Rethinking Menopause - The Blind Spot Costing Billions in Health and Productivity

This is the third edition of Giant Leap’s deep dive series, where our investment team explores the technologies and approaches addressing global challenges in climate, health and people with commercial solutions. In this continuation of our femtech deep dive series, we share our insights on where we see the greatest opportunities and challenges toward progress.‍

Understanding menopause 

Menopause signifies the end of reproductive years for individuals assigned female at birth and is officially diagnosed after 12 consecutive months without menstruation, in the absence of other medical causes. The transition encompasses:​

• Perimenopause: The phase leading up to menopause, marked by irregular cycles, fluctuating hormone levels, and symptoms like hot flushes or mood changes. This stage can last 4–8 years.​
  
  
• Premature Menopause: Menopause occurring before age 40, potentially due to genetic factors, medical treatments like chemotherapy, or surgeries such as ovary removal.​
  
  
• Induced Menopause: Resulting from medical interventions like hysterectomy or treatments that impair ovarian function, such as radiation.​

In Australia, the average age of menopause is 51 years, though it varies. 

The problem

Despite its inevitability, menopause remains shrouded in silence and stigma, impacting not only those experiencing it but also workplaces and economies. This lack of open dialogue leads to:​

1. Insufficient knowledge and tools mean that many individuals assigned female at birth lack the resources to manage their health during and after this significant biological and social transition.
   
   
2. Healthcare system shortcomings continue to result in a scarcity of accessible, evidence-based solutions for menopausal symptoms and associated chronic health risks.

This is a very real problem. In the US, menopause-related productivity losses are estimated at US$1.8 billion annually, with severe symptoms and inadequate support causing many to reduce work hours, decline promotions, or exit the workforce. In Australia, 25% of women experiencing menopause consider leaving their jobs due to symptom impact and lack of support, and a global survey by the World Economic Forum found that 59% of women aged 45 to 55 experiencing menopausal symptoms reported a direct and negative impact on their work performance.

For women at the peak of their careers, missed opportunities and financial loss exacerbates existing structural inequalities. For businesses, this results in a loss of highly experienced talent. Given ensuring diverse teams and leadership actively improves business outcomes, addressing menopause isn’t just a health issue – it’s an economic imperative. 

Symptoms and long-term health impacts 

Menopause induces various physiological changes affecting essential bodily systems, including cardiovascular, urogenital, and central nervous systems. During the perimenopausal years, the supply of mature eggs in a person’s ovaries diminishes, ovulation becomes irregular, and the production of oestrogen and progesterone decreases.

The significant drop in oestrogen levels leads to symptoms such as:

• Hot flushes and night sweats: Affecting up to 80% of women, with 28% experiencing severe symptoms during perimenopause.​
  
  
• Mental health challenges: Increased incidence of anxiety, depression, and severe mood swings due to hormonal fluctuations.​
  
  
• Urogenital symptoms: Issues like vaginal dryness, frequent urinary tract infections, and incontinence, often untreated despite affecting over half of postmenopausal women.​
  
  
• Sleep disturbances and migraines: Including insomnia and poor-quality sleep, exacerbating other symptoms and impacting quality of life and work performance.

Additionally, menopause is associated with heightened risks for chronic conditions such as:

• Cardiovascular disease: Increased likelihood due to reduced oestrogen levels.​
  
  
• Osteoporosis: Decreasing bone density heightens the risk of fractures and long-term mobility issues.​
  
  
• Diabetes and weight gain: Hormonal changes can slow the metabolism, leading to higher risks of type 2 diabetes.​

These systemic health risks underscore the need for preventative care and early intervention. 

Systemic healthcare failings 

The current system does not work for individual women or for the collective. Women are burdened by stigma, lack of education, and inadequate medical support. 

There is considerable societal stigma attached to the menopausal process, particularly for younger women, women from minority backgrounds and LGBTQI+ people, particularly in workplaces. Research shows that 83% of menopausal women report feeling stigma attached to their symptoms and 37% express feelings of shame. This stigma is compounded by ageism, often resulting in women suffering in silence. 

Health care providers, especially general practitioners (GPs), should be equipped to provide evidence‐based menopause advice to the 3.28 million Australian women aged 40–59 years. This is unfortunately not the case. 

Menopausal Hormone Therapy (MHT) is the gold standard for managing severe symptoms, replenishing oestrogen and progesterone levels to alleviate hot flushes, mood changes, and bone density loss. However, despite its safety and proven efficacy, over 85% of Australian women with severe symptoms remain untreated, attributable to lack of clinician knowledge and lack of access to services. Similarly, while over 50% of post-menopausal women have vaginal atrophy symptoms (vaginal dryness, itching, burning, dyspareunia, and urinary symptoms), fewer than 7% are prescribed vaginal oestrogen treatments.

For patients unable to take hormone treatments, other options include antidepressants or certain seizure and blood pressure medications that have been shown to relieve symptoms like hot flushes. However, these options often have side effects and were not designed specifically for menopausal symptom management.

This underscores the women’s health gap and the critical shortage of research and funding directed toward understanding and adequately treating health issues affecting millions throughout their lives.

Dr Alice Murkies - past clinician, researcher and educator at the Jean Hailes Foundation for Women’s Health - emphasises that one of the most important aspects of menopause care is giving women the time and a safe space to express what they’re experiencing. She notes that menopause is a complex transition, often occurring while women are juggling family, career and ageing parents. Yet, because it isn’t considered life-threatening, many medical practitioners dismiss women’s concerns - despite the profound impact symptoms can have on their wellbeing. 

Managing menopause in the workplace 

The stigma surrounding menopause in the medical realm is also felt in the workplace.

WORK180 CEO and co-founder Gemma Lloyd notes, “This shows us that women are suffering in silence and are choosing to leave rather than feeling that they’re able to have this conversation with their employer.”

Workplaces can move towards best practice by implementing a menopause policy that empowers staff to ask for adjustments that help them ease or manage symptoms without embarrassment, carry out their role in a safe work environment, and foster an inclusive work culture through open dialogue. 

Over the course of 2024, the implementation of a workplace menopause policy across businesses accredited as Endorsed Employers on WORK180’s platform rose from 19% to 22%. You can read a copy of WORK180’s recommended menopause policy here. 

Opportunities for innovation

Menopause care is a nascent but rapidly growing market, with immense potential for scalable, tech-enabled solutions. It’s by no means a small one either, valued at US$17.6 billion in 2024 and set to hit over US$27 billion by 2033.

We see immense commercial potential in solutions that are solving these systemic failings by providing accessible, high quality care to women experiencing perimenopause and menopause, as well as preventative care solutions that can help improve health outcomes post-menopause, when women experience disproportionately higher risk of various chronic conditions. 

We’re excited about the opportunity we see in spaces including: 

• AI-driven personalised therapies that tailor treatment plans based on individual health profiles.
• Longitudinal symptom tracking and digital support that empower individuals to control their health data - like Ovum and Clue. 
• Clinically validated digital therapeutics designed to help manage disruptive symptoms like hot flushes - like Mindset Health’s Evia.
• Accessible, clinically validated hormone testing and tracking solutions, including Hormona, Eli Health, Symex Labs, i-Screen and Oova.
• Digital MHT clinics that lower barriers to accessing the gold standard of care - like Emsee, Viv, Gennev and Evernow. 
• Innovative diagnostic tools for managing post-menopausal vaginal and urinary health, such as Daye’s diagnostic tampons.
• Platforms focused on patient education and stigma reduction to increase awareness and engagement.

Startups and innovators tackling these challenges have the opportunity to transform healthcare outcomes while tapping into a multi-billion dollar market.

If you’re a founder building in this space, or know someone who is, we’d love to hear from you. Get in touch with us here. 
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A note on language: In this deep dive, we use “women’s health” to refer to a market segment and health concerns specific to individuals assigned female at birth, regardless of gender identity. We acknowledge that not all people assigned female at birth identify as women and recognize the need for inclusive and responsive healthcare for intersex, transgender, non-binary, and gender-diverse communities.