the first two to eight weeks of treatment. This is likely due to hair follicles releasing hair that is no longer growing in order to start up new growth. In order to maintain the results you achieve, you will have to continue to take this medication indefinitely. Your provider will follow your treatment closely to help ensure optimal outcomes and minimize side effects.

What is the typical dosage of oral minoxidil for female hair loss?

Oral minoxidil is typically prescribed in lower doses when treating hair loss in women – ideally obtaining positive outcomes with fewer side effects. Oral minoxidil is made in 2.5mg tablets. Patients will start with taking a half of a tablet, 1.25mg per day. If after six months, you do not see results at this dose, your provider may recommend increasing to a full table. If you experience side effects, your provider may recommend reducing your dose or stopping the use of oral minoxidil.

What are the common side effects of oral minoxidil?

Taking oral minoxidil can result in certain risks. One of these risks involves hypertrichosis, which is the term for unusual hair growth on other parts of the body. This happens because oral minoxidil affects the whole body systemically, and can thus lead to hair growth in places other than the scalp. However, it's important to note that this condition usually resolves itself within four months of stopping the treatment.

Another potential side effect is lower extremity edema, a condition characterized by the swelling of legs, ankles, and feet. Some women may also experience headaches, palpitations, and nausea when taking this medication.

While they are less likely to occur, there are other risks associated with oral minoxidil usage. These include pleural effusion, which is the buildup of fluid between the layers of tissue lining the lungs and chest cavity. Also, some women may experience hypotension, a condition marked by lower-than-normal blood pressure. This can lead to feeling light-headed.

Read through important safety information.

What is oral minoxidil?

Oral minoxidil contains the same active ingredient as topical minoxidil, the main ingredient in many over the counter hair growth products. Oral minoxidil was first prescribed in the 1970s to treat hypertension, or high blood pressure, by allowing more blood flow through the body. A frequent side effect of this initial use was hypertrichosis, or excessive hair growth. Unlike topical minoxidil, which is FDA-approved and available without a prescription, oral minoxidil is considered “off-label” and requires a prescription. Learn more about off-label treatment.

What is minoxidil?

Topical minoxidil stimulates the flow of blood rich with nutrients and oxygen to hair follicles. This increased circulation prolongs the growth of current hair, shortens the resting time of follicles, and increases the size of follicles, helping them grow terminal rather than miniaturized hairs. 

Who is oral minoxidil for?

Oral minoxidil can be effective at addressing symptoms of hair loss including women in perimenopause and menopause. Some patients find it easier to take a single oral pill a day instead of applying topical treatments. Simple routines can help improve adherence and outcomes, leading to better results. Specific treatment recommendations are at the discretion of healthcare providers based on an individual’s medical history, contraindications and potential side effects. 

What is finasteride?

Finasteride blocks the chemical conversion of testosterone to dihydrotestosterone (DHT) - a hormone that slows down the growth of hair within the hair follicles. By inhibiting DHT, finasteride helps to maintain the growth phase of the hair cycle, preventing further hair loss.

What is the difference between topical and oral minoxidil?

While topical minoxidil is FDA-approved to treat hair loss and is available without a prescription, oral minoxidil is considered “off-label” and requires a prescription. “Off-label” means a product is not FDA-approved for that particular use, but it can still be prescribed to patients at their provider’s discretion. Learn more about off-label treatment. 

What is the minoxidil and finasteride topical solution?

This solution takes two ingredients and combines them into a single formula. The result is an easy topical treatment for hair loss that provides a compelling alternative to pills or multiple, messy drops. Simple routines can help improve adherence and outcomes, leading to better results. Specific treatment recommendations are at the discretion of healthcare providers based on an individual’s medical history, contraindications and potential side effects.

When should I expect to see results with topical minoxidil and finasteride for female hair loss?

Results may vary, but are generally seen within 6 months. In order to maintain the results you achieve, you will have to continue to take this medication indefinitely. Your provider will follow your treatment closely to help ensure optimal outcomes and minimize side effects.

How should I use the topical minoxidil and finasteride formulation for female hair loss?

This formulation contains 5.6% minoxidil and 0.3% finasteride in a propylene glycol base. Apply 5 drops once a day to full scalp. To do so, partition your hair in 5 sections from ear to ear and place one drop where you part each section. Massage the topical into the scalp with your fingers. Wash hands with soap and water after application. Let dry for one hour before lying down.

What medications does Evernow prescribe?

Our doctors and nurse practitioners prescribe estradiol, progesterone, venlafaxine, and paroxetine. We offer several forms of estradiol: Estradiol patch, Estradiol pill and Estradiol cream.

  • Estradiol (Estrogen): Evernow prescribes bio-identical estradiol, is effective at addressing menopause symptoms including hot flashes, night sweats, and vaginal dryness.
  • Progestin (Progesterone): Progesterone is prescribed to women with a uterus who are taking estradiol during menopause. This is because estrogen promotes the continuous growth of cells in the uterus. When you’re menstruating, those cells are shed every month through your period. Once menstruation stops (through menopause, for example), estrogen alone can make the the cells build up, thickening your uterus and leading to abnormal growths, which can then lead to uterine cancers. Progestin helps prevent this by keeping the uterine lining thin. 
  • Venlafaxine: Venlafaxine is an SSRI that is prescribed off-label to treat menopausal symptoms. As a treatment in menopause it is prescribed in very low doses. Venlafaxine is a non-hormonal treatment.
  • Paroxetine: Paroxetine is an SSRI that is FDA-approved to treat menopausal symptoms. As a treatment in menopause it is prescribed in very low doses. This is a non-hormonal treatment.
  • Topical and oral Minoxidil. The topical is a 5.6% minoxidil and 0.3% finasteride compound applied to the scalp, while oral minoxidil is a daily pill. Minoxidil stimulates hair growth, while finasteride increases the amount of hair that's growing. Both prescriptions improve hair growth and reduce hair shedding.
What are the common side effects of topical minoxidil & finasteride?

Taking minoxidil and finasteride has certain risks. The most common side effect is local scalp irritation. This is potentially caused by the propylene glycol base, which the minoxidil and finasteride are dissolved in. Additionally, shedding of hair is common in the first two to eight weeks of treatment. This is likely due to hair follicles releasing hair that is no longer growing in order to start up new growth. Additionally, the topical minoxidil and finasteride solution may cause facial hypertrichosis or the growth of excessive hair on the face. This normally resolves within 4 months of ceasing treatment. Facial hypertrichosis can be managed in a number of ways, including using a razor, waxing, nair, laser hair removal or threading. Some women may also experience headaches, metallic taste in mouth, metallic taste in mouth, breathlessness, palpitations and tachycardia when taking this medication.

Review important safety information.

Off-label Prescribing

The FDA approval process requires a rigorous clinical testing process to ensure a drug is safe and effective to treat a particular condition or indication. “Off-label” use is when a provider prescribes an FDA approved drug for an unapproved use (conditions that go beyond its approved indications). Such “off-label” prescribing is legal and commonly practiced. Healthcare providers have the discretion to prescribe drugs off-label if deemed appropriate for a patient based on their medical history, symptoms and preferences.

What are compounded products?

The topical minoxidil and finasteride solution, like most other compounded products, is not FDA approved. This means that the FDA has not evaluated the safety or effectiveness of the topical minoxidil and finasteride solution. Instead, licensed pharmacies in the United States “compound” the topical minoxidil and finasteride solution based on your unique needs as prescribed by your doctor.

Who is a good candidate for hormone therapy?

Hormone therapy has been shown to be the most effective treatment for many of the most troublesome symptoms of menopause, but deciding whether to try hormone therapy is a decision only you can make, based on your symptoms, needs, quality of life, and personal health history.

When prescribing treatment, our medical team takes your unique health profile into account and will prescribe hormonal treatment if indicated, or non-hormonal treatment if you are not a candidate for MHT.

If you’re considering the estradiol patch or the estradiol pill, be sure to talk to your Evernow medical provider about possible contraindications, especially if you have a history of an estrogen-sensitive cancers, liver disease, undiagnosed vaginal bleeding, coronary heart disease, a history of blood clots, or stroke.

The most common reasons people don't qualify for menopausal hormone therapy is because of health condition that contraindicates the treatment (like high blood pressure or breast cancer) or because the symptoms reported do not include hot flashes, night sweats, or sleep disturbances. If you have specific questions about why you may not have qualified after completing our health profile, please email support@evernow.com for help.

What are the ingredients in Evernow's hormone therapy treatments?

The only ingredient in our Estradiol patch and pill is bioidentical estrogen.

Bioidentical hormones are hormones that are structurally the same as hormones produced naturally in the body. As you age, your body produces less estradiol and other estrogens. Taking estradiol helps address the symptoms of these changes in hormones.

Are there non-hormonal treatment options for my symptoms?

Hormone replacement therapy is the most effective treatment for menopausal symptoms including hot flashes, night sweats, and sleep disruptions.

For women who are unable to take hormone replacement, we offer paroxetine and venlafaxine, which are both considered effective for the treatment of menopause symptoms.

What are bioidentical hormones?

Bioidentical hormones are hormones that are structurally the same as hormones produced naturally in the body. As you age, your body produces less estradiol and other estrogens. Taking estradiol helps address the symptoms of these changes in hormones.

What are common side effects of hormone therapy?

Breast tenderness, bloating, vaginal spotting, or headache are common and temporary side effects. In the first few weeks, as your body adjusts to your treatment, it’s normal to experience some side effects like breast tenderness, headaches, bloating, spotting, or mood changes.

Can I use hormone therapy if I have a history of breast cancer?

If you have or have had breast cancer, you are not a candidate for menopausal hormone therapy. However, we also offer effective, non-hormonal options to treat menopause symptoms. These can be used by people who have recovered from breast cancer.

In the health profile you create during sign-up, we ask about personal history of breast cancer and leave a space for a message to your provider where you can mention family history. This will help your provider understand which treatment is most appropriate for you.

Can I use hormone therapy if I have had a hysterectomy?

Many people who have had a hysterectomy benefit from menopausal hormone therapy. If you've had your uterus removed, only estrogen is needed and not progesterone. The Women’s Health Initiative (WHI) study showed that estrogen, taken alone, had a lower risk for breast cancer than postmenopausal women who took estrogen plus progesterone.

Whether you are taking menopausal hormone therapy or not, maintaining an accurate record of surgeries and procedures will help you and your doctor ensure you get the most appropriate treatment.

Pricing & Insurance

How much does Evernow cost?

An Evernow membership price varies by plan, but all plans include unlimited messages with a board certified menopause specialist, access to our app with our symptom tracker, and premium member's only content. Our current membership options include:

  • Month-to-month plan: $49 a month
  • 3-month plan: $129 for 3 months of Evernow ($43 a month)
  • 12-month plan: $348 for 12 months of Evernow ($29 a month)

If prescribed, medication is an additional cost. If you fill your Rx at your personal pharmacy, you can use insurance to pay for it (most plans have coverage) and/or your pharmacist may be able to use a discount code If you fill your Rx at the Evernow delivery pharmacy, you'll pay below market negotiated cash prices.

Can I use insurance to pay for Evernow?

Yes. You can use your insurance for your medication (most plans offer coverage). Simply select "Your Local or Online Pharmacy" when approving your Care Plan or update your fulfillment method in your account settings. You can use your insurance to pay for your prescription when you check out at the pharmacy. Insurance does not cover the membership fee; however, you can use your FSA or HSA card for membership.

Can I use my FSA or HSA to pay for Evernow?

Yes, we accept FSA and HSA cards. Most insurance plans also cover hormone therapies.

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