It’s getting hot in here: The unrealised potential of the $53 billion menopause market
Bhumi Shah, Milena Bacalja Perianes
This article examines the unexplored potential of the menopause market and the major reasons why VC should start investing in menopause. It provides an overview of the current landscape, market and consumer trends, and innovative opportunities for investors to get in before the hot flush passes.
‘Is it just another moody woman or is she going through menopause — I can never tell!’ joked the GP during his clinic on a cold Monday morning. Like many women’s health concerns, menopause remains undervalued and underinvested in, by healthcare professionals, clinical researchers, and most relevant to this audience, investors.
Globally, research demonstrates that there is a stark contrast in the quality of care that men and women receive within healthcare systems. The pain bias between men and women has often resulted in the minimisation and/ or misdiagnosis of women’s health concerns by healthcare professionals.
Whilst menopause affects almost 1 billion women for an average of seven years, menopause-related healthcare is lifelong. Despite this, menopause has remained relatively marginalized in conversations around health equity, especially within the health-tech sector.
Investing in menopause is a matter of smart economics
It is easy to understand why to date the male-dominated VC industry has been hesitant to invest in technologies addressing women entering menopause. People invest in what they know and people who look like them. A female-led menopause-focused start-up is likely to be as far from your average investment committee comfort zone as it can get.
But menopause has huge social and economic consequences for healthcare systems and workforces. The global healthcare burden of menopause is estimated to be approximately $660 billion. These costs are borne not just by public healthcare systems but also employers. Recent research by Lisa Health, the company behind the Midday menopause app found the estimated annual cost of menopause for US employers could be as much as several billion dollars due to increased healthcare costs through their providers and lost productivity.
Menopause is quickly becoming an economic imperative, that smart investors must capitalise on.
Four reasons why it’s time for VCs to start investing in menopause
The investment case for menopause in four arguments:
- As the population grows, this gigantic market will only become larger.
By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion. With a global ageing population, the number of women entering perimenopause and menopause is rapidly growing, a huge untapped opportunity which is underserved by public and private healthcare systems.
The current estimate of the menopause market is $53 billion by Femtech Focus. As menopause cuts across several other key health sectors — including breast, ovarian, mental, reproductive, bone, heart and uterine health — the opportunity spans several market sizes.
Currently, femtech companies only receive 3 per cent of all digital health funding. Of this investment, the majority is concentrated in three verticals: fertility, maternal health, and menstrual health. As customers accessing femtech services age, they will be primed as key seekers of digital menopausal solutions. This will only grow the gigantic market further.
2. Menopause is not just a singular experience, but a transitional shift in women’s health needs with a large potential for new players to dominate
Menopause is defined as a transitional period of life categorised by distinct and often debilitating symptoms, as well as increased health risks for women. Menopause can last from seven to fourteen years with 34 symptoms and increased vulnerability post-menopause to secondary, and often chronic conditions. While the average age of menopause for women in developed countries is 51, about 5% of women enter into early menopause between 40 and 45.
There are three distinct phases to menopause which all represent a unique set of customer needs.
- Peri-menopause: the transition phase before menopause and is usually about 5 years before menopause and one year after the last period. It is within this phase that women are likely to suffer from the most severe physical and emotional symptoms
- Menopause: reached when menstruation has been absent for a year.
- Post-menopause: lasts the rest of a woman’s life after her last period
Contrary to popular belief, the symptoms most commonly associated with menopause, are usually experienced during perimenopause and are a result of endocrinological changes in the female reproductive system, particularly, lower levels of oestrogen. Perimenopause has a variety of primary health implications which include: vasomotor symptoms (VMS) which manifest as hot flashes/flushes and night sweats; hormonal imbalances due to decreasing oestrogen levels; mental health issues; vaginal dryness and lowered sexual libido.
However, it is also important to note that fluctuating oestrogen levels experienced during menopause are also associated with an increased risk of developing more chronic conditions such as cardiovascular disease, musculoskeletal problems, and dementia. Consequently, menopause is linked to a variety of secondary conditions including hypertension, osteoporosis, cancer, and depression. Whilst menopause does not necessarily cause these conditions, vulnerability increases as a result of menopause. Thus, there are huge opportunities for innovation across the menopause market to prevent, diagnose and treat many of these associated conditions and create a holistic system.
The needs of women within the menopausal market go far beyond just menopausal symptoms but reflect the need for enhanced insights and innovative solutions that reduce women’s health risks and address their changing or changed body needs.
3. Macro tailwinds are accelerating implementation and access to menopause solutions
While peri-menopause and menopause affect a huge proportion of the population, it remains underfunded, under-researched, and misunderstood by healthcare professionals. However, increased socio-political attention will enable market innovation in this area.
Dr Brittany Barreto, Founder of Femtech Focus argues that in the US “menopause is almost completely ignored by the healthcare system with only <0.00001% of the National Institute of Health (NIH) funding in 2020 dedicated to menopause research. If we don’t have funding for basic research to understand it, we don’t know how and why these things happen, so therefore can’t make solutions that target them.” We can see support for this notion with the bi-partisan bill introduced this month in the US which would authorise US$100 million for both fiscal years 2023 and 2024 for menopause-related research.
Markets cannot innovate where there is a lack of research and willpower. Menopause is ultimately another battleground in the broader movement for gender equity. Louise Klintner, Research and Impact Lead at The Case for Her– a philanthropic investment collective focused on women’s health- believes that “the menopause market is limited because any innovation in women’s health has been directed at the one thing women’s bodies are seen as purposed for — fertility. After women have had their kids their bodies aren’t valued anymore.”
Shifts in social policy such as that in the US, or recent calls from English MPs for menopause checks and free hormonal replacement therapy to help solve the menopause crisis are helping enable innovative solutions to reach this relatively underserved and overlooked segment of the population.
4. The “average” menopausal woman is changing- and she has money to spend, and problems to solve
Within the next ten years, tech-savvy and financially independent millennial women will make up all the women entering peri-menopause.
Jessica Karr, General Partner at Coyote Ventures argues that “wave one of the menopause products on the market [are] the old school, traditional solutions such as the Amberen menopause supplements that treat all women and their symptoms as the same. Without understanding mechanisms or how to drive personalized insights, [they are] pushed on women with little other options…they are all branded as if women of this age are geriatric!”
The new menopausal generation will be at the height of their spending power when entering peri-menopause, and armed with a history of high technological adoption, especially as they transition from other femtech solutions. This provides the perfect market conditions for innovative solutions to solving their pain points to enter wave two.
As menopause becomes less taboo and more women access the help they need, we will see more of a spectrum of care required. For years, those accessing Menopause support suffered from complex conditions requiring specialist help — unlikely to benefit from most digital solutions. However, now we are seeing a broader spectrum of menopause sufferers seeking help.
In fact, whilst around 15% of women in menopause suffer from debilitating symptoms, the other 85% could benefit from solutions tailored toward tracking, prediction and self-management of their menopausal symptoms. This allows digital health solutions to stand a serious chance at taking on traditional care pathways.
Current Peri-Menopause and Menopause Market Landscape
Over the past five years, there has been a proliferation of menopause-focused innovations which look to track, ease, and manage peri-menopausal symptoms.
These solutions cut across four major markets: peri-menopause/menopause, menstrual health, sexual wellness and urinary continence- solving a variety of pain points. Whilst innovation has grown exponentially, there is limited maturation within each sub-sector.
Below we have begun to outline some of the exciting trends and untapped opportunity areas we think exist across the menopause market.
Current Trends and Future Opportunities in Menopause
The menopause market is growing fast but it is important to remember that it is still early stage. Investors need a high-risk appetite and willingness to be the first ones in a sector that with time could be hugely profitable.
Stasia Obremskey the Managing Director from US-based Rhia Ventures — a major investor in reproductive innovation- argues that “menopause is a really early-stage market, with a lot of experimentation and iteration. We see some convergence as these companies try to figure out what is the most sustainable and profitable business model. There is huge potential around B2B models with reimbursable services through employers, health insurance providers and beyond.”
Regardless of the sheer volume of potential customers with a propensity toward disposable incomes, innovation and investment in the menopause wearable market remain largely unexplored. There is a strong need for mature solutions focused on solving perimenopausal symptoms, whilst also beginning to better serve women post-menopause with their active ageing concerns.
- Growing demand for perimenopause and menopausal trackers which enable users to track and manage their symptoms.
With the normalisation of period cycle tracking apps and fertility apps such as Clue, Flo, and Glow- a natural expansion into the menopausal market is occurring. Either existing apps are expanding their functionality to cover peri-menopause and menopausal symptoms (under the menstrual health umbrella), or new peri- and-menopausal focused apps are entering the market.
Unlike their predecessors, which have had challenges in terms of employing profitable business models, menopause tracking and support apps offer the opportunity to position other preventative and symptom-alleviating products to users to create more profitable business models. SaaS offerings that link menopausal well-being to physical and mental health, as well as employee productivity could be revolutionary in this space.
The largest gap within this segment is the limited efforts to integrate smart textiles, e-textiles, or wearables devices which could further enhance a more personalised offering to users by tracking, predicting, and supporting the management of symptoms.
Jessica Karr from Coyote Ventures foresees a “ ‘wave three’ that will innovate in line with advancements in foundational research and overlaying more innovative technologies to launch more comprehensive and personalized (with feedback loops) solutions for women’s health, as well as more consolidation for brands to partner and create a more seamless experience for women.”
2. Holistic, integrated and natural solutions to solve hormonal balances are on the rise
Public health systems have overwhelmingly been dependent on hormone replacement therapy (HRT) to solve women’s menopausal needs. However, in the context of the controversial history of HRT and its long-term effect on women’s health, we can see growing trends of women declining hormonal contraception and avoiding menopause hormonal replacement therapy (HRT). Natural remedies such as vitamins, creams, and meditation can prevent or alleviate symptoms and are commonly sought after. Therefore, start-ups offering a marketplace approach could prove highly effective for solving across the phases of menopause and retaining customers across their lifetime. Importantly, this includes touching upon two priority areas for menopausal women: urinary incontinence and vaginal dryness — both of which dramatically decrease the quality of women’s lives with the latter affecting women’s sex lives.
Cristina Ljunberg, Co-Founder of The Case for Her, believes that the future of “menopause is all about hormone levels. The future will be to put more power in the hands of women to measure their hormone levels in real time and to make lifestyle and treatment adjustments. This should include understanding cortisol levels and the impact during the menopause transition. “
3. Telemedicine solutions can revolutionise menopause care
New emerging telemedicine products in the menopause market are focused on overcoming healthcare systems gaps and enabling improved healthcare access either through D2C models or B2B through employer partnerships where services are covered through healthcare benefit schemes.
Whilst this is more likely to be successful in contexts with privatized healthcare systems, these virtual clinics or telemedicine apps either provide access to medical experts and/or provide tailored menopausal care programmes. With the explosion of similar services across the whole femtech category (representing the largest amount of femtech start-ups over the past two years), integrated women’s health telemedicine services may prove more scalable than solving only one health issue at a time (ie fertility, maternal care, menopause).
Obremsky from Rhia Ventures sees huge potential in B2B models for healthcare service models generally. Particularly for perimenopause and menopause, Rhia Ventures believe that direct patient services that can be billed as telehealth and pharmacy benefits could not only help close the gender health gap in the US but also create profitable business models.
“Many femtech businesses start as D2C businesses, which perpetuates this myth that women’s health is not legitimate health care and that we should pay for it ourselves. Men don’t pay for comparable services, so why should we as consumers have to? We like to see reimbursable models out the door which validate the clinical need and the fact that this is real healthcare.”
We predict that a few big exits in the menopause market are likely to be either virtual care or telemedicine solutions which can scale such as the recent acquisition of Gennev by Unifed Women’s Healthcare.
4. The potential for wearables within the menopausal market remains relatively unexplored.
Wearables within the menopausal market have focused on solving the frequently experienced hot flashes which traditionally reflect the menopausal experience. Innovation is squarely focused on managing symptoms rather than preventative or predictive measures for menopausal symptoms or other related health conditions.
Innovators exploring the full potential of wearables could include smart clothing or textiles, electronic textiles or wearable devices which are designed to provide real-time data, insights, or support to help prevent, diagnose, or manage a variety of health illnesses and conditions across women’s lifecycles.
With a new tech-savvy generation of women reaching menopause over the next ten years, there is room for enormous growth in terms of digital health products, tracking devices, telemedicine, diagnostics, and prevention and most importantly the data they produce. This data could enable self-management and the optimization of women’s health, as well as improve the diagnosis and treatment of conditions through healthcare systems.
5. The rise of personalised and predictive menopause offerings could revolutionise the health experience of menopausal women
Whilst tracking apps exist across the femtech space, minimal advance in AI enhancement is seen in the market, and that remains within the period-tracking space.
There is space for wearable devices and/or e-textiles which not only collect data but also allow processing which leads to real-time insights and actionable takeaways for users. In particular, solutions focused on the prediction, prevention and treatment of peri-menopausal symptoms through AI-enhanced or connected apps and devices could be a game changer in this space for becoming more than habit trackers but central to health management. These apps could help prevent the 1 in 10 women who leave work due to their menopause symptoms, by allowing greater control and planning around their symptoms.
6. Multi-focus solutions which treat diverse pain points and possibly serve adjacent health conditions will have more potential to reach scale
Start-ups which can offer solutions to the many pain points women might experience will be able to dominate the market landscape. As Dr Brittany Barreto, from Femtech Focus “women have a multitude of symptoms but don’t want a solution for each. We will need to find some kind of a marketplace that has availability of all solutions at affordable price points. Currently, the price point on each solution is quite high because it’s still super novel solutions, founders are testing out the market with no scale to reduce the costs.”
Additionally, companies which are focused on understanding menopause as a transition phase for a particular customer segment will have a variety of opportunities to innovate and position solutions. This trend of the ‘active ageing’ demographic will have a variety of specific chronic conditions or comorbidities which are exacerbated or triggered by menopause such as osteoporosis, and obesity. dementia or depression.
Distribution models remain one of the biggest challenges facing menopause-related start-ups. As the femtech industry begins to mature and look to successes from health tech, shifts toward B2B and B2G models will increase. Such distribution models will be essential to ensure that solutions are accessible and scalable.
An investment thesis for the menopause market
Valuation within the menopause market remains low, with limited understanding among VCs of the huge potential that exists. With few women at the investment table, and even less technical understanding of menopause and women-centred products to truly assess and understand the demand for menopausal-related innovations, the market remains undervalued and relatively unexplored.
With a growing number of femtech exits, 116 in total, menopause start-ups are easily overlooked. However, there have been five menopause-related exits to date with the most recent being the acquisition of the menopause care platform Gennev by Unified Women’s Healthcare.
Investors have an array of opportunities to invest in the next frontier of menopause-related innovation
💰Investment Strategy: Menopause start-ups deploying B2B models with holistic healthcare offerings in addition to, or supplementing existing healthcare service providers are likely to prove highly scalable and profitable. Look for businesses whose offering can expand across the lifecycle of women’s health needs rather than solely solve for menopause symptoms. Similarly, e-commerce marketplaces could be well positioned to service consumer needs if well executed with reasonable price points. Models which have entry points back to public or private healthcare systems are where the money is at.
🌍 Geographic regions: As with most health tech, the US remains one of the most popular markets to invest in. Additionally, investors should consider exploring contexts in which governments are prioritising women’s health through the development of national health strategies which will create the right market conditions to facilitate innovation. The UK, the Netherlands, France and Germany are poised for such innovation considering policy shifts, female consumer purchasing power, and higher levels of health literacy which will make customer acquisition and product adoption easier.
📈 Stage: As a nascent market, large investments are needed from pre-seed and seed investors willing to explore novel solutions. Look for founding teams with a background in women’s health service provision, whether medical or sociological, who will be able to navigate the nuances of women’s health decision-making and easily iterate their product offerings.
➕ Value-add: Investors with experience scaling health teach start-ups and rolling out B2B models through employers or healthcare systems will be able to offer significant addition to menopause start-ups in their portfolio.
We predict that with a naturally growing user base whose purchasing power remains unparalleled, early investors in this market have the potential to invest in the next frontier of health tech. We think you should too.
Is it getting hot in here yet?
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A big thank you to the wonderful investors who shared their insights with us on the current and future state of femtech. A shout out to Stasia Obremskey from RH Ventures; Dr Brittany Barreto at Femtech Focus; Cristina Ljungberg and Dr Louise Klintner from The Case for Her; and Jessica Karr from Coyote Ventures.
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