On our Windows servers we have Posh-ACME and use DNS validation for our domains via plugin against our Windows DNS servers.
https://poshac.me/docs/latest/
We use scripts for provisioning, including IIS bindings, and a scheduled task for renew --
We've also used Posh-ACME with Cloudflare hosted DNS and it worked well. The module has multiple DNS plugins for handling semi-automated validation and renewals as needed.
MailEnable survivor / convert --