Is Menopause a Missed Opportunity?
Millions of women — and investors alike — can benefit from real innovation
Every day an estimated 6,000 women in the U.S. enter menopause (or 2 million a year), a natural part of the aging process during which a woman’s body experiences significant changes in two critical hormones, estrogen and progesterone. In addition to side effects including hot flashes, mood changes, insomnia and vaginal dryness, the rapid decrease in estrogen may also increase the risk of other health conditions including osteoporosis and heart disease. At least 20% of the U.S. workforce is currently in menopause and four out of five women will experience symptoms.¹ For relative scale, approximately 2 million women get married each year. However, unlike the wedding industry, there are far fewer products, services and resources designed to support aging women. In many ways, we have signaled to women that they are no longer a priority as their years of fertility have ended. Author Darcey Steinke writes:
“Earlier life stages, going through puberty and giving birth, had opened up new worlds, the excitement of sexuality and motherhood. But menopause arrived without absorbing directives. Instead of new obsessions and responsibilities, I felt a nothingness. It’s a void created in part by our oversexed patriarchal culture, a world that has little respect for older women. Valued most for our sexuality and role as mothers many women feel, once that phase is over, as I did. Marginalized. The message, never stated directly but manifesting in myriad ways, is an overwhelmingly nihilistic one: your usefulness is over. Please step to the sidelines.”²
In the U.S. healthcare system, primary care takes a one-size-fits-all approach which is often incongruent with the specific needs of the patient. Historically, the system has been built for men and their health needs, and only more recently retrofitted to try to address women’s needs.
To start, aging women’s health is not necessarily taught as part of the core curriculum in medical school and residency programs. One recent survey of OB/GYN residents found that fewer than one in five polled reported receiving any formal training on the topic.³ While the North American Menopause Society (NAMS) offers certification for health professionals who pass a competency exam regarding menopause symptoms and the best practices to manage them, nationwide, only 1,000 clinicians are NAMS-certified.⁴ This, in turn, leads to a lack of clinical expertise and educational resources for women who are navigating various treatment options as they struggle to manage their symptoms. Furthermore, primary care physicians and OB/GYNs are not incentivized based on existing reimbursement rates to invest time in this demographic.
Hormone replacement therapy (HRT), a popular treatment option, was first approved in 1942 to treat hot flashes, and in 1988, the FDA eventually included the prevention of osteoporosis as an approved indication.⁵ Encouraged by research suggesting HRT might be helpful for prevention, physicians readily prescribed HRT. In 2001, nearly 18 million women in the U.S. were using HRT.⁶ However, in 2002, the Women’s Health Initiative (WHI) released a highly publicized study that created confusion about HRT, misrepresenting a link between hormone replacement therapy and breast cancer and heart attacks. This confusion has led many primary care physicians and OB/GYNs to hesitate to prescribe hormone-related treatment today.
These structural challenges have created a supply and demand imbalance and there is a need for new products, services and resources to exist. With the adoption of telehealth, even further accelerated by Covid-19, it is now possible to offer specialized care directly targeting aging women’s needs ranging from hormone replacement therapy to low dose birth control. Additionally, there are several products that are available direct-to-consumer that do not require a prescription, including over-the-counter herbal products and supplements. Additional resources such as symptom trackers, cognitive behavioral therapy, nutrition and fitness regimens, as well as coaching support can also help to manage symptoms.
However, despite the increase in access to various treatment options, it remains challenging to get this woman’s attention. In her late 40s or early 50s, she is typically playing the sandwich role — between juggling kids and aging parents of her own — and is much less likely to put herself first. And the cultural stigma associated with this chapter of life and the debilitating symptoms can make a woman feel embarrassed, and even ashamed to admit her symptoms to herself, yet alone a friend or clinician. This age demographic unfortunately has the highest rate of substance abuse and suicide amongst women.⁷
Historically, women did not live as long so the diminishing quality of life due to symptoms was not discussed. Today, as the average woman’s lifespan continues to increase, women at the forefront of Gen-X who are starting to enter menopause are not able to look to the women ahead of them, many who struggled silently. But there is a real economic impact from leaving these symptoms unaddressed. A recent study published in the journal, Menopause, found that 250,000 women who suffered from hot flashes lost a cumulative $300 million per year in wages due to lost productivity and doctor visits, compared to asymptomatic women.⁸ There is work to be done to reverse the stigma associated with aging. Susan Mattern wrote in her op-ed in The New York Times:
“So let’s stop talking about menopause as though there’s something wrong with it. Menopause isn’t just a collection of symptoms or a pathological condition. It’s a transition to a phase of life that has been critical to human success — one that should be valued and respected, not approached with dread.”⁹
Undoubtedly, the legacy healthcare system has underserved women. We, at Able Partners, want to do our part to ensure that all women will have access to high quality, affordable care and a diverse set of treatment options as they enter menopause. We see this as a significant opportunity and are committed to finding and funding the entrepreneurs who are looking to innovate in the category to solve this gap. We know that it will take a movement to create change and we look to partner with the broader ecosystem including NAMS, clinicians, incumbent brands, advisors and influencers to work together to improve the quality of life for aging women and to help celebrate midlife with a renewed sense of purpose.