The $19 Billion Menopause Economy

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0:30Bill, why is my eye twitching? Does this mean I'm in perimenopause? Where's my phone? Juliana, maybe we can ask an actual human. Yes, because I have questions and I bet you do too. Like, is it normal to sleep in separate bedrooms? We do that and I still need to know why my poop's been green. We've got actual people answering these exact questions. Listen to Bill and Juliana. The podcast. On the iHeartRadio app, Apple Podcasts, or wherever you listen to your podcasts.

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1:32Bloomberg Audio Studios. Podcasts. Radio. News. Yasmin Harris was in her early 30s when she started noticing unusual symptoms. I was tired all of the time. My mood was horrible. I also started having minor hot flashes, right? My sex life just went 100 % out of the window. Around that time, she also got her first ever urinary tract infection. So that, as well as kind of like the mood swings, was really high on my radar that something more has to be going on with me. She says her primary care doctor told her it was probably just too much stress. He put her on antidepressants for her mood swings, talked to her about bathroom hygiene, and sent her on her way.

2:22One night, a few years later, in her kitchen around dinnertime, she started having chest pain and got diagnosed with heart failure. Her doctor put her on a series of medications, and eventually she was given a pacemaker. She was only 39. Shortly after, her periods became irregular, lasting for weeks at a time. Yasmin felt like this all had to be connected. I started Googling and just doing a ton of research, and one of the very first things that came up highlighted menopause and perimenopause. But she says her gynecologist told her she was still a little too young to worry about it. She gave Yasmin a prescription for birth control to manage her cycle.

3:07Still, Yasmin didn't feel satisfied with the care she was getting. So she turned to the internet for a second opinion. And she found plenty.

3:16Kristen V. Brown:Let's talk about some researched ashwagandha benefits for menopause. Taking a black coho supplement that I got from Whole Foods, and that has really seemed to be helping me. You need three supplements that are going to help bring back your intimacy, your libido during menopause. What worked? What didn't work? Nothing worked, Sarah. Nothing. Absolutely nothing. Nothing. Nothing worked. How much do you think you spent on these kinds of remedies and treatments and things that you'd found online? Girl, I've spent easily thousands of dollars. When women suspect they're experiencing the lead-up to menopause, finding the right way to treat their symptoms isn't always straightforward.

4:01And while a growing industry of startups and supplements are advertising more and more options for women seeking that treatment, the healthcare mainstream hasn't kept up with their needs. That's led to a massive, nearly$19 billion global menopause market, dominated by non-medical treatments, as opposed to evidence-backed therapies. This need is being filled by telehealth companies and Instagram influencers because it's not able to be met by the medical community. Kristen V. Brown is a health and science journalist who recently wrote a story for Bloomberg Businessweek tracking the rise of the menopause economy.

4:42She says the overall market for menopause treatment is expected to exceed$28 billion by 2033. We are in the midst of a menopause gold rush. But is it also leaving women behind? There is a real mismatch, and there is a real need to give more access to care, but that access isn't really coming from the best place for patients.

5:10I'm Sarah Holder, and this is The Big Take from Bloomberg News. Today on the show, we go inside the big business of menopause. From TikTok medical advice to complicated healthcare systems, how are women navigating this multi-billion dollar market? And will more money pouring into it make it easier or just more crowded?

5:36So about six months before I turned 40, like, it had gotten a calendar alert. Instagram started just serving me the menopause content. Health reporter Kristen V. Brown is writing a book about female fertility. She's also a woman on the internet. And when the menopause posts started coming, they didn't stop. And I have to tell you, it was so depressing. There are all these symptoms, right? Itchiness, weight gain, which, you know, is associated with menopause, but also like men experience weight gain in midlife, right? It's just like a fact of aging. And I started looking at myself, at my own aging body, and I was like, oh, I am itchy.

6:16I have gained some weight. Like, I have been kind of hot at night sometimes. And I mean, honestly, Instagram basically convinced me that I might be in perimenopause. Perimenopause is the stretch of a woman's life that comes before reaching menopause. So menopause, it's one day in your life, right? It's the day that you have gone 12 months since having a period. And a lot of the symptoms people sometimes associate with menopause actually begin in the lead-up to that single day. Because that's when your hormones are, you know, kind of going wild as your ovaries are kind of shutting down production, if you will.

6:55Those symptoms might be itchiness, hot flashes, or weight gain. They might also be mood swings or brain fog. Physical and emotional. And I think that's what makes it hard to diagnose because it's also happening at a time in your life where your body is just, you know, starting to not work as well in general. So it can be hard to know, is this menopause or is my skin just getting dry because I'm getting older? Yasmin Harris had similar questions. According to the Mayo Clinic, the average woman in the U.S. experiences menopause at age 51. Yasmin was in her 30s. But when the traditional healthcare system didn't have answers, Googling her symptoms had her convinced.

7:37Because the symptoms just, they just all fit, right? Yasmin asked her gynecologist to test her hormones at one point. And she says the doctor told her she didn't find indicators of menopause. I think that's really one of the tricky things about diagnosing it. is there's no test that you can take and say, oh, you've crossed some specific hormonal threshold and now you're in perimenopause. It really is just evaluating the sort of constellation of symptoms and trying to put together a picture of whether you are transitioning. And Krizin, how has this period of life been talked about historically?

8:15How has the healthcare industry approached perimenopause? Historically, menopause has been something that we haven't really talked about. And I think that's one of the biggest problems is, you know, it's been something that's sort of whispered about. Your doctor never talked to you about it. Your mom maybe never even talked to you about it. So women are going into this phase in their life without a lot of information often. I actually reached out to my mother as I started doing the research. And my mother is in her mid to late 60s now, and she didn't know any of this stuff either. Kristen says that even doctors don't always have the information.

8:54Something like 70 % of OBGYN training programs have no formal menopause curriculum, right? So they're literally getting no formal training on this. That's kind of crazy, something that every woman goes through. It's really crazy that doctors are not learning about it. And that's in part because of, you know, a scare over prescribing the best treatments for it. There have been treatments for many of the most common perimenopause symptoms, like hot flashes and vaginal dryness, for decades. The gold standard is hormone therapy, a boost of estrogen delivered as a pill, patch, or cream. Kristen says the therapy has faced setbacks on the road to wider adoption.

9:37Research in the 1970s linked it to higher risks of uterine cancer, though the problem has been mitigated by adding progesterone to the treatment. Then, in 2002, the U.S. National Institutes of Health published results from a randomized controlled trial called the Women's Health Initiative, suggesting that the risks outweighed the benefits. Doctors decided, you know, this isn't safe for women, and so people didn't learn about it because there wasn't a treatment option that the medical community sort of agreed with safe for a long time. You know, those sort of thoughts and feelings about hormone therapy have been walked back.

10:14You know, we now understand that they were sort of overblown, right? But in the meantime, you have generations of OBs who have received no training. At the same time, 1.3 million women go through menopause every year, right? So that math isn't mathing, right? There's just not enough practitioners. And so this marketplace has emerged to sort of fill that gap. Did you know that red light therapy can actually help more than just the skin? It can actually help with a range of menopause symptoms.

10:42Kristen V. Brown:You mentioned last month that I'm going through perimenopause. That's why I'm partnering with MidiHelp. If you're a woman approaching menopause, here's four supplements you must take. Kristen says this marketplace has flourished online as Gen Xers and millennials reach perimenopause. We are a very online generation, right? If the doctor tells us they can't do anything, we get on Reddit, we get on ChatGPT. We say, no, thank you. I'm going to find a solution myself, right? You have telehealth companies like Midi and Alloy that kind of grew out of the post-pandemic telehealth boom and looked at companies like HIMSS and said, oh, well, what they're doing for erectile dysfunction and, you know, later GLP-1s, we can do for menopause.

11:29Midi Health, which was founded in 2021, became the first menopause unicorn this year, meaning it's valued at over a billion dollars. Using their services, women can get prescribed hormone therapy and a host of other treatments. You can now get GLP-1s through them. You can get peptides, right, like longevity peptides that are prescribed by a doctor. You can get lots of supplements, right? So they are not just selling kind of the gold standard treatment, but also some of these things that there is less evidence behind. In emailed statements to Bloomberg Businessweek, Midi and Alloy emphasized their commitment to helping women access hard-to-find evidence-based care in a confusing marketplace.

12:14They said that they don't push specific courses of action and that they're dedicated to helping each patient find appropriate individualized care. Beyond established telehealth brands, there's also a vast cottage industry of individuals looking to cash in. This proliferation of influencers and doctors who have become influencers dispensing advice, often while also trying to sell you something, right? And so these things have coalesced to create this very noisy environment where women are learning about hormone therapy, but they're also learning about, oh, do I need a weighted vest? Do I need to take black cohosh?

12:55Black cohosh? What is that? It's this weird supplement that you really should not take probably without consulting your doctor because like a lot of supplements, it has been associated with liver damage. So I mean, these things, most of the things, right, you know, like a weighted vest, I mean, the evidence isn't great. The biggest risk is probably to your pocketbook, right? But some of these things could have real consequences. And then when you get into hormone therapy, women may need different hormone therapy products, different levels of them, right? You could just not be getting the right thing for you, right, if you don't see the appropriate medical professional.

13:32So there's really a lot of nuance in both making the diagnosis and approving and prescribing the appropriate treatment.

13:43So, will all this money pouring into the alternative menopause market make finding good care any easier? That's after the break.

14:10you.

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14:57Bill, why is my eye twitching? Does this mean I'm in perimenopause? Maybe I have adult ADHD. I need to look this up. Where's my phone? Juliana, your phone is hot to the touch. I think it's asking you for a break. You know what? Maybe I should just ask ChatGPT. Or maybe we can ask an actual human. Yes, like a couple sex therapist. Whoa, that escalated quickly, but okay. Because I have questions. We have questions. And I bet everyone has questions. Like, is it normal to sleep in separate bedrooms? We do that. How about this one? Is bribing your kids bad parenting or just negotiating? Oh, and I still do need to know, why was my poop green that one time?

15:35Hypothetically, right? Okay, well, instead of letting the internet guess, we've got actual people answering these exact questions. And laughing with us has got to be better than spending three hours down a rabbit hole online. Listen to Bill and Juliana. The podcast. On the iHeartRadio app, Apple Podcasts, or wherever you listen to your podcasts.

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16:31The market for menopause care is vast and growing. Journalist Kristen V. Brown says all these startups and supplements are responding to a real need for women. But the industry as a whole still has some growing up to do. Absolutely, there is a care gap and the telehealth companies are helping to fill it. That is indisputable, I think. Like some women are getting the appropriate treatment for them, while others are not getting the appropriate treatment, just sort of like getting prescribed some kind of cookie cutter thing. But the question is, how do you get women quality sort of personalized care?

17:08It's so funny. It makes me think of this, the joke that like if men had periods, cramps would be eradicated. Yeah. That there's women's health, again, has been underinvested in for so long. But I'm wondering, with so much money coming into this industry and so much money being spent by women on this industry, might that inspire more investment in the kinds of treatments and research focused on women's health that thus far have been ignored or under-invested in? You might think, right? No. So unfortunately, you know, there has been a renewed interest in funding women's health, but most of that interest from investors has gone to things that have a clear kind of ROI, like telehealth companies, because really solving the problems, right?

18:00Asking the questions of why does menopause occur? Figuring out if there is an intervention that can slow it. These are all really hard science problems that will take a really long time to, you know, figure out if there is a solution and then see a return on the solution. And Kristen says more research could make a big difference given the staying power of that 2002 Women's Health Initiative study laying out the risks of hormone therapy. One of the problems with the WHI study is that it looked at a population of patients that looked at older menopause patients primarily an extrapolated risk for all women who might be taking hormone therapy.

18:42It sort of drew conclusions that weren't necessarily relevant to every woman who might get this therapy. And then, you know, the sort of like classic thing that happens where like the media also kind of like gets a hold of it. And then like suddenly you have this huge fear about hormone therapy. And I should say that was not the first time that happened with hormone therapy. There's this real pattern you see in history of adopting hormone therapy for menopause, then the medical community deciding that it has too many risks. One of the previous scares was because they did find actual increased incidence of cancer when unopposed estrogen was given, right?

19:23So that was when they added progesterone to the treatment to protect the uterus. Right now, it's about 1.7 % of women who are the appropriate age are taking hormone therapy. Before WHI, it was like at least 25%. Some estimates are way, way higher than that. So, I mean, really, you can see in the numbers the damage that that study and the interpretation of it and coverage of it did. And there are groups, right? Like the Menopause Society that is working actively to combat this, right? training practitioners in how to treat women in menopause. But their efforts just can't yet fill the gap in the number of women that need care.

20:09And that gap in care is what's pushed people like Yasmin Harris into the online menopause marketplace. Even though what she really wanted was for a traditional doctor to hear her out and really get to the bottom of what she was feeling. I had never really stopped looking for a gynecologist that would listen to me. And I was also looking for, you know, a physician that I could more so relate to. So a Black woman physician, because in my experience, I felt like I just wasn't being taken seriously. In February 2025, she found one. And after enduring the typical months-long waiting period for a menopause specialist, she got an appointment.

20:50The menopause specialist puts her on an appropriate dose of hormone therapy. she gets an estrogen patch with progesterone and she said that like almost immediately she started feeling better this is probably going to sound really overdramatic but i promise you the minute i put the first patch on like i felt normal if that makes sense and the really crazy thing that i don't really know if we can attribute this to the hormone therapy her doctor was cautious about that but her symptoms totally went away to the extent that she actually had her pacemaker removed her heart condition vanished, which is, you know, Yasmin's a very, very extreme example.

21:30But I think that she illustrates how women can get caught in all this noise and the care gap. While getting access to care can be challenging, more women are seeking treatment. In the U.S. last year, about 32 million prescriptions were written for a form of estrogen used for menopause symptoms, up from 18 million in 2021. according to data from Symphony Health compiled by Bloomberg Intelligence. And last November, the Food and Drug Administration announced it would drop the black box warning from hormone therapy treatments. The narrative around menopause has been changing, too. There are new books and movies out about this time in a woman's life.

22:13There's less whispering. For Yasmin, talking about paramenopause with the right doctor changed her life. How do you feel today? I feel amazing today. I no longer battle with the perimenopause symptoms. I feel a lot more grounded. I feel a hundred times better and I feel a lot more confident in the care that I'm receiving. And I feel a lot more educated to be able to communicate with my different providers to actually explain to them what I'm experiencing and how I'm feeling.

22:52This is The Big Take from Bloomberg News. I'm Sarah Holder. To get more from The Big Take and unlimited access to all of Bloomberg.com, subscribe today at Bloomberg.com slash podcast offer. If you liked this episode, make sure to subscribe and review The Big Take wherever you listen to podcasts. It helps people find the show. Thanks for listening. We'll be back tomorrow.