After years of being overlooked, menopause has finally stepped into the spotlight of public conversation. Celebrities ranging from Drew Barrymore to Naomi Watts have candidly shared their experiences with symptoms and endorsed various products aimed at managing them.
Despite this increased discussion, there remains a substantial gap in effectively addressing these symptoms, presenting ample opportunities for companies to intervene.
According to a recent McKinsey report, menopause ranks among the female health conditions with the most pressing unmet needs, offering significant potential for innovative treatments.
The global market potential for addressing symptoms is estimated by the management consultant to range from $120 billion to as much as $350 billion.
Menopause typically marks the cessation of menstrual periods after 12 consecutive months, commonly occurring around the age of 51 on average. However, women may experience symptoms for years leading up to this phase, known as perimenopause, which can persist into postmenopause.
These symptoms encompass a wide range, including hot flashes, anxiety, weight gain, vaginal dryness, mood swings, sleep disturbances, and changes in skin conditions. McKinsey reports that over 450 million women worldwide are affected by symptoms related to menopause and perimenopause.
Anna Pione, a partner at McKinsey overseeing research on the future of wellness, highlights the significant unmet demand for menopause products and services. She asserts that menopause is severely underserved, underfunded, and lacks adequate attention, a sentiment applicable not only to women’s health in general but particularly acute in the case of menopause.
‘Exciting’ Developments
For decades, hormone therapy has been the go-to treatment for menopause. However, its reputation took a nosedive in 2002 following a Women’s Health Initiative study, which revealed that estrogen plus progestin therapy heightened the risk of breast cancer and heart disease in women.
Dr. Stephanie Faubion, Director of the Mayo Clinic Center for Women’s Health and Medical Director of the nonprofit Menopause Society, notes, “A lot of women abandoned hormone therapy due to their own fears, their doctors’ apprehensions, or a combination of both.”
Between 2002 and 2009, claims for hormone therapy plummeted by over 70%, as indicated by a 2012 study. This mass exodus left many women without any means of symptom management.
However, recent research suggests that for women under 60 or within 10 years of their menopause diagnosis, the benefits of hormone therapy may outweigh the risks.
“Our understanding has evolved,” says Dr. Karen Adams, Professor at Stanford University and Director of the institution’s Menopause and Healthy Aging Program. “It’s truly exciting, but women are often left scrambling to find assistance.”
Publicly-listed companies in this domain are scarce. The primary player in the United States is Pfizer, boasting a diverse portfolio including Duavee and Premarin—hormone therapy treatments catering to hot flashes and osteoporosis prevention.
Then there’s the relatively small Biote, with a market cap just above $400 million. Having gone public in May 2022 via a SPAC deal, Biote specializes in customized bioidentical hormone pellets designed to address hormone imbalances.
According to Jefferies analyst Kaumil Gajrawala, whose rating on Biote is buy, hormone treatment, especially for menopause, is gaining considerable traction. Biote’s approach involves customizing hormone pellets based on blood tests, ensuring consistent delivery, and eliminating concerns about compliance.
Meanwhile, Dare Bioscience, with a market cap of around $47 million, is developing a hormone therapy product in its pipeline. This clinical-stage biopharmaceutical company, concentrating on women’s health, is advancing an intravaginal ring hormone therapy toward a single Phase 3 study.
The pursuit of non-hormonal treatments is also underway. Last May, the FDA sanctioned Tokyo-based Astellas Pharma’s Veozah (fezolinetant) for hot flash treatment. Bayer is also in the fray with elinzanetant, which showed promise in reducing the frequency and severity of hot flashes and improving sleep in two late-stage trials.
Vistagen Therapeutics, a late-clinical-stage biopharmaceutical company, is currently conducting trials for a hormone-free nasal spray aimed at alleviating hot flashes.
In the non-drug arena, fertility benefits manager Progyny recently expanded its coverage into menopause by collaborating with private companies Gennev and Midi Health.
Sasha Kelemen, Head of Women’s Health Investment Banking at Leerink Partners, views this expansion as a significant indicator of the potential opportunity within the menopause market.
Private Innovation
Despite the buzz surrounding menopause, a significant portion of the innovation in this realm is occurring within the private sector.
“Menopause is inevitable, like death and taxes, and all women will go through this,” notes Kelemen. “We just don’t have a lot of public women’s health companies yet, and hopefully that will change.”
In 2022, Kelemen facilitated a deal for Unified Women’s Healthcare to acquire Gennev, the digital menopause care delivery platform partnered with Progyny. Although Kelemen did not disclose the financial specifics of the deal, it marked a significant move within the industry.
Midi Health, another Progyny partner specializing in virtual care clinics focusing on perimenopause and menopause, is also attracting substantial investment.
In September, Google Ventures, the venture capital arm of Alphabet, led a $25 million Series A funding round for the company, bringing its total funding to $40 million.
Despite these developments, women’s health has historically been underfunded, with menopause receiving only a fraction of available resources.
“The dollars don’t match the conversation that’s happening,” says Kelemen. “While it’s growing, it’s still growing too slowly and not in any way proportionate to the potential impact and the need of the actual population that needs to be served.”
Nevertheless, Kelemen remains optimistic about the future, anticipating increased funding and consolidation within the industry. She sees potential for innovations, recognizing that the hormonal changes associated with menopause span a significant period, creating diverse needs among women.
“Because it is a hormonal change for a 10-, 15-, 20-year period, the needs of women will change,” she explains. “There’s an opportunity for multiple platforms to succeed.”
