Midi health; Getty Images; Alyssa Powell/BI
Online platforms reflect a growing demand for menopause care like hormone-replacement therapy.More research is needed to better tailor virtual clinics’ treatment plans.This article is part of “Trends in Healthcare,” a series about the innovations and industry leaders shaping patient care.
When Jodi Miller was 49, she started to experience mood swings, hot flashes, weight gain, and adult acne — some of the many symptoms of menopause.
When Miller, then a middle-school teacher in Rochester, New York, sought care from her OB-GYN, she said she felt dismissed.
“I was told to stop focusing on the negative and to start focusing on the positive,” Miller, who is turning 50 this month, told Business Insider.
Levels of estradiol, or estrogen produced by the ovaries, typically drop to below 20 picograms per milliliter, compared with the 40 to 300 pg/mL produced during a normal menstrual cycle, according to Dr. Mary Jane Minkin, an OB-GYN and clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine.
This hormonal shift can lead to hot flashes and night sweats and negatively affect bone health, cardiovascular function, cognition, and skin elasticity. It can also lead to discomfort during sex because these hormonal shifts contribute to the thinning and drying of a woman’s vaginal walls, Minkin said.
Frustrated by the lack of support for her menopause symptoms, Miller reached out to Midi Health, a virtual care clinic that specializes in helping patients navigate perimenopause and menopause, or the stages in midlife when a woman’s hormones fluctuate and then decrease drastically.
Since launching in September 2022, Midi Health says it has served more than 100,000 patients. It’s one of a few dozen menopause-care startups that have launched since 2010 and one of a handful of virtual and hybrid clinics that offer menopause-symptom support, such as hormone-replacement therapy, to women.
An estimated 1.3 million women in the US reach menopause each year. Now, as millennials — one of the country’s largest generational groups — enter their 40s and many begin to experience perimenopause symptoms, some health professionals anticipate an uptick in patients seeking this specialized care.
Patients are demanding solutions for common and debilitating menopause symptoms
The menopause market — which includes supplements, medical devices, HRT, and telehealth services — is valued at an estimated $5.3 billion in the US and projected to grow by about 4.8% each year until 2030, according to an analysis from Grand View Research, a US- and India-based consulting firm for the energy, healthcare, and technology industries, among others.
One reason menopause-care initiatives are gaining visibility is women’s increasing presence in executive roles in the workplace, said Dr. Neel Shah, the chief medical officer of Maven Clinic, a digital platform that employers and health plans use to provide care for women and families.
With more women in top decision-making and hiring roles — many experiencing perimenopause or menopause themselves — there tends to be more awareness and empathy for employees seeking this type of midlife health support, Shah said.
And companies need to retain talent, so preventing absenteeism and attrition due to employees’ severe perimenopause or menopause symptoms could motivate employers to seek solutions like telehealth clinics for their workers, Shah said.
Miller, for example, said that her hot flashes and heart palpitations made it difficult for her to teach her classes. She was also transitioning to a career in higher education at the time and becoming an empty nester.
“I felt so horrible, and my energy levels were so low that I was ill-equipped to manage it all,” Miller said.
Shah added that millennials entering perimenopause and menopause may be more willing to advocate for the care they want than previous generations experiencing the same symptoms.
Fortunately for Miller, a combination of treatments — including low-dose HRT for estrogen and progesterone, another sex hormone — helped her manage tough-to-handle symptoms. After undergoing the therapy, she said she experienced fewer hot flashes and an increased sex drive. Miller’s doctor also prescribed her a low-dose antidepressant to help get rid of her mood swings and a GLP-1 medication to help her lose about 60 pounds, which helped regulate her blood pressure.
According to Joanna Strober, Midi Health’s CEO and cofounder, doctors may also prescribe supplements and lifestyle changes to patients who want to manage their symptoms.
Ramping up menopause research
As the demand for women’s midlife-healthcare support grows, research and education are critical to improving treatments and support.
“We started Midi out of a realization that very few doctors or medical providers are trained in understanding the issues of women in this age category, particularly with regard to their hormones,” Strober said.
Knowledge about perimenopause and menopause is still evolving, so more research into effective treatments and interventions is needed to improve and tailor treatments, Minkin said.
Researchers are collecting data as part of two long-term National Institutes of Health projects: “The Study of Women’s Health Across the Nation” and “Menopause Strategies: Finding Lasting Answers for Symptoms and Health.” These studies aim to develop a better understanding of women’s menopause symptoms like depression, insomnia, and hot flashes, with the goal of developing more helpful treatments.
Another influential — but controversial — piece of research has been the Women’s Health Initiative. Study results published in 2002 described some types of HRT as increasing some health risks, such as breast cancer and blood clots. In response, doctors resisted prescribing the therapy, Shah said.
However, the interpretation of the data in the media and in clinical practice lacked nuance, and secondary research papers have since demonstrated HRT’s benefits in most women, according to Shah. “To be honest, the medical profession is still catching up on the data,” Shah said.
To further address the need for perimenopause and menopause research and medical care, Congress introduced in May the bipartisan Advancing Menopause Care and Mid-Life Women’s Health Act. The bill is being reviewed by the Senate Committee on Health, Education, Labor and Pensions. If it’s passed, the legislation would boost federal research and public-health promotion of menopause care. Additionally, in his 2024 State of the Union address, President Joe Biden called on Congress to invest $12 billion in women’s health research, which would include menopause.
Most recently, a phase 3 Bayer study found that the nonhormonal treatment elinzanetant can help reduce the severity and frequency of hot flashes, according to a September 10 press release from the pharmaceutical company.
Expanding treatment options and providers for patient satisfaction
Overall, Minkin said, advancing women’s health during perimenopause and menopause requires a comprehensive approach that blends technological innovations like online care platforms with strong research and educational initiatives.
An estimated 30% of residency programs in the US offered a formal menopause curriculum, according to a 2023 report published in the journal Menopause. Minkin said this may be a lingering effect of the Women’s Health Initiative’s preliminary results. She added that an increased focus on menopause across all levels of medical training was needed.
“Addressing the physiological, mental-health, and social-support needs of women during these stages of life demands a multifaceted strategy,” Minkin said. “By integrating technological tools with a strong foundation in research and education, we can work toward closing this gap and improving menopause care for all women.”
After roughly a year of treatment for her menopause symptoms, Miller is flourishing.
“I’m getting my doctorate in higher educational administration, and I would have never been able to navigate such an enormous responsibility without menopause care,” Miller said. “I feel like anything is possible now.”
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