Meno-play: Virtual care solutions preventing the midlife 'pause'

Global Edition

Health and Wellness

Meno-play: Virtual care solutions preventing the midlife 'pause'

The menopause market opportunity has been valued at $600B, and investors are starting to notice innovators.

By Uma Veerappan and Margaret Malone

August 20, 2021

11:19 am

Photo: AleksanderNakic/Getty Images

“Combine the wild hormonal fluctuations with the immense pressure that women of the ‘Sandwich Generation’ face – caretaking for children & aging parents, career shifts, plus a pandemic now – and [menopause] may well be one of the hardest and loneliest phases in a woman’s life. In 2021, it’s time we reframe this universal female experience to ensure women everywhere have 21st-century support & solutions.”

-Alessandra Henderson, CEO & cofounder of Elektra Health, a Flare Capital portfolio company

Investors are beginning to realize that menopause care is ripe for innovation, validating the massive menopause market spending opportunity which has been valued at $600 billion by Female Founders Fund.¹Even so, there is ample white space for entrepreneurs to disrupt the existing models of care that address the menopause experience, given the current state of the market.

As an innovator interested in the gaps and opportunities that exist in menopause care, what key are some insights?

Menopause is complex, making timely, effective treatment critical.
The paucity of menopause specialists impacts the ability to diagnose and treat symptoms.
Virtual care solutions facilitate better menopause care journeys by offering convenient solutions to address symptoms and health sequelae of menopause.
As the direct-to-consumer menopause virtual care market evolves, the likely next step may be to penetrate the employer-sponsored market.

Let’s dive into a thorough analysis of these insights.

Insight 1: Menopause is complex, making timely & effective treatment critical.

Women going through menopause may experience some or all of 34 different symptoms which can impact sleep, work productivity, energy levels, emotional health, relationships, and sexual pleasure.^{1, 2, 3} Given that menopause impacts each woman differently, there is no “one-size-fits-all” solution. Current treatment options include Hormone Replacement Therapy (HRT) and lifestyle modifications that are related to diet, exercise and sleep.⁴

The onset of menopause may also increase the risk of serious health conditions, including osteoporosis, heart disease, and Alzheimer’s disease.⁵Studies have shown that women who experience frequent hot flashes, which can be extremely disruptive to daily life for many, are at a higher risk of heart attacks, strokes and heart failure.⁶Effective treatment may decrease these risks, in addition to alleviating symptoms of menopause. This fact emphasizes the importance of timely care.⁷

Insight 2. The paucity of menopause specialists impacts the ability to diagnose and treat symptoms.

Currently, a limited number of physicians in the US are trained to manage symptoms of menopause. Only 20% of OB-GYN residency programs offer formal menopause training, and 80% of OB-GYN residents indicate they are “barely comfortable” discussing or treating menopause.⁵North American Menopause Society (NAMS), which offers healthcare practitioners a certification that proves mastery of high-quality standards for menopause practice, estimates that there are currently 1,108 practitioners in the U.S. that are Certified Menopause Practitioners.

There are 1,655 U.S. providers who are members of NAMS, but not considered Certified Menopause Practitioners, which indicates that a slightly larger number of practitioners are exposed to relevant training and research through NAMS.⁸

In a nationwide study, 56% of physicians indicated that inconclusive messaging regarding HRT is the most challenging aspect of patient care.⁹Although NAMS recommends HRT as the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause, it has been a source of much confusion.¹⁰A flaw in the design of the 2002 Women’s Health Initiative study that claimed HRT carried an increased risk of breast cancer and heart disease led to a 50% reduction in HRT usage and symptoms left untreated.

Despite later studies (from both the same Women’s Health Initiative group and others) confirming the HRT risk-benefit ratio is favorable for women younger than 60 years or who are within 10 years of the onset of menopause, hesitation to prescribe HRT among providers and fear among women regarding HRT persist.¹¹

Women are motivated to find appropriate support as they seek to manage symptoms of menopause, making menopausal care a viable and valuable market. If menopause is discussed with a gynecologist or primary care physician, there is a 91% chance that the patient initiated the conversation by complaining about her symptoms.⁹

Furthermore, given women may not feel adequately counseled by current providers, many instead look to friends, family, and the Internet to piece together information regarding symptom management. While women going through menopause are eager for better care, their options are limited.

Insight 3: Virtual care solutions facilitate better menopause care journeys by offering convenient solutions to address symptoms and health sequelae of menopause.

In the first quarter of 2021, global telehealth funding hit an all-time high of $4.2B, indicative of industry momentum towards virtual care solutions.¹² Virtual care will continue to experience growth. In the menopause care market, startups are beginning to use virtual care solutions to promote better quality care for an overlooked segment of women.

While not a replacement for pelvic and other exams that require in-person gynecologic visits, virtual care provides the unique benefits above and therefore warrants the attention it is beginning to receive. Such solutions may benefit women experiencing menopause by providing:

Access to menopause specialists
Reliable educational resources
Integrative care combining medical interventions with lifestyle recommendations and alternative/complementary therapies, especially for those who can’t or don’t wish to take hormones
Streamlined communication across the care team
Community support network

Companies that are best positioned for success exhibit a careful understanding of the market and are able to build trust with consumers. This is largely because of obstacles specific to the menopause market, including arbitrary advertising restrictions on platforms like Facebook and social taboos which prevent open discussion regarding care options.¹³Companies that go to market by building trust and credibility are best positioned to connect with women going through menopause.

Dr. Rebecca Dunsmoor-Su, chief medical officer at Gennev, explains, “Listening is the most important skill. Every woman has a different experience of menopause and needs different solutions, but all really need to be heard.”

Companies in this market may differ in their approach to building trust. Jannine Versi, COO and cofounder of Elektra Health (a Flare Capital portfolio company), explains that Elektra seeks to deliver an experience that is “rooted in science without being patronizing.

She adds, “Women trust Elektra because we combine empathy and evidence-based decision-making in everything we do, and it has also helped us to attract top medical experts in the space, which in turn reinforces our members’ trust in us.”

Looking forward, virtual care companies in this market have numerous opportunities to expand both offerings and customer base, including:

Mental health services. The CDC reports that suicide rates are highest among women aged 45-64.¹⁴Dr. Rebecca Dunsmoor-Su agrees that mental health is complementary to menopause care, but also acknowledges that this is a “big lift.” The current shortage of mental health providers makes their ease of accessibility through virtual care platforms crucial.
Education for the support network. Beyond equipping menopausal women with reputable educational resources, it will be paramount to train employers and family members on how to support women in this life stage. Dr. Philip Sarrel, Emeritus Professor of Obstetrics, Gynecology, Reproductive Sciences and Psychiatry at Yale School of Medicine, urges companies to provide menopause education to employees and believes “the single most important thing for women in the workplace is to have a supervisor who they can talk to.”
Inclusivity. The conversation regarding menopause is currently heteronormative and largely white-centric in nature. We must consider the unique needs of the LGBTQ+ community. At present, the LGBTQ+ community is even less likely than others to view providers as resources given medical advice is often tailored to heterosexual women. Additionally, the current conversation does not apprehend the cultural needs and traditions surrounding menopause across different ethnicities. Although variation exists, data reveals women of color are more likely than others to exhibit disruptive menopause symptoms earlier on and for a longer duration.¹⁵
Full-spectrum women’s health virtual care platform. An opportunity exists to be the “one-stop” virtual care platform to address women’s health needs across different stages of life, including fertility, parenting and menopause.

Insight 4: As the direct-to-consumer menopause virtual care market evolves, the likely next step may be to penetrate the employer-sponsored market.

“While many employers today continue to grapple with women’s health benefits specific to the fertility window (fertility, pregnancy, early parenting, etc.), menopause support is becoming more important as self-insured employers, among other simply enlightened companies, seek to engage, support, and care for women across their lifespan.”

- Jannine Versi, COO & cofounder of Elektra Health

Elektra Health has already heard from forward-looking U.S. employers seeking to beat the competition in this space. According to Dr. Rebecca Dunsmoor-Su, Gennev is also actively exploring this approach.

Although the number of women in the workforce is growing, the segment of women between the ages of 45 and 55 is declining, in part due to menopause.¹⁶ “This might be the most productive time in a woman’s career, but she may be hit with uncontrollable symptoms,” says Dr. Sarrel. In fact, 12% of women in the U.S. declined more demanding jobs because of symptoms of menopause that may have impeded their ability to function productively.¹⁷Ultimately, this will lead to the loss of talented women in the workplace.

Large, global employers are beginning to adopt health benefits related to menopause. In January 2021, the U.K. and Ireland arm of the global public relations firm Edelman announced 10 “paid time out” days for women experiencing menopause, in addition to access to Peppy Health, a specialist healthcare and wellbeing support application. Jonni Learoyd, former Head of HR Benefits in EMEA at Edelman, stressed that these announcements reaffirm Edelman’s commitment to supporting women throughout their careers.

While first movers like Edelman are setting examples, menopause remains taboo. An HR representative at a U.S.-based professional services organization shared, “We have not had any conversations in this space as our population is very young. The average age is 33. Fertility is more of an issue for our people than menopause.”

For employers, there is a compelling financial case to offer such benefits. Research estimates up to $6,500 in productivity losses per menopausal woman per year in the United States. Considering that presenteeism of women with moderate and severe vasomotor symptoms was found to be 14.3% and 24.28%, respectively, there is reason to believe additional losses exist that are more difficult to quantify.¹⁸

The conversation around menopause is growing. Jannine Versi predicts, “The case for such investments by employers and payors will grow only more compelling as more data emerges tying near- and longer-term health outcomes and cost savings, and as more examples - like some British firms - set the standard with their implementation of menopause policies and benefits.”

Prior to penetrating the employer-sponsored market, the focus will remain on evolving the direct-to-consumer menopause virtual care market.

What’s next for innovators?

While progress is being made, the need for innovation in this market continues to exist. In a recent report, Frost & Sullivan predicted that menopause will be “the next big opportunity" within the women’s health technology market.¹⁹ The combination of strong business models and growing investor enthusiasm has the potential to significantly shape women’s health outcomes.

About the authors

Uma Veerappan (LinkedIn) is an MBA candidate at the University of Chicago and a Flare Capital Scholar. After spending a year in South Korea with the Fulbright Program, Uma joined EY as a strategy consultant. Prior to business school, Uma worked with telemedicine startup Hazel Health and healthcare apparel startup Care+Wear. At Chicago Booth, Uma interned at venture capital firm Portfolia, focusing on Femtech and Active Aging & Longevity investments.

Margaret Malone (@_margaretmalone & LinkedIn) is a senior associate at Flare Capital Partners, a healthcare technology and services-focused VC firm. Prior to joining Flare Capital, Margaret partnered with entrepreneurs to build executive teams at Oxeon Partners, and she led clinical process improvement initiatives at health systems nationwide at Huron. While completing her MBA at the University of Chicago, she was a Flare Capital Scholar.

Sources