Naomi Watts, Katie Couric, Tamsen Fadal, Alisa Volkman and Natalie Nixon at a menopause symposium in October. Photo / Angela Pham/The Swell via The New York Times
Venture capitalists, former magazine editors and Goop have all converged on the new frontier in women’s wellness.
Whenever a thing is known by a euphemism, it’s probably a thing that makes people squirm. Long has this been the case with menopause, or “the change,” which is typically spoken in a whisper, with an air of tragedy or a joke about a sweaty lady with frizzy hair wailing about something, probably her inevitable slide into irrelevance. Menopause has historically been treated as a way of saying not dead, exactly, but part dead for sure.
Women have been going through menopause (named by a French physician in 1821) and its assorted difficulties since forever. Only recently, however, did this fact of life become a lucrative consumer category.
We’re in the middle of a menopause gold rush. The market is flooding with high-profile, well-funded menopause-related beauty products and telemedicine startups, as well as a growing roster of celebrities willing to admit it’s happening to them. There’s the potential not only for a big cultural shift to happen, but for some number of people to profit off it.
After all, women are living longer than ever and have taken unprecedented steps to spend those extra years in excellent health. Has any previous generation in the history of women done quite so many squats? Consumed so many “good fats”? Sworn off so much bread? Moisturised with such intensity and care?
Modern menopause can be a long, and dynamic, slug of time. It comes in three stages: perimenopause, which typically begins in one’s mid- to late 40s, when the ovaries slow production and estrogen levels begin to dip. Perimenopause can last as long as 10 years and can cause an enormous range of symptoms, from mood swings and headaches to hot flashes and vaginal dryness. Next up is menopause, the moment one year after the last menstruation.
Then there’s postmenopause, which is the period-free rest of your life, when the risk of heart disease and osteoporosis and pretty much everything else shoots way up. The Gen X women who are now reaching these milestones didn’t endure the indignities of Tae Bo just to cut their hair into tidy little bobs and accept these symptoms without a fight.
Their Gen Z daughters are profoundly frank when it comes to their ever-evolving bodies: They would never call their period being “on the rag,” or, God forbid, “the curse.” They have period underpants marketed for slumber parties, tampons that come in adorable wrappers, first-period kits that include hot-water bottles and “conversation starter” sets of cards for discussing the milestone with the adults in their lives. How pathetic would it be for their mothers to be so embarrassed of their own hormonal shifts? Call it generational trickle-up.
As a result of — or, maybe, as a precursor to — these changes in attitude, discussing menopause is no longer taboo.
“I’m going through perimenopause at the moment,” Tracee Ellis Ross told Harper’s Bazaar last year. “It’s really frying my brain.” In a 2020 episode of her podcast, Michelle Obama described a hot flash she experienced on Marine One as being “like somebody put a furnace in my core and turned it on high.” Drew Barrymore remarked on her show that menopause had her feeling like she was filled either with cortisol or cottage cheese.
Erykah Badu posted a video of herself on Instagram with a caption that read, in part: “Peace Peace I’m 51. Let’s talk about the flowering of menopause.”
“I miss the thought of having lil babies in my belly and periods and womb stuff like that,” she wrote. “BUT I AM NOW ABLE TO SHARE MY WISDOM AND JOYFULLY GROW INTO THE GLITTER DRIPPING PHOENIX CREATED THRU THE FIRE.”
It’s no accident that this is coming at a time when the exceedingly narrow confines of beauty are beginning to stretch. Race and size are becoming more diverse in fashion. So why not age, too? There is a line to be drawn between the celebration of menopause and the ascendance of what we might call menocore in fashion, all soft fabrics and gentle shapes. (Will we ever leave behind mom jeans? End the fetish for coastal grandmothers?)
Popular models of the 1990s — Amber Valletta, Christy Turlington, Carolyn Murphy — are experiencing career longevity that models never dared imagine before. Older women have begun appearing in ad campaigns (AYR jeans, Rachel Comey) and on runways. Ageing no longer requires that a woman either accept her invisibility shrouded in Eileen Fisher, or desperately try to appear forever 28.
Entrepreneurs, as a result, have seen a business opportunity in creating an advocacy and visibility movement for menopause. Alisa Volkman, 49, who has twice greeted new phases of her life with an online startup (the sex-positive nerve.com in her 20s, followed by the modern parenting hub babble.com) is now on to the Swell, an online membership community for the middle-aged.
In October, the Swell helped host a menopause symposium featuring Katie Couric and comedian Jill Kargman. (“I loved being in a room with hundreds of women who could commiserate with my waking up in a Jill-shaped sweat stain, heart pounding like Roger Rabbit, and having to insert a tampon with a T-shirt cannon,” Kargman said.)
Like all new wellness categories (like sex toys, for instance, which are now marketed as self-care), it’s an investment category, for a group with specific, underserved needs — and a lot of money.
The new menopause economy divides neatly along medical versus beauty lines.
The telemedicine startups deal largely in the prescribing of hormone replacement therapies, using a business model that has found success in other sectors. Hims & Hers Health, for example, which uses telemedicine to prescribe generic versions of Rogaine, Viagra and a range of antidepressants, birth control and other medications on gender-specific sites, has a market capitalization of more than US$1 billion. The drugs the companies sell are generic versions of the name-brand formulations, and the company gets the profit. Subscription models are famously lucrative, as subscribers often fail to unsubscribe, even when a need has been met.
But HRT is a complicated issue. After a large study in 2002, it was determined that the risks of HRT were greater than the potential upsides. Further studies found that many of those concerns were overblown, or not applicable to populations who might benefit from hormone therapy, but many women and doctors were scared off and have stayed that way. According to Dr Stephanie Faubion, a women’s health expert at Mayo Clinic and the medical director of the North American Menopause Society, the current official position is that the benefits of hormone therapy typically outweigh the risks for most healthy, symptomatic women younger than 60 and within 10 years of menopause onset. Faubion specified that it should be prescribed by a doctor educated in menopause management.
However, most OB-GYN residents get about one to two hours of instruction on menopause care and, when surveyed, said that they did not feel comfortable managing menopause upon completion of their programmes.
These factors, combined with the pandemic accelerating consumer openness to telemedicine, make for a great big gaping hole of opportunity to investors.
“To discover an entire category of health care that is entirely underserved is very, very rare,” said Alicia Jackson, the 42-year-old CEO of the menopause telemedicine company Evernow, which started this year and offers text consultation with trained doctors who arrange for the delivery of the appropriate prescription hormone therapies on a subscription basis.
When Jackson first started looking into the menopause landscape, she said, she was shocked at how little information and support was available for this huge category of human beings. “I live in Silicon Valley,” she said, “and there are all these male billionaires figuring out how to live forever. It’s like, are you kidding me? Every woman who goes through menopause says it’s like she’s the first person on earth who has ever done it because no one knows how to help. If men went through menopause. …” Her voice trailed off.
Jackson said her first call after having the idea for a telemedicine company focused exclusively on treating menopause was to a friend at a Silicon Valley venture capital fund, to ask whether he thought it was worth pursuing. He listened for an hour or so, she said, and then wrote her a check for US$1 million on the spot.
NEA, a major health care venture capital fund, wound up being her lead investor. “It’s a very unique thing for investors to have done their homework,” Jackson said. “But they got religion on menopause early.”
Those investors, Liza Landsman and Vanessa Larco, had indeed done their research: After exploring the possibilities for funding fertility companies, Larco said, she was shocked to come across statistics revealing how few gynaecologists are even trained in menopausal medicine, and how many were uncomfortable treating the symptoms of menopause.
After NEA led Evernow’s first round of investments, the company secured more funding from investors including Gwyneth Paltrow, 50; Cameron Diaz, 50; Drew Barrymore, 47; Abby Wambach, 42; and Glennon Doyle, 46, all of whom agreed to make their involvement public.
Alloy is another splashy menopause telemedicine startup, begun in 2021, that has Dr Sharon Malone, an OB-GYN in Washington whom Obama has called “a godsend,” as its chief medical officer. Its offerings are similar to those at Evernow — hormone therapies following text appointments with a trained medical provider. The company was co-founded by Anne Fulenwider, 50, the former editor-in-chief of Marie Claire magazine who pitched her idea in the midst of what she called “a venture-capitalist-fueled startup frenzy.”
“When I mentioned the word ‘menopause’ in passing to Ankur Jain,” Fulenwider said, referring to the then-29-year-old man who ended up incubating and seed-investing in Alloy, “his eyes got wide and he practically shouted, ‘I’ve been looking for a menopause company!’”
Shocking, really, when Fulenwider considers her days as a young editor at Vanity Fair in the late ‘90s, when she and her co-workers all rolled their eyes and giggled over writer Gail Sheehy’s menopause work. “We were chasing the 25-year-old reader,” she says now, “and menopause was 100% taboo.”
In the other category are the beauty companies that are competing to convince women that the current, enormous beauty market does not consider their very specific needs. Which is mostly for more, more, more moisture — plus cooling sprays.
The entries here include Stripes, a line of “scalp to vag” beauty products for the menopausal woman (stripes, as in, she’s really earned hers) created by actress Naomi Watts, 54. Stripes sells “Vag of Honor” revitalising gel and a facial moisturiser called “The Drench Revolution.”
“I didn’t really get my start until a bit later,” Watts said. “I was 32 at the time of Mulholland Drive and I was told, ‘It’s all going to be over when you’re 40.’”
But Watts, who is starring in Netflix series and making movies, too, is eager to prove that theory wrong. “Sexual currency is suddenly much more expansive and inclusive now,” she said. “I think we are becoming more open to the notion that worth and value comes from more than shiny faces and tight bottoms and thigh gaps.”
Stripes is not alone. Pause is the work of Rochelle Weitzner, a cosmetics executive who panicked after her first hot flash, and recovered by noticing a huge gap in the market. (Pause’s products have far more direct names: “complete face serum,” for example, and “hydrating cleanser.”) And there’s also Better Not Younger, a hair care brand for “ageing hair.” Jennifer Coolidge is an avowed user of its “Second Chance” shampoo.
Faubion says attention to the needs of midlife women is, in general, a good thing. “But many of these products are capitalising on this need without adding anything new, novel or even effective,” she added. “We don’t want this group of women to pay a premium for the same product that is marketed to younger women for less.”
There’s a risk the menopause products can carry an updated version of the pink tax — a long-established tradition of charging more for female grooming products (razors, soaps) than their male-pitched counterparts. It’s tricky. As is often the case in the fuzzy area of wellness, there is a collapsing of the health and beauty matrix when it comes to menopause. What here makes a body work better, and what here just makes you feel as if it will all be OK? And is just feeling that it will all be OK, feeling seen, worth it anyway?
One might hope that one of the sweet-relief parts of getting old is a bit of gentle ignoring by the marketers who have been plaguing women since we could read. But for anyone looking for a clear view at the way stuff is marketed to women via aspiration and under the guise of feminism and altruism, Paltrow’s Goop is an excellent case study. In 2018, Paltrow announced that she was ready to talk about menopause; and also, by the way, she was releasing a vitamin pack called “Madame Ovary” for women whose time had come.
Then there were the musings she posted on Goop before her 50th birthday, beside a photograph of a taut Paltrow mid-leap in a small, triangle-top bikini. She looks great. Her hair is long and blond and looks summer-camp salty. She writes that “the sun has left her celestial fingerprints all over me,” but “I have a mantra I insert into those reckless thoughts that try to derail me: I accept. I accept the marks and the loosening skin, the wrinkles. I accept my body and let go of the need to be perfect, look perfect, defy gravity, defy logic, defy humanity. I accept my humanity.”
And yet, Paltrow also accepts some form of remuneration as a spokesperson for Xeomin, a brand of injectable Botox alternative that she says makes her look “less pissed off,” and recently debuted Goop brand “Dark Spot Exfoliating Sleep Milk” to combat those “celestial fingerprints” that come with age. It is available on Goop, and elsewhere, for $98. In other words, the new menopause market is still closely related to its anti-ageing doppelgänger.
This article originally appeared in The New York Times.
Written by: Amy Larocca
©2022 THE NEW YORK TIMES
OPINION: A decline in strength as we age is little recognised and infrequently discussed.