By Katja Rosenkranz
At the Women’s Health Technology Summit on 1st of October, England’s Women’s Health Ambassador Dame Lesley Regan opened by taking apart four persistent myths: that women live longer and are therefore healthier; that the women’s health gap sits at the end of life; that women’s health is only about sexual and reproductive health; and that it is a niche market. Her challenge to the sector was to stop “admiring the problem” and start building solutions.
Women’s health research is slowly moving beyond ‘bikini medicine’ — the focus on breasts, reproductive organs, and fertility that has left large gaps in our understanding of almost everything else. But there is still a long way to go, perfectly illustrated using perimenopause as an example.
Perimenopause is the transitional phase leading up to menopause — when a woman’s ovaries stop releasing eggs and menstruation permanently ends. But during this time, which typically lasts 4–8 years, levels of the hormones estrogen and progesterone do not simply decline steadily; they swing erratically before they fall, triggering a wide range of physical, mental, and emotional symptoms. In a podcast episode on women’s health, urologist Rachel Rubin compares it to a fuel tank that overfills, then suddenly empties without warning.
The symptoms of perimenopause go far beyond hot flushes: many women suffer from night sweats, thinning hair, weight gain, joint pain, anxiety and depressive symptoms. Changing hormone levels also give rise to brain fog, where trouble with memory, concentration, and finding words so closely resembles the cognitive symptoms of early dementia that many women fear the worst.
These symptoms also feed into each other. Night sweats break sleep; poor sleep worsens mood and concentration. In a 2026 US survey, 75% of women with menopausal symptoms reported sleep problems, compared with 50% of those without.
There is also a significant shift in metabolism: an analysis of more than 300 million lab tests from over a million women found that 52 of 90 blood markers change abruptly around the final pre-menopause period — across lipids, liver, kidney and bone — often showing pro-inflammatory signs, potentially increasing the risk for subsequent neurodegenerative disease.
The lesson is simple: estrogen is a whole-body hormone, not just a fertility hormone.
These symptoms vary from woman to woman and from stage to stage, and there is no clear biomarker or diagnostic test for perimenopause But there are treatment solutions: many of these symptoms could be ameliorated with hormone replacement therapy (HRT).
Yet only a small percentage of women who could benefit from treatment are receiving them. In 2025, nearly half of American women between 40 and 60 reported at least one symptom of menopause. Of that group, only 15.6% are taking prescription medications to manage symptoms, according to the CDC.
Why are so many women left untreated? One reason is a general lack of information, leaving women to figure it out on their own. A recent Gallup poll found that only 37% of US women say that they have a good understanding of the symptoms of menopause and only 25% feel they understand menopause treatment options. But another contributing factor is fear.
In 2002 the Women’s Health Initiative stopped a trial of one oral hormone combination treatment after a small rise in the incidence of breast cancer. These findings — widely misinterpreted and overgeneralized — sparked fear among women and clinicians. HRT use among US women plummeted from nearly 26% to under 5%, and research funding dried up.
Some regulatory agencies are now correcting course. In November 2025 the FDA finally removed the black box safety warning that had covered every menopausal hormone therapy product for the past 22 years. While Europe never had a black box warning, the EMA’s latest review is from 2020, and still advises the lowest dose of HRT for the shortest time possible.
Unfortunately, the fear far outlasts the labels. In a global survey of women with moderate-to-severe hot flushes, 56% of eligible European women said they were averse to HRT. Many physicians contribute to the ongoing hesitance, remaining reluctant to prescribe HRTs and warning patients away from treatments with outdated information of disproven risks.
For two decades the HRT debate has centered around one question: what are the risks of taking hormones? Few consider the counter-question: what are the risks of not taking them?
In her podcast episode, Dr. Rubin points to higher risk of osteoporosis, cardiovascular disease, dementia, and recurrent urinary tract infections in postmenopausal women who didn’t undergo HRT.
Randomized clinical trials are few and far between, but some data indicate that HRT could even lower the risk of Alzheimer’s disease. However, many questions remain regarding the long-term risks vs. protective benefits of HRT — which is why we need more research and better trials, not fearmongering and silence.
The costs of inadequate treatments go beyond the burden to each individual woman suffering from perimenopause. In a Mayo Clinic survey of more than 4,000 working women, 13% reported an adverse work outcome due to menopause symptoms and 11% had missed work. The researchers put the cost at an estimated US$1.8 billion per year in lost work time and US$26.6 billion once medical costs are included, just in the US.
HRT is not a magic fix. Even for women who do receive treatment, many symptoms persist. These women are often told by their physicians to accept the issue, wait for it to pass, or maybe try yoga and meditation, because there are hardly any treatment alternatives.
For a condition that will affect most women at a certain point in their lives, this simply isn’t good enough. We need more information and an open conversation. We need more research, to better understand the manifold effects of these hormones beyond fertility and discover new avenues for treatments. And we need better clinical studies and diagnostic tools.
Progress starts with women voicing their experiences and no longer accepting being dismissed. Our job as investors is to listen, to encourage the founders and scientists working in this field, and to start building solutions.
Nearly half the world’s population will go through this transition. The market is not hiding. We just need to start looking.
