Where is the market for menopause? A genuine health care mystery

That makes menopause challenging in a health care system designed to manage acute, episodic care needs. Today, most women can’t access appropriate treatment and support without resorting to expensive, boutique clinics. For many mainstream providers, including OBGYNs, menopause care has historically not been a core part of their practice. Provider groups and practices lack reimbursement pathways to help women manage related symptoms and health challenges. Commercial insurers and Medicaid programs do not offer coverage that can accommodate health needs comprehensively. The lack of clinical research and longitudinal data, rooted in decades of misunderstanding, faulty science, and neglect, reflects and reinforces these barriers.

The number of women in need of menopause care, however, is undeniable. Six thousand women in the U.S. enter menopause each day, or about 1.3 million annually. Eight to 10 million are experiencing menopause at any given time, with 75 million women experiencing perimenopause, menopause, or post-menopause.

Despite a projected global value of $37.84 BN by 2035 growing at a 10.3% compound annual growth rate, the menopause market remains highly underdeveloped. Given the massive need for services, there is significant opportunity for investors to back integrated provider-led solutions that drive aggressive growth and profitability.

What will it take to make that happen?

A complex health challenge

Most women enter menopause around age 51 and experience menopausal symptoms for an average of seven years. Perimenopause can begin up to seven years earlier, while post-menopause lasts until end of life.

The hormonal shifts associated with menopause can lead to many health challenges, ranging from hot flashes and sleep problems to brain fog and bone density loss. These shifts can also increase the risk of chronic illnesses like diabetes and cardiovascular disease. When these symptoms and conditions are left untreated or unaddressed, they can diminish health, productivity, quality of life, and physical, emotional, and economic well-being for decades.

Menopause research is only beginning to flourish after decades of misunderstanding. In 2002, an NIH-funded Women’s Health Initiative study into the effects of estrogen on post-menopausal chronic conditions showed significantly higher risk of heart attacks, blood clots, strokes, and breast cancer. This dramatically curtailed the study and use of hormone replacement therapy until a 20-year follow-up study revealed that those dangers had actually been statistically insignificant. 

Today, new research has brought increased focus on symptoms, causes, complications, and effective treatments even as wearables like the Apple Watch and Oura Ring are aggregating more data. Advocates and peer networks are helping to raise awareness and amplify calls for better care.

The importance of integrated care

Like family planning or care for chronic illness, effective menopause treatment is anchored in primary care; but it is also a specialty that requires deep understanding of hormonal health and appropriate training to guide care plans.

Health systems recognize the need for menopause care but face barriers. The lack of claim codes and government-directed coverage makes reimbursement difficult; and few can afford to offer 30-minute clinician visits and coordinated follow-ups. Menopause HEDIS measures, which could incentivize better care, were retired in 2005.

Less than 20% of physicians receive formal training or instruction on menopause during medical school. Only 31% of responding OBGYN programs reported that menopause training was part of their curriculum. Less than half of women report that their care provider helped them understand what to expect during their menopause transition. These percentages are likely to improve in the coming years with more attention on menopause.

There are currently 4,100 multidisciplinary menopause centers at academic health systems around the country. But patients face long waitlists, and coordination with primary care and other specialists is usually lacking. This makes navigating multiple symptoms and care needs more difficult.

Market-based offerings

Big wellness sees market opportunity in providing direct-to-consumer access to menopause-related services like hormone replacement therapy and nutrition support. Medi-spas and boutique clinics are growing in number. Telehealth provider Hims & Hers recently launched a menopause and perimenopause specialty service. Patients pay out-of-pocket but can tap health savings or Flexible Spending Accounts and may be able to leverage prescription coverage. Generally, however, these services are not coordinated with primary care, and the out-of-pocket costs may be unaffordable for many patients.

A growing number of employers offer menopause-specific health benefits, including prescription coverage, paid time off, and other accommodations. Some also provide access to specialized telehealth providers. Maven Clinic partners with large employers like Amazon, Microsoft, and Manulife to direct employees to a range of specialists for menopause care, including OBGYNs, nutritionists, mental health professionals, and physical therapists along with educational resources and community support. Midi Health partners with health systems and benefits platforms like Progyny to provide insurance-covered menopause care. Integration with primary care is not built into those offerings, however.

Unified Women’s Healthcare, one of the nation’s largest women’s health organizations with nearly 3,000 affiliated providers, acquired Gennev, a menopause care platform in 2022. The goal is to unify menopause care with the gynecology and primary care Unified’s patients receive today and create a comprehensive offering. Even a few years into the acquisition, however, there is still difficulty achieving this because of the lack of clear reimbursement pathways.

Elektra Health also provides virtual access to clinical care specialists, but its model is based on integration with primary and OBGYN care. It found the employer market challenging. Buyers tend to prioritize fertility and pregnancy benefits over menopause care or look to a comprehensive women’s health solution, which may not provide the best menopause care path. Instead, Elektra negotiates directly with payers based on the ROI of its interventions. It then works with health systems as a virtual care partner, tracking patients for screenings and coordinating referrals to in-network providers.

In some markets, Elektra provides clinical services, education, support, and community forums. Elektra has also partnered with Oscar Health to launch HeloMeno, providing beneficiaries with labs, hormone therapy, insomnia medications, and bone density scans at no cost in addition to low-cost access to Elektra’s network of providers.

To recruit providers, Elektra draws from primary care or OBGYN clinicians who are then certified by The Menopause Society and receive additional training.

The reimbursement-data challenge

Today, reimbursement is managed by submitting claims across a range of primary and specialty care services. The lack of a standard billing code is a formidable hindrance to better care. Even HEDIS measures for menopause care, initiated in 2000, were retired in 2005, possibly because of erroneous HRT research.

Policy remedies are scant. Since 2024, Louisiana has required Medicaid and commercial plans to cover treatment for menopause and perimenopause. Starting in 2026, Illinois requires plans to cover all FDA-approved hormonal and non-hormonal menopause treatments. No other states have taken similar measures, including California, where the governor vetoed a menopause care coverage bill in mid-2025 on the grounds that it was too far reaching.

Payers are reluctant to take a long-term, comprehensive or bundled approach to care coverage because of member churn. They need robust, longitudinal data to understand the total costs of menopause-related health needs and the ROI of providing proper care.

Today, only 19% of women ever receive a menopause diagnosis, and 70% who seek menopause care don’t receive treatment. Women with a clinical diagnosis of menopause spend 45-47% more on healthcare. Only 26% of women have full insurance coverage for menopause-related prescriptions. For many, out-of-pocket co-pays make those medicines less affordable and accessible.

What are the true costs of health and quality of life challenges related to menopause, including chronic conditions like osteoporosis and diabetes? How much could be saved with integrated clinical care, nutrition counseling, behavioral healthcare, and HRT? In a commissioned study of 2021 claims data from 2.6 million women aged 40 to 60, Elektra determined that menopause-related costs are $14.9 thousand per member per year or between $107 thousand and $209 thousand over a 7 – 14 year transition period.

No doubt, more data will help fortify the argument, but the potential savings are evident.

Conclusion: A new chapter

Until recently, behavioral health was overlooked, underfunded, and insufficiently appreciated for its impact on physical health, total care costs, and economic productivity. With accumulated research, reduced stigma, and passage of the Mental Health Parity and Addiction Equity Act, stakeholders came to recognize the critical importance of more comprehensive, integrated care services. Scalable models are emerging in different markets to meet the pressing human and societal need.

Menopause care is positioned to follow a similar trajectory because of growing awareness, improved research, increased advocacy, and better understanding of total care costs. Menopause care is not a replacement for primary care or OBGYN care; it is a specialty that must be complementary. Integrated, in-network care platforms that offer a scalable solution have the most potential for expanding mainstream access. Virtual platforms help with margins and scalability. Clinical care, reimbursement, and purchaser economics must align. Commercial insurers are hampered by the ability of beneficiaries to change plans frequently, just as employers fear losing employees. But menopause care needs are highest for women who are still in their prime career years and more likely to remain with their current employer and insurer. Menopause care can be viewed as a recruitment/retention strategy that keeps healthcare costs down.

Menopause has been treated as a niche market for too long, but it is a natural stage of life that has major ramifications for health, productivity, and healthcare costs. There’s no mystery to the demand or the need. It should be increasingly possible for service providers to operate profitably and at scale. Investors and sponsors should be enticed by the size of the menopause market and the growth and profitability potential for menopause services while remaining mindful of the challenges and barriers.

A podcast recording of the full conversation accompanies this article.

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