We need more focus on perimenopause

In 1977, the FDA explicitly barred women of “childbearing potential” from clinical trials, citing fears of birth defects if participants became pregnant after a clinical trial mishap. While the move was well intentioned, the cost was staggering. For 16 years, women were systematically excluded from all of the data that drives modern medicine. When the National Institute of Health finally reversed course through the 1993 Revitalization Act, mandating the inclusion of women and people of color, but the damage was already done.

The consequences are everywhere. One small example — the FDA has approved more than 30 different testosterone therapies for men, but not a single one for women, even though both sexes produce and rely on the hormone. Doctors can and do prescribe testosterone off label for women during perimenopause, but insurance rarely covers it. That leaves many women paying out of pocket for treatments that could dramatically improve their quality of life.

Meanwhile, human biology hasn’t materially changed. Women’s bodies still move through the same stages: estrogen, progesterone and testosterone all fluctuate and decline as we age. 

While menopause has been recognized for centuries documented as far back in western medicine as French Revolution times, knowledge never translated into a practice of care. For most of modern history, the medical establishment shrugged at what is in fact one of the most significant hormonal and physiological transitions a human body undergoes. And I think I can safely say that women are done running in circles when they need perimenopausal medical care. And when it comes to perimenopause, the symptoms are still frequently misdiagnosed as depression, anxiety, thyroid issues or simply “stress,” and women lose years cycling through incorrect treatments while their actual needs remain unaddressed.

And the scale of this issue is only growing. Today, almost 45% of American women are in perimenopause, menopause or postmenopause. Over the next decade, tens of millions more will join them, pushing that number toward a majority of American women by 2035.

This is one of the largest demographic health shifts of our time, and Gen X and millennial women are refusing to stay quiet. They carry the legacy of dismissal, but they’re turning the tables around and are demanding that women’s midlife health is treated as a public health crisis rather than another one of life’s burdens.

Gen X women are now living through perimenopause themselves. They’re in online communities talking to one another and figuring out that they aren’t alone, and this is an important step in driving health at scale. Millennials, who have already disrupted taboos around mental health, IVF and skyrocketing PCOS diagnoses, are amplifying the conversation through podcasts, TikTok and workplace advocacy. Together, these generations are rewriting the script for women’s health care to where perimenopause and menopause are not shameful, not invisible and not negotiable. They are natural, important and transformational.

Traditional medicine’s failure to show up has created a wave of startups filling the gap. Tia, Midi Health and others are reimagining women’s primary care and their rapid growth is both an indictment and a blueprint: Women’s health deserves attention, investment and innovation.

The solution at scale requires systemic change. Medical schools must require menopause and perimenopause education in their curricula. The FDA needs to prioritize therapies for aging women as aggressively as it has for men. Insurance providers should cover treatments based on medical need and not regulatory inertia. We cannot afford another generation forced into stoic endurance. The coming tsunami of 100 million American women in midlife are shouting at the top of their lungs that it’s time for medicine, policy and culture to catch up.