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00:00This is a story about market failure, failure of the markets to address something half of the world's population will
00:06experience,
00:07but has historically been largely ignored, menopause.
00:11For generations, women were told the physiological changes that come with aging were something they should endure quietly if they
00:18were told anything at all.
00:20Now that silence is being broken by doctors, celebrity influencers, startups and investors who see menopause as one of the
00:27next big markets in women's health.
00:29Our colleague Scarlett Fu brings us the story.
00:34It's health care for half the world.
00:36Menopause is hot.
00:37It is a $360 billion category.
00:40The plain wrong part was it's all over at menopause.
00:44Go to the corner, sit in the rocking chair and pull out your knitting needles.
00:49That's changed significantly now.
00:52Menopause is finally getting its big business moment after decades of being overlooked.
00:57Beauty brands, supplement makers, telehealth startups and investors are all racing to stake their claim on a growing market to
01:05provide relief to women whose ovaries stop producing estrogen.
01:09But this gold rush raises a key question.
01:11Which products and services actually help versus those cashing in on confusion?
01:16We developed a report on the biggest on-met needs in women's health last year and established a $360 billion
01:24ghost market.
01:25For Carly Saper, the opportunity is clear.
01:28Menopause often hits during women's peak earning years, driving more than $150 billion in global productivity losses and underscoring one
01:36of the biggest white spaces in women's health.
01:38The market for menopause is specifically a huge market.
01:43There is 75 million women in the U.S. today going through menopause.
01:47Just by comparison, there's only 400,000 IVF cycles in the U.S. today.
01:53And that doesn't mean IVF is a bad place to invest.
01:55It just means the solutions have to be relatively expensive for the market size to be venture-backable.
02:01Whereas in menopause, even a relatively low-cost solution, if it's effective, can have a venture outcome.
02:07For Naomi Watts, that market gap started as something very personal.
02:12At the age of 36, the Oscar-nominated actress was at the precipice of fame, starring in films like Mulholland
02:18Drive.
02:18I can't believe it.
02:20I'm just so excited to be here.
02:23The Ring and King Kong.
02:25Then she received an unexpected diagnosis.
02:28I wasn't getting pregnant.
02:29And so a friend said, why don't you go to your doctor and get a blood panel?
02:34And I was like, what's a blood panel?
02:36I really was so clueless.
02:38She said, check your hormones.
02:40And I went, okay.
02:41So my gynecologist did exactly that.
02:45And he then told me the results were looking like I was close to menopause.
02:50That diagnosis collided with an industry that has often treated aging women as expendable.
02:55There are many times you're told that, you know, you get to a certain age and you're not sexy anymore.
03:01And this was told to me.
03:03I started my career late and they said, you better get your skates on because, you know, you haven't got
03:09many years left.
03:10I said, what do you mean?
03:11Why?
03:12And they said, well, you know, it sort of all finishes at 40.
03:16Why?
03:17Well, because you're not sexy after that.
03:20Why?
03:22Getting angrier by the second.
03:23Because you're, and you might need to bleep this, unfuckable.
03:28It would take years for Watts to speak openly about what she was going through.
03:32I spent a lot of time feeling the fear and shame and panic about it and very lonely.
03:39I tried to connect with other women.
03:42And they would sort of laugh it off and say, oh, don't be silly.
03:45You're not in menopause.
03:47You're far too young.
03:48So the more I sort of tried to connect with people and not get the reaction that I wanted, which
03:55was compassion and comfort, it just sort of made me retreat further.
03:59It really took 10 years and probably entering into my 50s for me to own that and say, I'm in
04:06menopause.
04:07I need help.
04:08Why do you think menopause has become a consumer category now in the mid-2020s?
04:13I think it's in large part thanks to women like Naomi, who have kind of come out of the shadows
04:19and shouted from the rooftop and said no more.
04:22Watts eventually turned her experience into Stripes, a wellness platform aimed at women in perimenopause and menopause.
04:28Kara Kamenev is the CEO of Stripes.
04:31How do you build a women's wellness brand that empowers women without monetizing on everything that they might be feeling?
04:39This is a pro-aging brand and it was born that way.
04:42It wasn't changed to be that because it became trendy.
04:46This was born out of like a very personal moment of like, I need care.
04:51I'm not getting care.
04:53And at the same time, we don't want to change who women are and we don't want to lie to
04:57them.
04:57We do see a lot of kind of legacy brands in the industry who are changing tune.
05:03You know, for years, all of the products said, erase time, turn back the clock.
05:07They call these age spots.
05:09Or the ads had, you know, 25-year-old women and they were purporting to erase 25 years of time.
05:15And it was just ridiculous.
05:16That's never really been the Stripes proposition.
05:18It's about feeling the best that you can feel, embracing where you're at, but improving what you can and being
05:25comfortable and confident and happy and supported.
05:28Stripes is just one company in a menopause market that is getting more crowded by the day.
05:33Even so, investment dollars in women's health barely register.
05:36Of the almost $2.9 trillion in funding that investors plowed into the healthcare sector in the first half of
05:42the decade, women's health companies received less than 1% of the total.
05:47As the menopause economy expands with new products and increased visibility, who is setting the standard for what actually works?
05:55It should be American physicians in the medical community.
05:59And number two, the FDA, which has a very distinct role mandated by Congress to ensure that if a product
06:06makes a medical claim about improving your health, that that claim has to be supported by data.
06:12Marty McCary served as FDA commissioner from March 2025 to May 2026.
06:17The former surgeon and professor began his tenure at the FDA, intent on reversing long-held medical dogma around the
06:24risks of hormone replacement therapy.
06:26That reversal became official last November.
06:29I'm curious about the overall history of HRT.
06:32What were the early days of HRT like?
06:35It was extremely popular.
06:36Women were experiencing the life-changing benefits in terms of their health.
06:43Living longer and feeling better with hormone replacement therapy.
06:47In 2002, a study came out linking HRT to breast cancer, stroke, and blood clots.
06:54The number, of course, fell from 40% of women using HRT down to about 4% in the mid
07:00-2010s.
07:01As long as I've been in medicine, I've heard this dogma, this dictum, that women should avoid hormone replacement therapy
07:07after they go through menopause.
07:09Researchers said that a study claimed that there was an increased risk of breast cancer, suggesting that a woman had
07:17an increased risk of dying of breast cancer.
07:19It turns out the study didn't really represent the opportunity that women have to benefit from hormone therapy.
07:25But regardless, the FDA piled on with some scary warnings in 2003.
07:31And so for the last 22 years, before we tackled this at the FDA, women had been talked out of
07:38it.
07:38But the mantra that women should avoid it at all costs took on a life of its own and sadly
07:45scared away a generation of women.
07:47Some call it the lost generation.
07:50Approximately 50 million women over 23 years who were denied, talked out of, or never offered hormone replacement therapy because
07:59of that dogma in the field.
08:01I consider it to be one of the greatest mistakes of modern medicine.
08:05The FDA is taking action.
08:07So during his brief tenure, McCary took a major step towards fixing this.
08:11I immediately convened experts and tackled this issue.
08:14And we told women the truth nationwide.
08:17We removed black box warnings that were not supported by the data.
08:20And we described the profound short-term and long-term health benefits that ultimately are good for public health.
08:28I think there's a lot of relief because so many women who are experiencing the symptoms are really relying on
08:35the FDA to tell them if they should be taking HRT or not, are now going to see that they
08:40should access HRT and have the care that they deserve and need.
08:43Under McCary, the FDA's move helped to advance a medical conversation stunted by stigmatization over the past two decades.
08:50Just in the past five years, progesterone-containing HRT prescriptions for women aged 45 and older have more than tripled,
08:58and prescribing rates have increased more than 19% since the FDA's label change.
09:02And in the past, this was a taboo topic.
09:05Women would be embarrassed to talk about it.
09:07If they brought it up with their doctor, they would sort of be dismissed.
09:11And now you're seeing a national conversation emerge where very respected leaders around the world are saying,
09:17look, when I go through menopause in the next few years, this is what I intend to do, or this
09:24has changed my life.
09:25The FDA's actions may be helping to remove some of the stigma of menopause, but the health care industry has
09:31to catch up in preparing professionals to address women's changing needs.
09:35Only 20% of residency programs in the U.S. have a formal menopause track.
09:41So we're seeing that providers are lacking education on how to treat women going through menopause.
09:47This is a huge gap that allows for innovation to come in by democratizing access to menopause care.
09:53There are very few people trained in the science and medicine of midlife care for women, and essentially, they treat
10:00you the wrong way.
10:01So the opportunity that I saw was to create a company that would give great women's health care, focusing on
10:10hormones, to women covered by insurance.
10:12Because it shouldn't be that you have to go to a concierge doctor like I did and pay $1,500
10:17in order to get this care.
10:18That idea became MidiHealth, a telehealth company started by Joanna Strober, focused on midlife women's health care.
10:25It reached a $1 billion valuation back in February, the first menopause company to do so.
10:31I was around in my late 40s.
10:33I was suffering from anxiety and heart issues and gaining weight, all the things.
10:40I went to a primary care provider, and that primary care provider sent me to therapy.
10:46They gave me a sleep test and said that I had perhaps sleep apnea.
10:51They also gave me an antidepressant medication.
10:54So I eventually, after about a year, found a concierge doctor who was a specialist in women's health.
11:01And within two weeks, she cleared up all of the issues that I was experiencing.
11:05We're sending people to get colonoscopies.
11:07We're sending people to get blood tests, but we're basically creating a care layer of expert women's health providers.
11:14None of that requires in-person.
11:16It can all be done online.
11:17How do you separate durable medical demand from the hype and the excitement that surrounds menopause?
11:2235 and 65 is one of the biggest care gaps that we have.
11:26Essentially, there's a lot of focus on babies, and then there's a lot of focus on geriatric care.
11:32And we have this huge gap of care in between.
11:34And what people have realized is that this gap of women has been dramatically underserved.
11:39What do investors misunderstand about menopause?
11:43And how do you think that that's evolved or changed over the years?
11:46So I think there's a perspective that menopause is a moment, and you're going to take care of people in
11:51that moment.
11:51But we've learned that menopause care is both symptoms and preventive care for a 30-year period of time.
11:59So women might come to us in their 30s having had a baby, and their hair is falling out, and
12:04they're having some anxiety.
12:05They come to us in their 40s because they're having symptoms of perimenopause and menopause.
12:10They're not sleeping.
12:11They're having anxiety.
12:12And then in their 50s, they're worried about their bones, and they're worried about cardiovascular disease, and what can I
12:17do to age healthier?
12:18So we're finding women start with us for one thing, and they stay with us for many, many years.
12:23The same conditions that make menopause a promising market also make it a confusing one.
12:28As products, clinics, and wellness claims multiply, the challenge for women will be figuring out what kind of help they
12:34can trust.
12:35There are many companies out there claiming to treat menopause symptoms, either in the short term or in the long
12:41term.
12:41What should women look for in buying certain products?
12:44How do they distinguish between something that's real versus something that just claims to do the trick?
12:49I think in every industry, there are products out there that just don't survive because they don't live up to
12:55the claims.
12:56Look for the FDA brand.
12:58It's one of the greatest brands in the world.
12:59If a product does not have that brand, I'd run it by your doctor.
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