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After being ignored for years, menopause has entered the public debate.
Celebrities from Drew Barrymore to Naomi Watts have spoken out about symptoms and promoted products. But despite the increasing talk, there's still a long way to go in treating the symptoms – and there are plenty of opportunities for companies to step in to fill the gap.
In fact, menopause is one of the women's health issues with the highest unmet need and holds “tremendous potential for innovative treatments,” according to a recent McKinsey report.
The management consultant estimates the global market potential for the treatment of symptoms to be between 120 and 350 billion US dollars worldwide.
Menopause occurs when women have not had a period for 12 consecutive months. While this happens on average around the age of 51, women in what is known as perimenopause can experience symptoms years earlier. The symptoms can persist even in the postmenopausal phase.
These symptoms include hot flashes, anxiety, weight gain, vaginal dryness, mood swings, sleep problems, and changes in skin condition. According to McKinsey, menopause and perimenopause symptoms affect more than 450 million women worldwide.
There's also a lot of unmet demand for menopause products and services, said Anna Pione, a partner at McKinsey who leads the company's research on the future of wellness.
Menopause is “underserved, underfunded and under-recognized,” she said. “That would apply to women’s health in general and then specifically and acutely to menopause in particular.”
“Exciting” developments
Hormone therapy was the typical treatment for menopause for decades. However, it got a bad rap in 2002 after a study by the Women's Health Initiative found that estrogen-progestogen therapy increased a woman's risk of breast cancer and heart disease.
“Many women chose not to take hormone therapy because of their own fear, or because their doctors were afraid, or a combination thereof,” said Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women's Health and medical director of the nonprofit Menopause Society.
A 2012 study found that claims for hormone therapy fell by more than 70% from 2002 to 2009.
“Many women no longer had management at all,” Faubion said.
However, research now shows that the benefits may outweigh the risks for women under 60 or less than 10 years after menopause is diagnosed.
“Our knowledge has changed,” said Dr. Karen Adams, a professor at Stanford University and director of the school's Menopause and Healthy Aging Program. “It's really very exciting, but women are shaking the trees trying to find someone who can help them.”
Invest in the topic
There aren't many listed companies in this space. The biggest US name is Pfizer, which has a number of products in its portfolio. These include Duavee and Premarin, hormone therapy treatments for hot flashes and osteoporosis prevention.
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Pfizer year to date
Then it's tiny Biote, whose market capitalization is just over $400 million. The company, which went public in a SPAC deal in May 2022, makes customized bioidentical hormone pellets to address hormonal imbalances.
Hormone treatment in general is a focus area that is “really bubbling to the surface,” said Jefferies analyst Kaumil Gajrawala, who rates Biote a “buy.”
Menopause accounts for the largest market share, he said. Biote uses blood tests to customize its hormone pellets, which are introduced subcutaneously into the body.
“This gives you a consistent delivery amount and … there are no concerns about compliance and whether you remember a day or forget a day,” he said. “In the end, it means you feel better.”
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Biote year to date
In the meantime, Dare to explore life sciencesThe company, with an even smaller market cap of around $47 million, has a hormone therapy in the pipeline. The clinical-stage biopharmaceutical company focused on women's health has an intravaginal ring hormone therapy that will advance to a single Phase 3 trial.
There is also a race for non-hormonal treatments.
Last May, the Food and Drug Administration approved Tokyo-based Astellas Pharma's Veozah, also known as Fezolinetant, to treat hot flashes.
Bayer also has a drug called elinzanetant in its pipeline. The German company said in January that the therapy reduced the frequency and severity of hot flashes and improved sleep in two late-stage trials. Results from a third Phase 3 trial are expected in the coming months, Bayer said. It is then submitted for approval.
Additionally, a late clinical stage biopharmaceutical company Vistagen TherapeuticsThe company, which has a market capitalization of around $100 million, is currently testing a hormone-free nasal spray to treat hot flashes.
In the “non-drug” category, the fertility manager benefits Progyny Recently, the company announced that it will expand menopause coverage through a partnership with private companies Gennev and Midi Health.
“The fact that they are focusing on menopause as one of the next steps of defecation is an indicator of the potential opportunities there,” said Sasha Kelemen, head of women's health investment banking at Leerink Partners.
Private innovation
Nevertheless, many innovations during menopause take place in the private sector.
“Menopause is inevitable, like death and taxes, and all women will go through it,” Kelemen said. “We just don’t have a lot of public women’s health companies yet, and hopefully that will change.”
In 2022, Kelemen arranged a deal for Unified Women's Healthcare to purchase Progyny partner Gennev, a digital platform for providing menopause care. Kelemen did not want to provide any information about the financial conditions.
Midi Health, the other Progyny partner, a virtual care clinic specializing in perimenopause and menopause, is another company attracting investor money. In September, alphabetThe venture capital arm of Google Ventures led a $25 million Series A funding round for the company, bringing total funding to $40 million.
Yet women's health has long been underfunded, and menopause only gets a small slice of that.
“The dollars don’t match the conversations that are happening,” Kelemen said. “Although it is growing, it is still growing too slowly and is definitely out of proportion to the potential impact and the needs of the actual population” that needs to be served.
Still, Kelemen is optimistic that funding will continue to increase. She is also optimistic about consolidation in this area and the potential for new innovations.
“Because it's a hormonal change over a period of 10, 15, 20 years, women's needs will change,” she said. “There is a possibility that multiple platforms will be successful.”