Digital Health, Menopause, And The $150 Billion Ignorance

The idea of this story came from personal experience. During the past year, I have spent countless hours and a bucketload of money trying to figure out what the heck is wrong with my health. I was feeling worse and worse, having various symptoms, totally inexplicable with my impeccable test results. During this journey, not a single doctor asked or suggested that my symptoms may come from entering perimenopause - the stage of life of women preceding menopause.?

I am 47 years old, and as I have learned since then, extremely average in starting to have perimenopause symptoms at the age of 47. Also very average with the specific symptoms I have. And even more average in entering this phase of my life with zero practical knowledge or info about the possible symptoms, and treatment options. As it turns out, an overwhelming majority, about 90% of women report the same.?

A loss of $150 billion every year

Perimenopause and menopause have lasting health implications that profoundly impact our aging process - how we retain strength, mobility, and cognitive abilities. This isn't an issue confined to a few years, it impacts all women over 45 - that's roughly 1.2 billion people worldwide, about 30% of the living female population till the end of their lives. And around 40% in developed nations where lifespans are longer.

Even if we don’t care about the “subjective” factors, like women feeling terrible and getting osteoporosis, hard economic reasoning also dictates that humanity should tackle the issue of (peri)menopause. The annual global economic impact from productivity loss and healthcare costs is estimated at $150 billion, Bloomberg reported.

Despite menopause's far-reaching consequences, funding for medical research in this area is shockingly scarce. Of the $254 million invested in women's health technology over the past decade, a mere 5% has been allocated to menopause treatments. Most funds were prioritized for reproductive health and fertility. We have already analysed how underfunded female health issues are in general, menopause is a great example.?

Dr. Mary Clair Haver, an American OB-GYN specializing in menopause revealed a disheartening observation from her training: many women detailing (what we now recognize as) menopausal symptoms were handed over to her with the label "WW patient" (as in whiny woman) along with dismissive condolences. Even today, responses such as "It's all in your head" or "Why the drama, get over it!" remain distressingly typical.

The doctor also shared that it's not uncommon for women to be taking 7-8-10 different medications for various symptoms by the time they reach her. These women recognize that something is wrong, seeking help from one doctor to another. However, healthcare professionals often fail to recognize (peri)menopause as the root cause. Instead, they either dismiss the issue or prescribe separate treatments for individual symptoms.

This is worrisome for two reasons: these women fail to receive crucially important info on how to preserve their physical and mental health, strength, bone density, and muscle mass while taking a handful of unnecessary drugs day after day. And meanwhile, their overall quality of life doesn’t improve.

(Peri)menopause symptoms can be confusing: from heart palpitations to anxiety, from sleep troubles to weight gain, from tinnitus to brain fog, from burning mouth to muscle pains, bloating, hair loss and fatigue - seemingly unrelated, very varied. But they are also well documented and should be considered when a woman in the right age cohort (meaning: over 35) starts listing them. Or so you would think.

70% have serious symptoms, 10% receive treatment info

While 70% of women report that (peri)menopause symptoms negatively affect their quality of life, only 10% get sufficient information about treatment options - these shocking figures come from this interview. Canadian Dr. Peter Attia talks about how misinterpretations of the results of the Women’s Health Initiative (WHI) resulted in demonizing hormone replacement therapies in the past few decades.?

Hormone replacement therapy faced a significant setback when results generated a widespread media hysteria reporting that HRT increased cancer risk by 25%. However, a closer examination reveals that the actual increase was from a very small risk to a slightly larger (but still very small) risk. In fact, HRT's long-term protective effects against cardiovascular disease, osteoporosis, muscle loss, mental health issues, and weight management are well-documented and compelling. Yet, the misinterpretation of the WHI study tarnished HRT's reputation for decades.

For many women, HRT can be an effective way to manage menopausal symptoms and improve quality of life. It can help with immediate symptoms, and it can also offer decade-long protection against osteoporosis and cardiovascular disease. But we just don’t know about it.

Digital health to the rescue?

There are signs that the digital health sector is starting to recognize the significant potential for innovation in menopause care. One indication of this is the emergence of calls for research, such as this one:

"The goal of this Research Topic is to bring together a collection of papers that individually and collectively used digital technologies to shed light on the symptom experience during the menopause transition. In so doing, these insights will identify novel strategies for both clinicians and researchers to use in improving the clinical tools and advancing the science needed for enhancing the management of menopause symptoms."

This call for research highlights the growing recognition that digital technologies can be leveraged to:

• Improve symptom tracking and monitoring: digital tools can empower women to track their symptoms more accurately and consistently, providing valuable data for clinicians to inform treatment decisions.
• Enhance self-care: mobile apps and other digital resources can provide women with personalized guidance and support for managing their symptoms, promoting self-efficacy and reducing the burden on healthcare systems.
• Advance clinical research: digital technologies can facilitate the collection of large-scale, real-world data on menopause symptoms, enabling researchers to identify new patterns and trends, and develop more effective treatments.

The global menopause market hit $15.4 billion in 2021 and is projected to reach $24.4 billion by 2030, according to data from Grand View Research - Fierce Healthcare reported. According to findings from a survey, of women who seek medical attention 75% are left untreated.

This is a vast market potential. Venture capital firm SJF Ventures identified 50 startups working in this area, delivering solutions in five sectors, many of which (but not all) list scientific publications and clinical trials on their sites. These categories are

• Biopharma: biopharmaceutical and therapeutic solutions to ovarian health and menopause symptoms.
• Consumer Goods: health supplements, personal care, and sexual wellness products.
• Digital Technology: platforms for menopause management, including symptom tracking, educational resources, and social networks.?
• Medical Devices: devices or wearables that alleviate menopause symptoms such as hot flashes and vulvovaginal atrophy.?
• Virtual and Hybrid Care: clinical care, including consultations and medications, for menopause symptoms.

There are many apps for that

If a woman reaches the point where she suspects she might be experiencing menopause symptoms, there are numerous apps to aid her journey. I've downloaded and tested several myself in recent weeks - including Balance, Perry, Caria and Menopause. Here's what I've learned:

• You can save considerable time by getting detailed info from the app compared to starting research from scratch.
• Most apps I tested did an excellent job collecting menopause symptoms.
• Most go beyond basic symptom recording. They promote a holistic approach, offering advice, programs, and information about how to adjust lifestyle, sleep, nutrition, and exercise to offset symptoms and the long-term negative effects of hormonal changes.
• Several apps feature reviews where users evaluate the effectiveness of various treatment options (HRT, herbal therapies, lifestyle changes) determining whether they helped significantly, slightly, or not at all. This is immensely helpful for learning about various treatment options and making informed decisions.
• I tried free apps, and all of these come with in-app purchases. Understandable, they need to make money somehow. But they are also quite annoying with their aggressive pushiness, and tons of locked premium features. On the other hand, they are typically not expensive, and if you haven’t learned a Ph.D. worth of info by the time you get them and live in their service area - US mostly - using the full-access versions must be much better.?
• The Menopause app from Johns Hopkins is an outlier, which was specifically developed for healthcare providers. Although I am not the target audience, I found its matter-of-fact tone, lack of sales push, and depth of information comforting.

Overall, these apps are great resources for women at this particular stage of life. It's crucial, however, to raise awareness that they exist, so others find them before they have to spend months researching the topic and visiting dozens of doctors looking for the non-existent illness making them feel off.