A neglected aspect of women’s health could represent a $350 billion market opportunity

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. Yet despite the intensifying discussions, there is still a long way to go when it comes to treating symptoms – and plenty of opportunities for companies to step in to fill the void.

In fact, menopause is among women’s health conditions with the highest unmet need and has “enormous potential for innovative treatments,” according to a recent McKinsey report.

The management consultant estimates that the global market potential for treating symptoms ranges from $120 billion to $350 billion globally.

Menopause occurs when women have gone 12 consecutive months without a period. Although this occurs on average around age 51, women may experience symptoms years earlier, known as perimenopause. Symptoms may also persist into the postmenopausal phase.

These symptoms include hot flashes, anxiety, weight gain, vaginal dryness, mood changes, sleep problems, and changes in skin condition. More than 450 million women worldwide are affected by symptoms of menopause and perimenopause, according to McKinsey.

There is also high unmet demand for menopause-related products and services, said Anna Pione, a partner at McKinsey who leads the firm’s research on the future of wellness.

Menopause is “an underserved, underfunded and underfunded topic,” she said. “This would apply to women’s health in general and then specifically and acutely to menopause in particular.”

Hormone therapy has been the typical treatment for menopause for decades. However, it got a bad rap in 2002 after a Women’s Health Initiative study found that estrogen and progestin treatment increased women’s risk of breast cancer and heart disease.

“Many women have given up on hormone therapy because of their own fear, or because their doctors were afraid, or a combination of both,” said Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health and medical director from the non-profit organization Menopause Society. .

From 2002 to 2009, requests for hormone therapy were reduced by more than 70%, according to a 2012 study.

“It left a lot of women without any direction,” Faubion said.

However, research now shows that the benefits may outweigh the risks for women under 60, or within 10 years of menopause diagnosis.

“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 exciting, but women have to shake the trees trying to find someone who can help them.”

There aren’t many publicly traded companies in the industry. The biggest American name is Pfizer, which has a number of products in its portfolio. They include Duavee and Premarin, hormonal treatments for hot flashes and osteoporosis prevention.

Then there is a little Biota, whose market cap sits just north of $400 million. The company, which went public in May 2022 through a SPAC deal, makes personalized bioidentical hormone lozenges to address hormonal imbalances.

Hormonal treatment in general is an area of ​​interest that is “really surfacing,” said Jefferies analyst Kaumil Gajrawala, who has a buy rating on Biote.

Menopause makes up the biggest part of its market, he said. Biote uses blood tests to personalize its hormone pellets, which are inserted into the body subcutaneously.

“It gives you a consistent delivery volume, and … there’s no worry about compliance and whether you’ll remember one day or whether you’ll forget it,” he said. “At the end of the day, it means you feel better.”

In the meantime, Dare to bioscience, which has an even smaller market cap of around $47 million, has a hormone treatment in the works. The clinical-stage biopharmaceutical company, which focuses on women’s health, offers intravaginal ring hormone therapy that is expected to progress toward a single Phase 3 study.

There is also a race to find non-hormonal treatments.

Last May, the Food and Drug Administration approved Veozah, also known as fezolinetant, from Tokyo-based Astellas Pharma, to treat hot flashes.

Bayer also has a drug in development called elinzanetant. 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 study are expected in the coming months, Bayer said. It will then be submitted for approval.

Additionally, a late-stage clinical-stage biopharmaceutical company Vistagen Therapeuticwith a market capitalization of about $100 million, is currently testing a hormone-free nasal spray to treat hot flashes.

In the non-drug category, responsible for fertility benefits Progyny recently announced its expansion into menopause coverage by partnering with private companies Gennev and Midi Health.

“The fact that they are focusing on menopause as one of the next steps in the process is an indicator of the potential opportunity in this area,” said Sasha Kelemen, head of investment banking for women’s health at Leerink Partners.

Yet much of the innovation in menopause is happening in the private space.

“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 companies focused on women’s health yet, and I hope that changes.”

In 2022, Kelemen orchestrated a deal for Unified Women’s Healthcare to purchase Gennev, Progyny’s partner which is a digital menopause care delivery platform. Kelemen would not disclose financial terms.

Another company attracting investors is Midi Health, Progyny’s other partner, a virtual care clinic specializing in perimenopause and menopause. In September, AlphabetThe venture capital arm of Google Ventures, led a $25 million Series A funding round for the company, bringing its total funding to $40 million.

Yet women’s health has long been underfunded, and menopause is only a small piece of that pie.

“The dollars don’t match the discussions going on,” Kelemen said. “Even as it grows, it continues to grow too slowly and is in no way proportional to the potential impact and needs of the actual population” that must be served.

That said, Kelemen is optimistic that funding will continue to increase. She is also optimistic about consolidation in the sector 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 opportunity for success for multiple platforms.”