Rapid Response: Menopause is having a hot moment, with Midi Health’s Joanna Strober

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0:41That's why over 3 ,000 firms trust Affinity, the CRM platform purpose-built for private capital. Affinity's relationship intelligence reveals your team's strongest paths to founders, investors, and decision makers using insights It's hidden in emails, calendars, and meetings. With powerful AI tools like Affinity NoteTaker and Deal Assist, you'll spend less time managing data and more time closing the right deals. Learn more at affinity.co slash marketplace. Well, let's talk about sex, Bob. Let's just go there, right? As we age and estrogen goes down for about 80 % of women, sex becomes painful.

1:25What happens then? Then women don't want to have sex anymore. Menopause means you have not had your period for a year. Perimenopause is the period of time starting around 35. What I want women to know is at a much younger age, start thinking, if I'm not feeling right, this could be perimenopause and I should be getting treatment for it because you don't have to suffer. Honestly, I think there's a huge acceptance in society of women suffering. The amount of money that's gone into erectile dysfunction versus the amount of money that has gone into sexual wellness for women is just totally unbalanced.

2:06That's Joanna Strober, CEO of Meaty Health, which has raised$100 million to help women with menopause. The topics that Joanna and I discuss in this episode aren't often explored in business media. But that's just the point. Discomfort about addressing menopause is both a cultural limitation and a business opportunity. Joanna explains why 2024 has been a hot year for menopause, how historical errors have stopped women from getting treatments that can improve their lives, and why 10 % of women have left the workplace as a result. She also shares insights about risks worth taking, embracing controversy, and the biggest mistake founders make when fundraising.

2:49There's a lot to learn, so let's get to it. I'm Bob Safian, and this is Rapid Response.

3:01I'm Bob Safian, and I'm here with Joanna Strober, the CEO of MidiHealth. Joanna, thanks for joining us. Thank you. Happy to be here. So MidiHealth is focused on an area that, candidly, we don't discuss much on this show or in society overall, which is menopause. But this year, there's been like a sequence of headlines. You know, Halle Berry on the steps of the U.S. Capitol to promote a new bill for menopause research, a 20-year-old study that scared women and doctors away from hormone drugs for a long time, being debunked, even a New York Times article recently asking if menopause provides a key to longevity.

3:43It feels a little strange to say this, but is menopause having a moment? Have you seen my t-shirt? It says menopause is hot. And I wear it to the supermarket and the woman at the checkout stand will go, it is. But like, why now? Do you have a sense about why there is, you know, attention being paid to something that maybe attention should have been paid to a long time ago, but finally that there's some momentum? So a lot of it does have to do with the Women's Health Initiative study that you initially referenced. When that study came out in 2001, pretty much all research into estrogen and women's health stopped.

4:25That study was just wrong. Not just a little wrong, horribly wrong and horribly misinterpreted. And so you have 20 years of women who have not gotten the right treatments. You have 20 years where no research happened. So a lot of it, I think, is women kind of angry, saying, look, like, we're really suffering here and we deserve better care. And it's time that you start to give it to us. I mean, I remember when that study came out and it was like increased risks everywhere, cancer, heart attack. Like it just made it sound like this is just a terrible idea. The reason we started the company a few years ago was that my co-founders and I read the new information and we said, we want access to this medication.

5:08It protects our bones. It protects our brain. It protects our heart. We were earlier than everyone talking about it now, but we read the revised information and realized how wrong the perception was. Yeah. Why was it so wrong? You know, they had good intentions. They were studying the wrong age people. So almost all the women on the study were over 65. They just didn't interpret the information correctly. And so it actually turns out that women who were within 10 years of menopause and on estrogen actually had a reduced breast cancer risk. And then they looked at the progesterone and they realized that the progesterone was actually causing this.

5:51And now we don't even use that same progesterone anymore. It's a completely different progesterone that we use. So it was just a confluence of events, the wrong age, the wrong medication, the wrong data that many people think it's one of the biggest miscarriages in healthcare in the last 25 years. And the revision was like with the same data, just looking at it differently because there hadn't been any new data collected because no one was using it. That's right. No, it's just looking at the data differently. People are very scared of breast cancer. So as soon as there was any indication at all that perhaps this was causing breast cancer, panic and everything stopped.

6:27Does that mean that studies have to be done all over again to know what's healthy and what's not? I can imagine, and when I told some friends who are women about having this conversation, they were like, Yeah, but do I know that it's safe? There's no new information needed to understand that the data was misinterpreted. There is data that's still missing, a lot of it having to do with the preventative aspects of estrogen. We know that women have 30 % more cardiovascular issues than men, and there's some speculation that that's also connected to estrogen. So now there's research getting started on that.

7:06Can you use estrogen in order to prevent heart issues? For bones, honestly, like it's just 100 % established that taking estrogen prevents your bones from weakening. So I have osteopenia. I started on taking the hormones and my bones stopped deteriorating. I have to tell you, I'm never stopping taking my estrogen because as soon as I stop, my bones will start going down again. And we don't want that. So, you know, what we're telling our patients is do everything you can possibly do to keep your bones strong, whether that means weightlifting or more protein or weighted vests, but estrogen can be a big part of that too.

7:42Menopause has been almost like a taboo subject in some ways. How much of what you're trying to address is a medical issue versus a cultural issue? Well, let's talk about sex, Bob. All right. Let's just go there, right? When women, as we age and estrogen goes down, for about 80 % of women, sex becomes painful. It's because the vaginal wall becomes thin and sex starts to hurt. What happens then? Then women don't want to have sex anymore. It hurts, right? So is that a physical thing or is that a cultural thing? And why is it that when women go to their marriage therapist, the first thing the marriage therapist doesn't say is, have you considered estrogen in your vagina?

8:32Because if you try estrogen in your vagina, you might actually enjoy sex more. And then you don't have to come talk to us every week about the mismatch and sexual desire here. So I want to like, it is all tied together. You can't just say, you know, is it just physical? Is it just emotional? It's all very connected. Honestly, it's the same thing if you're not sleeping because your estrogen is making it so you don't sleep at night and you're having hot flashes all night and then you don't want to have sex, there you go. It's another reason. So it is all very tied together. And it's not just about sex, but that's just one thing that I think about because women have been told just, you know, it's okay, your libido goes away.

9:10But that's actually not the case. It's just that you need things that can help you along. This has been something that has sort of been misunderstood by cultures for, you know, for centuries. Well, and one thing that I've learned that's pretty interesting, so as women age, our skin gets thinner, and that's directly related to estrogen. So there were some early studies done that actually show putting estrogen on your face, it actually thickens your skin and takes wrinkles away. But because dermatologists take care of skin, and they don't learn about hormones, and OBGYNs take care of other parts of your body, but they don't think about your face, no one was making this connection and saying, well, actually you could put the same type of product on your face as you could in your vagina and you can actually help people feel better.

9:55So we're actually making a skin that does that and it works. I mean, it absolutely works. It's the science is there. So there are a lot of just things that are not interconnected or seen as interconnected in our bodies because of how medicine is structured, right? Well, you have a skin doctor or you have a breast doctor and they're not looking at you as a whole body. Are there medical specialists trained in menopause, or are you just going to an OBGYN or a gynecologist that's not specialized in that stage of life? Yeah, so the average OBGYN gets two hours of training of menopause in medical school.

10:36When they go to become OBGYNs, they're learning about babies. That's their job is to deliver babies. So what we have found is that we have to put together a lot of different specialties in our care to basically do this because we have to include hormone specialists and bone specialists and brain health specialists and cardiovascular health specialists. And they each know a little component of it, and then we put it all together. But there's not one group of doctors who have been trained in this. Part of what you do is recruit and train clinicians. Like you are training them about how to engage with menopause?

11:15We are. You can't hire people who are trained. So we have an entire training system that we've built out. It's actually quite extensive because they don't come to us knowing how to do this. You said earlier that menopause is hot. You raised$60 million in May as part of a Series B round. You're continuing to talk with big name strategic investors, as I understand. We're very mission driven at our company. and our goal was really to find investors who were really quite mission aligned. We are a menopause company. We are also a perimenopause company because women don't even know they're in menopause and so they start having symptoms around 35 and 40 and they need a place to go.

11:57But then honestly, we're also a longevity and preventive care company because as I said, women want to stay longer, healthier. And the question is, how can we help them do that as well? There are a slew of virtual options for obtaining supplements and hormone patches and other things that promise relief. So can you describe what makes Midi different? We're the only one that has national insurance coverage. So most of those other companies make money selling you the patch or they make money as like a concierge company. We are the only national virtual care company covered by insurance. By the end of this year, 70 % of all women on commercial payment plans will be covered by MIDI.

12:43And then next year, we hope to go into Medicare. But we are very focused on democratizing access to great care. And the way to do that is to have insurance coverage. You're also expanding into new products, into weight loss treatments like Wagovi and Ozempic and Manjaro and maybe even testosterone. own. Can you talk about what you're exploring and why? So I joke a lot that our core issues are hormones, weight, and sex. Those are the top three that women are interested in. You can't take care of one without taking care of the other. So we saw that 87 % of the women who came to us, weight was one of their top three concerns.

13:24We wanted to make sure they had access to weight loss medications if appropriate. If not appropriate, we also have a whole apothecary of other things that they can take to help their weight if they don't qualify for the weight loss medications. So we'll talk to them about berberine, about metformin, about intermittent fasting. We have a whole weight loss protocol for people who are eligible for the medications and those who are not. Weight gain is often something that comes along with menopause, right? It's incredibly frustrating. Women come to us and they say, I'm not eating any different. I'm not exercise any different.

13:58I'm gaining a lot of weight. And so actually hormones can be a very good solution to that. There is actually evidence that just taking hormones can help you lose weight. There was another study that came out recently that said the best weight loss for women in menopause is combining both hormones and the GLP-1 medications. And then testosterone, I mean, testosterone is really important. So every woman has testosterone, not just men, Women have testosterone. It's been proven that testosterone works to increase libido, but there is emerging evidence, and I want to be careful how I say this. There is emerging literature and evidence that testosterone can be good for our mood, for our bone health, and while testosterone is not FDA approved for women, it is possible to do it in very slow doses and monitor closely, and we're seeing that women are really interested in this and they really feel good on it.

14:50So by August, we should be in 20 states with testosterone. So it's not a on-label FDA use of the testosterone? Am I understanding that the right way? Isn't that crazy? I mean, I don't know exactly why they are regulating it the way that they do, but it is not approved for women, despite the fact that there is research that shows that it absolutely does have proven benefit for increasing your libido. So we do it in a compounded solution, and women are very interested in it. Joanna isn't shy about calling out inequities or taking steps to address them, even if that means off-label use of testosterone.

15:31The fact that Meaty has had to take on training medical professionals about menopause illustrates the gaps in women's health care. It's also smart business, creating expertise that's in short supply. After the break, Joanna talks about how menopause impacts the workplace and the biggest lessons she's learned in fundraising. We'll be right back.

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17:32So if you're scaling, make it simple with Deal. Go to deel.com slash mos and get up to three months free. Before the break, Midi Health CEO Joanna Strober explained why menopause is having a moment in 2024. Now she talks about how COVID rules enabled Midi to get off the ground and the overlooked impact of menopause in the workplace. Let's jump back in. midi is your second startup you built a a digital service for childhood ambacity curbo yeah spurred by some personal experience in your family which you you sold to weight watchers and midi was was also spawned from personal experiences i understand is that right yeah so midi really was initially came out of my co-founder sharon mares and i trying to get hormones we were both experiencing some pretty bad menopause symptoms.

18:30And we were doing the research and we're like, wow, we really should get the access to these medications. And we couldn't get it. I ended up going to my primary care doctor. I said, look, I'm not sleeping. I'm having anxiety. They said, go get a sleep test. You can have some sleep medication once in a while and go to therapy. And I didn't need therapy. So I said, well, what about hormones? And they said, well, we don't prescribe that. So eventually I I went to San Francisco and I paid$750 to go to a hormone specialist. And two weeks later, my entire life was better. I mean, literally, I hadn't slept for years.

19:05And I was sleeping through the night. All these symptoms went away within two weeks. This all happened during COVID. And we realized that the COVID laws were changing. And so the opportunity for this company was now, for the first time, you could offer insurance-covered visits. We started with just two providers. We got them licensed in 50 states. And we just started doing visits. It's, you know, we're growing insanely fast. It's super exciting. But we started just with two providers and we got a lot of feedback from women, what they liked, what they didn't like, how they wanted their care to be different.

19:34And so we've just iterated and iterated to try to make sure that we have something that women really respond positively to. You know, I'm thinking about your initial startup, Curbo, which garnered some controversy around it. You know, the notion of getting kids to diet, sort of that idea kind of sparked backlash. and midi and what it's doing around menopause there i mean there's potential controversy with that also you're you're not phased by the idea of there being controversy or naysayers i'm not you know i think it's really important to give people choice i guess that's really what it comes down to if a child wanted to lose weight and they're that's what they wanted i wanted to give them an option of a safe, effective way to do that.

20:23And if a woman wants to live a life that she feels good and she is able to sleep and she does not have anxiety and her bones are strong and there's a medication that is out there for that, I think she should absolutely have access to that. I guess I feel really strongly that people deserve access to things that make them feel better. And then you can make those choices whether they're appropriate for you. But I don't think that we need to be paternalistic about it. But I do feel really strongly about giving people access to things that help them to live a healthier, happier life. There's a lot of research that show that women's careers actually often get destroyed in their 40s because of these menopause symptoms.

21:01When you can't think straight because you're having brain fog and you're not sleeping, you're not performing as well at work as you want to. And then actually a lot of times women quit. And there's some research that say that 50 % of women think about leaving their jobs because of menopause symptoms, and 10 % actually do leave their jobs because of this. So it's not innocuous, right? This is not just something about, oh, we just want to help them feel better. It's really to help us thrive, to help us provide for our families. It's a really important thing, this care. I was looking at a study by another women's health company recently, Bonafide, about sort of the lack of workplace accommodations for menopause.

21:40Is that another thread of where Midi hopes to have impact? So I'm going to be a little controversial here. If you use the appropriate medications, you don't need accommodations. I believe really strongly that there are medications, there are hormones, there are non-hormonal medications, there are supplements, there's lifestyle. There are things you can do to help feel better in menopause. And I am very focused on that, not on making accommodations for women. I think that could be more stigmatizing than necessary. I'm more interested in asking them to give access and paying for this care so that women can just thrive at work.

22:20My experience of menopause personally is a reflected one, right? From the women in my life, it's not something that I've personally been through. What are the things that you think people misunderstand about menopause, whether women who haven't been through it or men like myself who will never go through it? Okay, menopause means you have not had your period for a year. That's all it means. perimenopause is the period of time starting around 35 when your hormones start to go like this, right? And they're slowly working their way down, but they're a little jagged. So you don't actually know that you're in perimenopause.

22:58And so what happens is that women stop sleeping. They start becoming angry a lot. They go through mood changes. A lot of things happen to our bodies and we don't really understand them. And what I want women to know is at a much younger age, start thinking, if I'm not feeling right, this could be perimenopause and I should be getting treatment for it early. Because you don't have to suffer and you don't have to feel like shit for years, quite honestly, which is what most women do. They don't need to suffer. And also, honestly, I think there's a huge acceptance in society of women's suffering. Like we seem to just think it's okay for women to suffer.

23:33And they're just told, you know, this is just what it's like as you grow older. And that's just not true. So I feel really strongly that we just need to like really be clear with women that when, if something doesn't feel right, you should find the right provider who can help you and can help you find the right medication so you don't have to suffer. Is there a test you can take that will tell you if you're perimenopausal? Women want a test. So they come to us and they say, I want a test. And our providers will say, well, there is no test. And they will say, I want to test. And the provider will say, well, I can give you a blood test, but whatever it shows, it's just going to be a point in time.

24:12And whatever that point in time is, is not going to tell you if you're in perimenopause or not. The menopause test, which is you haven't had your period for a year, that is clear, but it's the 15 years beforehand that's not clear. And women need to be looking for care much earlier. As a business, I'm curious, like women entrepreneurs have a harder time raising money than men, but you have done a very good job in raising a fair amount of capital relatively quickly. Do you take a particular tactic when you're facing, you know, the reality that like it's harder as a woman entrepreneur? There are less dollars that tend to go to women?

24:51Yes. I actually went to a pitch session a year ago before I raised this most recent round. And it was done by David Hornick. He did something called the Lobby for Women. And he was training women on pitching. He had venture people sitting in rooms and you went in and you pitched to them. And you know what? The first two people that I pitched to were super nice. This is nice. Great business. Blah, blah, blah. The third and the fourth one were like, this is not going to get funding. You have not nailed your story. It is not big enough. You don't understand how to tell a story that is big enough.

25:32And they were really honest about what mistakes I was making. And I just remember driving home and I was just, wow, like that was very helpful. It was a little discouraging, but it was very helpful. And I think a lot of times women And probably are like me, we're very practical. Then we're very thinking about our margins. And we're thinking about, you know, the business that we're building. And, you know, one of these men is like, well, you're not telling me why you're going to be a$10 billion company. I was like, well, we could be. And he's like, well, you didn't tell me that in your story. And it was a little humbling, but it was actually incredibly helpful.

26:05I think a lot of times we don't tell the story, we women don't tell the story big enough. And I really did go back and say, look, every woman in this country is going through menopause, every single one of them. And if you look at what's going on in the country with the decrease in OBGYNs, half of the counties don't even have an OBGYN in this county. And in most of the other places, they have nine-month waiting lists. And then you look at the decrease in primary care, and you realize that we have a massive shortage in primary care. And so when you look at that and you look at we have this population, aging population of women, every woman in the country could be actually my patient.