You are not falling apart. You are earlier than you think.
The anxiety, the 3am waking, the brain fog your doctor called stress. There is a hormonal explanation — and a clinically proven treatment. Not a supplement. Not a wellness retreat. A real prescription, from a real specialist, based on what actually works.
S
M
J
A
2,400+ women treated this year
Perimenopause care
Sleep support
Mood and clarity
Free consultation
Diagnosis first, pay after
Free shipping
Pause or cancel anytime
Made for your body
Free consultation
Diagnosis first, pay after
Free shipping
Pause or cancel anytime
Made for your body
What we treat
One body. One hormonal picture. Six ways we help.
Perimenopause does not affect just one part of you. It shows up in your sleep, your mood, your energy, your weight, and your sense of self. Our clinicians treat the whole picture, not just the most obvious symptom. Every treatment plan starts with a free consultation. No payment until after your clinician has assessed your case.
Perimenopause and HRT
Bioidentical hormone therapy personalised to your symptoms, cycle, and health history.
Learn more →
Sleep support
Progesterone protocols and clinician guidance for hormonal sleep disruption.
Learn more →
Mood and mental clarity
Addressing the hormonal roots of anxiety, brain fog, and mood swings.
Learn more →
Weight and metabolism
Hormonal support for metabolic shifts, including GLP-1 where clinically appropriate.
Learn more →
Sexual wellness
Low libido and vaginal changes are hormonal, treatable, and more common than anyone says.
Learn more →
Hair, skin and aging
Estrogen decline accelerates collagen loss and hair thinning. Both respond well to treatment.
Learn more →
Why sela
The menopause market is full of supplements that do not work. We are not that.
There is no supplement proven to treat hot flashes. No wellness retreat that reverses hormonal decline. Doctors know this — and the women spending money on those things deserve better. Sela prescribes what the clinical evidence actually supports: bioidentical hormone therapy, compounded to your exact dosage, reviewed by a specialist who has chosen to focus on this.
94%
report improvement within 60 days
0
supplements on our formulary
How it works
Diagnosis first. Treatment only if right for you.
01 - Free
Complete the quiz
5 minutes. No account, no payment. Just your symptoms.
02 - Free
Clinician reviews your case
A specialist gives you a full assessment within 24 hours. No charge.
03 - Your choice
Choose your plan
If treatment makes sense, choose a plan from $49/mo. If not, we will tell you that too.
04 - Ongoing
Prescription delivered
Compounded to your dosage, shipped to your door. Adjustments included.
Patient stories
What our patients say
★★★★★
I was 37, seeing a therapist for anxiety, and taking SSRIs that were not really working. A Sela clinician looked at my hormone panel and said this is estrogen, not serotonin. Three weeks later I felt like myself for the first time in two years.
Rachel M. — age 37, Chicago
★★★★★
My GP told me I was too young for perimenopause at 40 and suggested I try meditating. Sela ran a full panel, identified the issue in 24 hours, and had a treatment plan to me before my next GP appointment would have even been scheduled.
Diane K. — age 40, Austin
★★★★★
I had been waking at 3am every single night for almost two years. I thought it was stress. Progesterone fixed it in eleven days. Eleven days. I wish someone had told me about this years ago.
Priya S. — age 43, New York
What actually works
The menopause market is a $600 billion industry. Most of it is noise.
Hundreds of products launched in the last four years claiming to treat menopause symptoms. Supplements. Cooling pyjamas. $4,800 retreats. Red light therapy vibrators. Doctors are exhausted by it. So are we. Here is what the clinical evidence actually says.
Bioidentical hormone therapy
The gold standard. Supported by NAMS, the Endocrine Society, and decades of evidence. Addresses the root cause — not just the symptoms.
Clinician-prescribed protocols
Every treatment starts with a licensed specialist reviewing your full history. No algorithm. No one-size-fits-all. A real clinical assessment, at no charge.
Compounded to your dosage
Your prescription is made specifically for you by a licensed 503A pharmacy. Not a generic dose. Not a supplement. The exact formulation your clinician determines you need.
Supplements
No supplement has been proven to treat hot flashes or hormonal symptoms. The Menopause Society has not endorsed a single one. We do not sell them.
Wellness retreats and rebranded products
$4,800 hormone-balancing retreats. Hair care with "menopause" on the label. Products that disappear as fast as they appear. Your money deserves better.
Influencer advice and TikTok protocols
Videos with #menopause have over a billion views on TikTok. Most of it is misinformation. Some of the supplements being promoted can cause liver damage. We cite our sources.
Not ready yet? Stay in the loop.
We will let you know when we launch in your state and share helpful guides in the meantime.
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Find out first. Pay only if it is right for you.
Free quiz. Free clinician review. Choose a plan only after you have the full picture.
No credit card required. Results in under 24 hours.
How it works
From question to care in under a week.
No waiting rooms, no dismissive appointments. A clinical process designed specifically for women navigating perimenopause at any age.
01
Take the free quiz Free
5 minutes. No account, no payment. Your answers go directly to your assigned clinician.
5 minutes - no commitment
02
Clinician reviews within 24 hours Free
A board-certified clinician reviews your intake and gives you a full personalised assessment at no charge.
Within 24 hours - licensed in your state
03
Choose your level of care Your choice
After your assessment, you decide. Plans start at $49/month. If it is not the right fit, we will tell you honestly.
From $49/mo - cancel anytime
04
Prescription delivered to your door
Compounded to your exact dosage and shipped within 3-5 days. Ongoing messaging and dosage adjustments included.
All 50 states - free shipping
Ready to find out?
The quiz is free. The clinician review is free. You only pay if treatment is right for you.
Symptoms
Does any of this sound familiar?
These are not signs of aging, stress, or anxiety. They are hormonal — and they can start a full decade before most women expect them to.
Sleep
Waking at 3am for no reason
You fall asleep fine but wake between 2 and 4am with your mind racing and cannot get back to sleep. This is not insomnia. It is a progesterone signal and it has a direct treatment.
Mood
Snapping at people you love and not knowing why
Irritability, sudden anxiety, or a low-grade feeling of dread that has no obvious cause. Estrogen directly regulates the brain's calming systems. When it fluctuates, so does everything else.
Cognition
Forgetting words mid-sentence
Walking into a room and forgetting why. Losing the thread of a conversation. Feeling less sharp than you used to be. Estrogen is neuroprotective — when it drops, cognitive clarity drops with it.
Cycle
Your period is doing something new and strange
Shorter cycles, heavier flows, spotting between periods, or skipping one entirely. These are almost always the first hormonal signal — and almost always dismissed as stress or a fluke.
Body
Joint pain that appeared out of nowhere
Aching hands in the morning. Stiff knees that were not stiff before. Estrogen has anti-inflammatory properties and as it declines, the body feels it in ways that have nothing to do with aging.
Metabolism
Gaining weight without eating differently
The same diet, the same routine — but your body is changing anyway. Estrogen governs where your body stores fat. When it shifts, fat moves to the abdomen. This is metabolic, not a willpower problem.
Sexual health
Losing interest in sex and feeling guilty about it
Low libido in your late 30s or early 40s is almost entirely hormonal. So is vaginal dryness or discomfort. Both are common, both are treatable, and neither is something you have to just live with.
Energy
Exhausted no matter how much you sleep
Eight hours and still running on empty. Hormonal fatigue is driven by disrupted cortisol patterns — it does not respond to more sleep. It responds to addressing the hormonal shift underneath it.
If you are experiencing three or more of these consistently, a conversation with a clinician who specializes in hormonal health is worth it — regardless of your age or what your last lab result said.
Pricing
How much support do you want?
Your consultation and diagnosis are always free. Choose a level of ongoing care only after your clinician has assessed your case and you have decided treatment is right for you.
Medication billed separately - typically $35 to $90/mo
Essential
$49
per month - cancel anytime
Prescription access and clinician oversight without the ongoing check-ins. For women who know what they need.
Free initial clinician consultation
Personalised treatment plan
3 clinician messages per month
Prescription management
Free shipping every order
Most popular
Standard
$79
per month - cancel anytime
Ongoing clinician access, dosage adjustments, and proactive care. For women who want a real clinical relationship.
Free initial clinician consultation
Personalised treatment plan
Unlimited clinician messaging
Monthly check-in appointment
Prescription management
Free shipping every order
Symptom tracking tools
Comprehensive
$129
per month - cancel anytime
The full picture — labs, priority access, and a dedicated clinician who knows your case inside out.
Free initial clinician consultation
Personalised treatment plan
Unlimited clinician messaging
Bi-monthly check-in appointments
At-home lab work coordination
Priority response under 4 hours
Dedicated care manager
Symptom tracking and health reports
Consultation
Always free
No charge until you choose a plan
Commitment
Pause or cancel
No contracts. Stop anytime.
Shipping
Always free
Free shipping on every order
Formulation
Made for you
Every prescription compounded to your exact dosage
Our clinicians
Specialists, not generalists.
Every clinician on Sela has specific training in women's hormonal health. They chose this specialty. That matters.
Dr. Diana Marsh, MD
OB-GYN - NAMS Certified
15 years in women's hormonal medicine. Fellowship-trained in menopause management.
Dr. Kezia Patel, DO
Integrative Medicine - NAMS
NAMS certified. Specializes in bioidentical hormone therapy and integrative perimenopause care.
Dr. Laura Torres, NP
Women's Health - Endocrinology
Dual specialization in women's health and endocrinology. Fluent in Spanish.
Dr. Amara Bell, MD
Internal Medicine - Preventive
Preventive care specialist focused on long-term hormonal health and cardiovascular risk.
Dr. Sarah Wu, MD
Psychiatry - Hormonal Mood
Board-certified psychiatrist specializing in mood disorders related to hormonal transitions.
Dr. Jade Rivera, CNM
Nurse Midwife - Holistic Care
12 years supporting women through hormonal transitions with a whole-person approach.
Our clinical standards
NAMS certification required
All prescribing clinicians hold or are working toward North American Menopause Society certification.
State licensure verified
Every clinician is licensed in the state where they practice.
Evidence-based protocols only
Treatment protocols reviewed quarterly against current NAMS and Endocrine Society guidelines.
24-hour response commitment
Every intake reviewed within 24 hours. Messages responded to within one business day.
The standard of care for perimenopause in most primary care settings is about 7 minutes and a referral to a therapist. We built Sela because that is not care, it is dismissal.
Sela medical advisory board
The Sela Journal
What your doctor is not telling you.
Evidence-based writing on perimenopause, hormonal health, and feeling like yourself again.
Perimenopause
Why you feel like a different person after 35 — and what nobody is telling you about why.
The symptoms most women attribute to stress and why hormones are almost always part of the answer.
8 min - Dr. Diana Marsh
HRT
The 2002 study that scared women away from HRT — and why the science has completely changed.
The Women's Health Initiative trial upended hormone therapy for 20 years. Here is what the updated evidence says.
12 min - Dr. Kezia Patel
Mental health
Your anxiety got worse in your late 30s. Here is the hormonal reason nobody mentioned.
The connection between estrogen, GABA, and the anxiety that appears out of nowhere in perimenopause.
9 min - Dr. Sarah Wu
Metabolism
It is not what you are eating. How hormonal changes drive the weight gain that diet cannot fix.
Estrogen's role in fat distribution and why the approach that worked at 30 stops working at 40.
7 min - Dr. Laura Torres
Sleep
Waking at 3am: the hormonal explanation nobody gives you.
Why progesterone decline disrupts sleep architecture and what the clinical options are beyond melatonin.
6 min - Dr. Jade Rivera
Supplements
No supplement has been proven to treat hot flashes. Here is what doctors actually say.
The $600 billion menopause market is full of products that do not work. A plain-language guide to what has evidence and what does not.
11 min - Dr. Kezia Patel
sela.
Welcome back
Sign in to access your care plan, message your clinician, and manage your prescriptions.
Every Sela treatment is compounded to your exact dosage by a licensed 503A pharmacy. Free shipping on every order. Pause or cancel anytime.
Estradiol cream
Topical creamHot flashes - Sleep - Mood - Skin
+
What it does
Replenishes estradiol, the primary estrogen that declines in perimenopause. Addresses hot flashes, night sweats, sleep disruption, mood instability, brain fog, and skin changes at the source.
How to use
Applied once daily to thin-skinned areas such as the inner wrist or inner thigh. Rotate sites. Dosage is personalised by your clinician based on your symptoms and response.
Key ingredient
Bioidentical 17-beta estradiol, structurally identical to the estradiol your body produces. Compounded in a transdermal base for optimal absorption without liver metabolism.
Safety
Supported by current NAMS and Endocrine Society guidelines. Transdermal delivery is associated with lower clot risk than oral estrogen. Not appropriate for women with certain hormone-sensitive cancers.
Oral micronised progesterone
Oral capsuleSleep - Mood - Anxiety - Cycle
+
What it does
Progesterone has a direct sedative effect via GABA receptors. Taken at bedtime, it significantly improves sleep architecture, reduces 2 to 4am waking, and has a calming effect on mood and anxiety.
How to use
Taken orally at bedtime, usually 100 to 200mg. Bedtime dosing is strongly preferred due to the sedative effect. Take with a small amount of food for optimal absorption.
Key ingredient
Bioidentical micronised progesterone in a peanut-oil or sunflower-oil base. Micronisation reduces particle size to maximise bioavailability.
Safety
Bioidentical progesterone has a more favourable safety profile than synthetic progestins. May cause drowsiness. Sunflower-oil base available for those with peanut allergy.
Libido and vitality support
Topical creamLibido - Energy - Mood - Vitality
+
What it does
Restores the hormonal foundation behind low libido, flat energy, and diminished vitality. Women produce a key hormone naturally that declines significantly in perimenopause — replenishing it at the right level makes a meaningful difference to how you feel day to day.
How to use
Applied once daily to the inner wrist or inner thigh in a very small amount. Doses are precisely calibrated for women. Avoid skin contact transfer for several hours after application.
Key ingredient
Bioidentical hormone compounded at female-appropriate doses in a transdermal base for consistent, controlled absorption. Your clinician determines the exact concentration based on your labs and symptoms.
Safety
Well-tolerated at female physiologic doses. Regular monitoring by your clinician ensures levels remain in the optimal range. Adjustments are made based on your ongoing symptom response and lab results.
Vaginal estrogen cream
Topical creamVaginal dryness - Discomfort - UTIs
+
What it does
Restores vaginal tissue thickness, moisture, and elasticity. Reduces dryness, irritation, and pain during intercourse. Also reduces recurrent UTIs associated with vaginal atrophy.
How to use
Applied vaginally using an applicator, typically nightly for 2 weeks then twice weekly for maintenance. A small amount applied externally is also effective for vulvar symptoms.
Key ingredient
Low-dose bioidentical estradiol in a cream base designed for vaginal application. Minimal systemic absorption means this is considered safe even for most women who cannot use systemic HRT.
Safety
NAMS guidelines confirm local vaginal estrogen has minimal systemic absorption and is considered safe for most women, including those with a history of breast cancer, subject to oncologist approval.
Topical minoxidil
Topical solution or foamHair thinning - Hair loss - Regrowth
+
What it does
Prolongs the growth phase of the hair cycle and increases follicle size. Clinically proven to reduce hair shedding and promote regrowth in women with androgenetic alopecia.
How to use
Applied directly to the scalp once or twice daily. Allow to dry before styling. Consistent daily use is required as results diminish if stopped.
Key ingredient
Minoxidil 2% to 5% in a solution or foam base. Compounded formulas allow precise dosing for your clinician-determined protocol.
Safety
FDA-approved for female pattern hair loss. Initial shedding in weeks 2 to 6 is normal as resting follicles shed to enter the growth phase. Not recommended during pregnancy.
Oral finasteride
Oral tabletHair thinning - Androgenic hair loss
+
What it does
Blocks the conversion of testosterone to DHT, the androgen responsible for follicle miniaturisation and androgenetic hair loss. Reduces shedding and supports regrowth over time.
How to use
Taken orally once daily, typically 0.5 to 2.5mg for women. Often used alongside topical minoxidil for synergistic effect. Results visible from 3 to 6 months.
Key ingredient
Finasteride, a 5-alpha reductase inhibitor. Compounded to female-appropriate doses which are lower than standard male formulations.
Safety
Not suitable for women who are pregnant or may become pregnant. Post-menopausal women are generally good candidates. Your clinician will assess suitability.
GLP-1 receptor agonists reduce appetite, slow gastric emptying, and improve insulin sensitivity. Particularly effective for hormonal metabolic changes in perimenopause where estrogen decline disrupts normal fat regulation.
How to use
Self-administered as a small subcutaneous injection once weekly. Doses are titrated gradually upward over weeks to minimise nausea. Injection training is included.
Key ingredient
Compounded semaglutide, the same active ingredient as Ozempic and Wegovy. Compounded by a licensed 503A sterile pharmacy with full batch testing.
Safety
Common side effects include nausea, which typically resolves within weeks. Not appropriate for those with a personal or family history of medullary thyroid cancer or MEN2. Requires clinician assessment.
Not sure which treatment is right for you?
That is exactly what the free consultation is for. A clinician reviews your symptoms and recommends the right protocol for your body specifically.
Legal
Privacy policy
Information we collect
We collect information you provide directly to us when you complete the symptom quiz, book a consultation, or create an account. This includes your name, email address, and health information you share with us.
How we use your information
We use your information to provide and improve our services, connect you with licensed clinicians, process your prescriptions, and communicate with you about your care. We do not sell your personal information to third parties.
HIPAA compliance
Sela Health is committed to protecting the privacy of your health information in compliance with the Health Insurance Portability and Accountability Act.
Data security
We implement appropriate technical and organizational measures to protect your personal information. All data is encrypted in transit and at rest.
Your rights
You have the right to access, correct, or delete your personal information at any time. Contact us at privacy@selahealth.org.
Legal
Terms of service
Acceptance of terms
By accessing or using Sela Health, you agree to be bound by these terms of service.
Medical disclaimer
Sela Health provides telehealth services facilitated by licensed healthcare providers. The information and services provided are not a substitute for professional medical advice, diagnosis, or treatment.
Subscription and billing
Subscription fees are billed monthly in advance. You may cancel at any time. Cancellations take effect at the end of your current billing period. Medication costs are billed separately.
Refund policy
If you are unsatisfied with your consultation, contact us at hello@selahealth.org within 7 days. We review all refund requests on a case-by-case basis.
Bioidentical hormone replacement therapy is the most effective evidence-based treatment for perimenopause symptoms. It works by replenishing the estrogen, progesterone, and other hormones that decline during the hormonal transition.
What it treats
Hot flashes, night sweats, sleep disruption, mood instability, brain fog, joint pain, low libido, vaginal dryness, and accelerated bone loss.
What we prescribe
Bioidentical estradiol, progesterone, and other hormonal support compounded to your exact dosage and delivered to your door.
The evidence
Current NAMS and Endocrine Society guidelines support HRT as the most effective treatment for menopausal symptoms in women under 60.
Is it right for me?
A clinician will assess your full health history before recommending HRT. Most women in perimenopause are good candidates. Your free consultation is the starting point.
Hormonal sleep disruption is one of the most common and most undertreated perimenopause symptoms. Declining progesterone disrupts sleep architecture directly. Both have clinical solutions that go well beyond melatonin.
What causes it
Progesterone has a direct sedative effect on the brain. As it declines, sleep becomes lighter and waking more frequent. The 2 to 4am pattern is almost always a progesterone signal.
What we prescribe
Oral micronised progesterone taken at bedtime, estradiol to address night sweats, and targeted supplements where appropriate.
How quickly it works
Most patients notice improvement within 2 to 3 weeks of starting progesterone. Full benefit typically develops over 6 to 8 weeks.
Who it is for
Women who wake between 2 and 4am, struggle to fall back asleep, wake drenched in sweat, or experience unrefreshing sleep despite adequate hours in bed.
Estrogen is a direct regulator of serotonin, dopamine, and GABA. The anxiety, irritability, and cognitive fog that appear in your late 30s are not a mental health crisis. They are a hormonal one.
What causes it
Estrogen modulates serotonin receptors and GABA. Fluctuating estrogen destabilises both, producing anxiety, low mood, and irritability without a clear pattern.
What we prescribe
Estradiol to stabilise hormonal fluctuations, progesterone for its calming GABA-modulating effects, and collaborative care with mental health professionals where appropriate.
Brain fog specifically
Estrogen is neuroprotective. It supports memory consolidation and verbal recall. When it drops, cognitive clarity drops with it. Largely reversible with hormone support.
Why SSRIs alone often fail
SSRIs treat serotonin pathways but do not address estrogen fluctuation. Many women find limited benefit because the root cause is hormonal, not purely serotonergic.
The abdominal weight gain that appears in perimenopause is not a lifestyle failure. Estrogen directly regulates insulin sensitivity, fat distribution, and metabolic rate.
The hormonal mechanism
Estrogen regulates adipokines and insulin sensitivity. When it declines, fat redistributes to the abdomen. Cortisol patterns also shift, further promoting central weight gain.
What we prescribe
Hormone therapy to restore estrogen's metabolic role, GLP-1 medication where clinically appropriate, and thyroid support if indicated by labs.
GLP-1 and perimenopause
GLP-1 medications can be effective alongside hormone therapy for women experiencing significant metabolic changes. Your clinician will assess whether this is appropriate.
What to expect
Hormone therapy alone often produces modest improvements in body composition. Combined with targeted lifestyle guidance, most patients see meaningful changes within 3 to 6 months.
Changes in libido and sexual comfort in your 30s and 40s are almost entirely hormonal. Both are common, both are well understood, and neither requires accepting them as inevitable.
Low libido
A key hormone plays a central role in female desire. As it declines in perimenopause, libido often drops significantly. Low-dose therapy is effective and well-tolerated.
Vaginal changes
Estrogen maintains vaginal tissue health, moisture, and elasticity. As it declines, dryness and discomfort develop. Local estrogen therapy is highly effective with minimal systemic absorption.
What we prescribe
Targeted topical therapy for libido, local vaginal estrogen for tissue health, and systemic hormone therapy where appropriate. Treatment is discreet and shipped directly to you.
How quickly it works
Vaginal estrogen typically improves comfort within 4 to 6 weeks. Libido improvements are usually noticeable within 6 to 12 weeks.
Estrogen plays a direct role in collagen production, skin hydration, and hair follicle health. Both respond well to hormone therapy combined with targeted topical treatments.
Skin and collagen
Estrogen stimulates collagen synthesis and maintains skin thickness. Studies show skin loses approximately 30% of its collagen in the first 5 years after estrogen begins to decline. Hormone therapy significantly slows this process.
Hair thinning
As estrogen declines, the hair growth cycle shortens. Hair becomes finer, sheds more, and grows more slowly. Hormone therapy, topical minoxidil, and finasteride all have supporting evidence.
What we prescribe
Systemic hormone therapy to address the root cause, topical minoxidil and oral finasteride for hair loss, and dermatology referral coordination where needed.
What to expect
Skin improvements from hormone therapy are typically noticeable within 3 months. Hair density improvements are visible within 6 to 12 months.
Step 1 of 60%
About you
How old are you?
This helps us understand where you are in your hormonal journey.
Your symptoms
What is affecting you most right now?
Women in their 30s often experience hormonal shifts before they would ever suspect perimenopause.
Your symptoms
Which symptoms are affecting your quality of life most?
Select the area that feels most urgent.
Mood and anxiety
When do these mood or anxiety changes tend to happen?
This helps distinguish hormonal patterns from other causes.
Sleep
How does your sleep disruption usually show up?
The pattern tells us which hormonal pathways are involved.
Your cycle
How has your cycle changed recently?
Cycle changes are often the earliest hormonal signal and often missed by GPs.
Your symptoms
How long have you been experiencing these symptoms?
Duration helps us understand how far along your hormonal transition may be.
Your healthcare history
Has a doctor discussed hormones or perimenopause with you?
We want to understand what you have already been told so we can give you something better.
Impact
How much are these symptoms affecting your daily life?
Be honest. There is no wrong answer here.
Your results
Your symptoms are consistent with perimenopause.
A hormonal explanation is likely. A clinician review would clarify what is driving your symptoms at no charge.
Book your free consultation
No credit card. No commitment. A clinician reviews your case within 24 hours.
or continue with email
HIPAA compliant - your information is never shared
You are booked.
A Sela clinician will review your intake and send your personalised assessment within 24 hours. Check your email.