Menopause care is still a largely untapped market. Here's why investors and startups should dive in

Menopause is having its moment. High-profile investments and startups with celebrity names attached have brought long-overdue attention to this once-taboo area of women's health.

Actress Naomi Watts launched a beauty and wellness brand focused on menopause health, called Stripes, in partnership with biotech company Amyris. Actress Judy Greer became a founding partner at menopause-focused startup Wile with a focus on products for women in their 40s and 50s.

Generally, women lack education and resources about symptoms related to perimenopause and menopause, Greer said during Fortune's recent Brainstorm Health Conference.

"There's so little education out there about perimenopause. Menopause is one day of your life, 365 days after you've had your last period. So we're talking about one day versus potentially 12 years leading up to this one day. We're not educating our health practitioners. They're not learning about this. When you're a woman, and you either are done having kids or you decide you don't want to have kids, it's like, 'Good luck. Don't get osteoporosis'," Greer said during a panel discussion about menopause education.

The global menopause market hit $15.4 billion in 2021 and is projected to reach $24.4 billion by 2030, according to data from Grand View Research.

The World Health Organization estimates that more than 50 million women in the U.S. are over the age of 51, the average age that menopause hits. Approximately 1.3 million women become menopausal each year. Hormonal changes during menopause often cause women to experience hot flashes, incontinence, sleep loss, mood changes and brain fog, and physical changes such as weight gain or loss, a slowing metabolism, and joint pain.

For women, managing menopause and perimenopause symptoms can be challenging both personally and professionally. A national survey in the U.S. revealed that 4 out of every 10 women said menopause symptoms interfered with their work performance or productivity at least on a weekly basis. What's more, 17% of women said they have actually quit a job or considered quitting due to menopause symptoms. 

The annual global economic impact of menopause, between productivity loss and healthcare costs, is estimated at $150 billion, Bloomberg reported.

There is clearly a huge business opportunity and also a need to fill gaps in care and overcome medical barriers for the millions of women experiencing menopause. 

Studies show that medical residents and practitioners have significant knowledge gaps that inhibit their ability to address menopausal symptoms. A survey published in the Journal of the North American Menopause Society published back in 2013 indicated that only 20% of OB/GYN residency programs provide any kind of menopause training, mostly elective courses.

According to findings from a survey conducted by the American Association of Retired Persons, only 1 in 5 women in the U.S. received a referral to a menopause specialist. Of the 60% of women who seek medical attention, an appalling 75% of them are left untreated. 

"There's this massive white space out there. It goes far beyond the anti-aging rhetoric of like wrinkles and weight gain that really is ripe for innovation," said Gwendolyn Floyd, CEO of Wile, speaking on the same Fortune Brainstorm Health panel as Greer. "There are big challenges but it's such a huge opportunity and it's vital that we address it."

Startups disrupting menopause care

A recent market analysis from venture capital firm SJF Ventures outlines the startups disrupting menopause care and the opportunities for investors.

The menopause market includes therapeutic solutions that lengthen ovarian health, medical devices that cool a body experiencing hot flashes, virtual clinical care that connects patients with physicians who specialize in menopause care and direct-to-consumer subscription services for hormone replacement therapy, according to report author Devon Sanford, an associate at SJF Ventures.

The analysis identified 50 companies categorized into five sectors: biopharma, consumer goods, digital technology, medical devices and virtual and hybrid care. 

In the biopharma market, Oviva Therapeutics has developed novel therapeutics to address ovarian health and longevity, and Gameto is focused on solving diseases of the female reproductive system.

There is a growing list of companies offering health supplements, personal care and sexual wellness products for aging women such as Bonafide Health, which provides hormone- and prescription-free health products for menopause symptoms, Sanford noted in the report.

In the digital health space, Midday is one startup that developed a personalized menopause app to help people manage their menopause symptoms and midlife health.

There's a big focus on innovation with medical devices and wearables to help alleviate menopause symptoms. Embr Labs is a pioneer in this sector and developed the Embr Wave, a wearable that's a personalized cooling device for hot flashes. Founded in 2014, Embr Labs' technology was invented by the company's founders while at MIT and the company has raised $50 million from investors to date.

A growing list of startups offer virtual and hybrid care for menopause symptoms including Elektra Health, Stella and Gennev. Evernow, a telehealth company focused on providing services for perimenopause and menopause, banked $28.5 million in series A funding with backing from notable angel investors Gwyneth Paltrow, Drew Barrymore, Cameron Diaz and Color co-founder Othman Laraki.

Northwell Holdings and Aegis Ventures teamed up to launch a new virtual menopause care startup called Upliv. The startup partners with employers to provide telehealth and whole-person care to workers who are dealing with perimenopause or menopause symptoms. 

Women's health startups also are expanding their offerings into menopause care. Carrot Fertility rolled out benefits for menopause and low testosterone services to its platform last year and also added hormone replacement therapy (HRT) coverage. Women's health "unicorn" Maven Clinic broadened its services to include a dedicated program for menopause and ongoing care. 

Primary care provider Parsley Health also provides menopause support as part of its women's health program.

Hello Heart, a startup that helps people manage their heart health at home using their smartphone, rolled out a new feature that provides menopausal women with the tools and information they need to take control of their heart health. 

Market ripe for more investment, innovation

In the past seven years, going back to 2015, approximately $530 million has been invested in startups addressing menopause care, according to SJF Ventures' report, citing PitchBook and Crunchbase data. That figure excludes large health tech companies like Everlywell and Maven Clinic, which offer menopause care as part of a suite of services.

"While $530 million may seem substantial at first glance, it is a drop in the bucket of VC funding. As a point of comparison, fem-tech startups received $1.9 billion in 2021. This means all menopause care investments account for just 3% of fem-tech funding from one year. In the same year, digital healthcare companies received $30.7 billion," Sanford wrote in the report.

In 2022, $10.2 million was deployed in this sector in 17 deals. So far in 2023, funding already has doubled with $25 million invested in menopause startups.

Sanford notes that 80% of healthcare dollars are controlled by women, so the people experiencing the problem are the same people deciding how to spend on healthcare costs. "People experience menopause at a greater rate than pregnancy or motherhood, yet patients consistently cite a lack of effective medical support and solutions to menopausal side effects," she wrote.

Companies solving for these challenges can reach a large audience with high spending power, Sanford wrote.

One challenge for investors and startup founders is that menopause care represents unchartered territory for exit opportunities. Most startups have not surpassed early-stage funding rounds. Of the 50 companies SJF Ventures identified in the analysis, only three have been acquired and no companies in the space have gone public so far.

Another hurdle is getting employers and insurers to cover the services. Most menopause care startups are direct-to-consumer companies.

"We anticipate that securing payers or employers will be challenging in the near term but will likely gain traction quickly over the next decade. Payers may be less apt to cover menopause care compared to innovations in chronic care (e.g. diabetes, COPD, kidney care) as menopause symptoms are often less acute and cost payers less in hospital stays or ER admissions," Sanford wrote in the analysis.

A Gennev survey of 2,500 women in 2021 found that 99% of respondents are not provided with any menopause care benefits at work. But trends in the payer and employer space may be starting to shift.

Some players in the market have started pilot partnerships with payers or have secured insurance coverage. Gennev's services are covered by Aetna in all 50 states. Midi, a virtual care clinic for women over 40, works with major insurance plans in 12 states including Aetna, UnitedHealthcare and some Blues plans.

A Mercer health and benefits strategy report released earlier this year found that 15% of employers intend to offer menopause care benefits in 2024, up from 4% in 2023.

"At SJF, our hope is to see more menopause companies targeting insurance and employer coverage, as such coverage would ensure middle- to low-income Americans can access services that they otherwise could not afford," Sanford wrote.

Sanford also noted that it will be interesting to watch menopause care companies compete against one-stop shops such as Maven or Carrot Fertility. "It remains to be seen whether employers will be more interested in specialty services with high-quality care or bundled packages that reduce point-solution fatigue," she wrote.