Why Innovation in Women’s Health Still Lags And What Needs to Change
Despite growing demand, women’s health remains chronically underfunded. This essay unpacks the incentive structures stalling progress in menopause care, endometriosis, and midlife health innovation.
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In 1998, Viagra launched and changed everything. It wasn’t just fast-tracked. It was embraced by regulators, investors, media, and men. Appoved in six months1. Backed by billions. Framed not as indulgent, but essential. Became a billion-dollar drug.
That same year, a menopausal woman in the U.S. was still being told that hot flushes were “just anxiety.” Her brain fog, just stress. Her low libido, just disinterest.
Viagra became a symbol of vitality. Midlife women became a symbol of decline. The system didn’t just reward male biology. It priced female biology out of the market.
In Part 1 of this series, we explored what gets excluded when longevity tech ignores women’s bodies. In Part 2, we looked at how those gaps deepen after 40. Today, we ask the harder question: Why does innovation in women’s health keep falling behind no matter how big the market or how strong the science?
New Here?
This is Part 3 of my five-part series on why longevity tech needs a gender lens. If you are an investor, operator, or women’s health advocate, start here.
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The Real Reason Innovation in Women’s Health Still Lags
Every investment is a story about incentives. We don’t fund what matters. We fund what maps neatly to a model. What’s easy to measure. What exits fast.
That’s how you get erectile dysfunction as a public health success story and menstrual pain confined to Instagram wellness reels. Because in biotech, the real driver isn’t unmet need. It’s quantifiable upside.
What the Market Rewards
Biotech loves a clean biomarker. Pharma wants a definable disease. Regulators need endpoints. And venture capital wants 10x returns - on a 7-year clock.
But women’s health, especially at midlife rarely fits the mold.
Menopause? No diagnostic standard2.
Endometriosis? Often misclassified or delayed.3
Female sexual dysfunction? Still debated as a legitimate category.
Even when the data is robust, the ROI doesn’t hit the familiar signals.
I know a founder who built a precision diagnostic for endometriosis. Her science was airtight. She had partnerships lined up across Europe. A top-tier VC told her: “We just can’t model the exit.”
Women’s health doesn’t just fall through the cracks. It was never designed into the system. That’s why funding lags. And innovation stalls. Because without structural alignment, suffering doesn’t convert into scale… unfortunately.
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It’s Not Just Bias. It’s Infrastructure
Stigma is real. Bias is real. But the deeper issue is this: the infrastructure wasn’t built for women.
Even wearables use male circadian baselines. Even menopause is miscategorized as sleep disturbance or mood6. And so the capital system labels women’s biology as complicated. Too nonlinear. Too emotional. Too hard to underwrite.
And founders have to swim upstream through all of it: regulatory drag, reimbursement gaps and market skepticism so deep, it borders on denial.
Even when millions of women are suffering. Even when the data is clear. Even when the solution is obvious.
I Have Seen The Pattern Up Close
This is the part most people miss. The system isn’t malfunctioning. It’s performing exactly as it was designed to:
to favor speed over nuance.
endpoints over complexity.
profit over persistence.
I’ve spent 20 years inside the system advising investors, managing billions, sitting across from the people who decide what gets funded.
I have seen how brilliant female founders get told their addressable market "feels soft." I have seen data-backed science dismissed because it doesn’t fit the standard drug playbook. I have seen investors say “too early” while 1 in 3 women over 40 suffers in silence.
This is not just bad investing. It’s bad math.
If you care about changing the future of care, join me in the Women’s Health Investing Masterclass. Because awareness drives intention. And intention changes everything.
Incentives Can Be Rewritten
The system isn’t broken. It’s doing exactly what it was built to do. But that doesn’t mean it has to stay that way. Incentives are not fixed. They evolve with public pressure, commercial proof and narrative power.
We’ve seen it before:
HIV went from panic to priority
Mental health went from stigma to startup category
Erectile dysfunction became a symbol of vitality, not shame7
We can do the same for women’s midlife health. But only if we build:
Clinical trial design that reflects female biology
Investment vehicles that back complexity
Media narratives that redefine relevance
Because what we fund is what survives. And what we overlook quietly disappears.
This Is The Moment
There is no longevity revolution without women. No aging well if we ignore the aging female body. If we want to build a healthcare system that truly sees women, we need to start with how we fund it.
If this essay moved you, share or restack it.
Public pressure and narrative power change incentives but only when we show up.
Those who can fund the future, should. But every one of us can amplify the future we want to see. Share this with your network. With your employer. With your doctor. With anyone who still thinks this is “just a women’s issue.”
Because the future of care depends on who speaks up and who gets heard.
This is Part 3 in a five-part series on why longevity needs a gender lens. To go deeper, pre-order my upcoming book The Billion Dollar Blind Spot to learn why women’s health is the future of healthcare investing.
Join Our Network
Are you building or backing credible, under-the-radar solutions in women’s health?
We want to hear from you. Reach out privately or reply to this post. FHV curates brands and breakthroughs that deserve broader attention in the women’s health ecosystem.
I write weekly at FemmeHealth Ventures Alliance about capital, care, and the future of overlooked markets. If you are building, backing, or allocating in this space, I’d love to connect.
Disclaimer & Disclosure
This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.
References
Viagra sales: Approved by the FDA in March 1998, Viagra generated over $400 million in U.S. sales in its first year and became the fastest-selling prescription drug in history at the time. It crossed $1 billion in global annual sales by 2000.
Sources:
The New York Times, “Viagra Proves a Potent Hit for Pfizer” (1999)
Forbes, “Viagra: The Little Blue Pill That Could”
Pfizer Annual Reports, 1998–2000
Lack of diagnostic standard for menopause: There is currently no universally accepted biomarker or diagnostic test for perimenopause or menopause. Diagnosis is often based on symptoms and menstrual history, leading to delayed or missed care. Many guidelines (including from the North American Menopause Society and British Menopause Society) explicitly state that hormone tests are not required and may even be misleading, especially for women over 45. Diagnosis is still clinically based on symptoms and menstrual patterns not on a universal test.
Sources:
Mayo Clinic
North American Menopause Society
British Menopause Society guidelines (2023)
Endometriosis diagnosis delay: On average, it takes 7–10 years for a woman to be diagnosed with endometriosis after symptom onset.
Sources:
NIH Office of Research on Women’s Health
The Endometriosis Foundation of America
Fuldeore & Soliman, Journal of Managed Care & Specialty Pharmacy, 2017
Clinical trials underrepresenting women post-reproductive age: Most trials do not stratify by sex after age 50, and older women are routinely underenrolled in clinical studies, especially in cardiovascular, oncology, and neurology research.
Sources:
FDA Drug Trials Snapshots (2020–2023)
Nature Reviews Drug Discovery, “Sex Bias in Clinical Trials” (2020)
U.S. Government Accountability Office, “Better Oversight Needed for Inclusion of Older Adults” (2022)
NIH funding gaps in female-specific conditions: Female-specific diseases (e.g., endometriosis, fibroids, chronic pelvic pain) are underfunded relative to disease burden.
Sources:
Becker et al., American Journal of Obstetrics & Gynecology, 2021
NIH Research Portfolio Online Reporting Tools (RePORT)
WHAM Report: “The Case to Fund Women’s Health Research” (2023)
Menopause apps misclassifying symptoms: Studies have shown that popular health apps often fail to track or categorize menopause symptoms accurately, defaulting to non-specific sleep or mood issues.
Sources:
Journal of Medical Internet Research, “Quality of Menopause Apps: A Review” (2022)
ORCHA (Organization for the Review of Care and Health Apps), 2023 audit
Incentive-driven turnaround examples:
HIV: Public health prioritization accelerated in the 2000s after massive advocacy and targeted funding.
Mental health: Global mental health market projected to exceed $537B by 2030.
Erectile dysfunction: ED was rebranded in mainstream media and pharma marketing as a quality-of-life issue for aging men, not just a stigma.
Sources:
WHO Global Health Estimates
Statista, Mental Health Market Forecast
Harvard Health, History of ED Treatment
Sorry, but the country can’t afford to divert limited public funds to these issues; we need to spend all available funds on the only health issue that really matters: ED 😊
Women have never been a priority with HIV. Quite the opposite whereby there is concerted effort to silence women living with HIV if they do not adhere to the "community guidelines" which include not talking about how women acquire the virus.