Women’s health is a fairly new category of medicine. This isn’t because women have previously lacked health needs, but because society has only recently begun to recognize them. It wasn’t until the 19th century that scientists linked periods to ovulation (as late as the 1920s medical professionals believed periods were disconnected from women physiologically) and it was only in the 1980s that women’s health emerged as a separate component of the U.S. healthcare system. The first anatomically correct drawing of the clitoris was made in 1981; women’s inclusion in clinical research was not required by law until 1993.
We can thank the women’s rights movement for these advances, but we’re still feeling the hangover from centuries of having our health needs ignored. A historical lack of funding for research coupled with a fundamental lack of interest in investing in women’s health has left us with a gaping gender health gap. In recent years, however, female founders have risen to the challenge—and business is booming.
By 2027, the women’s healthcare market is predicted to be worth $47.8 billion. Per an upcoming report by research firm Frost and Sullivan, femtech is projected to be worth $522 million by the end of 2021, and investment in healthcare companies with a female founder or co-founder has steadily grown, now comprising more than 43 percent of dollars raised so far this year. (In 2011, that share was less than 25 percent.) So what does the future of women’s healthcare look like? Will conditions like endometriosis and PCOS be a thing of the past with predictive AI? Will DNA profiles be used to uncover medical solutions customized to a woman’s individual needs? What will treatments for menopause, infertility, and even Alzheimer’s (which disproportionately women) look like? Here, we dive into four key trends predicted to drive change in women’s health—and the women founders who are leading the charge.
Closing the data gap with advanced monitoring
In the absence of data about how women experience health and disease—thanks to a long history of being excluded from clinical trials and medical research—male data has been used universally to inform clinical decisions. This, of course, has led to healthcare disparities. Women are nearly 75 percent more likely to have an adverse reaction to prescription drugs than men and 50 percent more likely to receive an incorrect initial diagnosis when they’re having a heart attack.
The first wave of fem-tech, circa 2013, used tracking and monitoring technology to address this problem. Using apps such as Clue and Glow, women would input which days they were bleeding and receive a prediction for when their next period and fertile window might be. Today’s solutions go a step further by collecting a wider breadth of data that is not only more accurate, but is interpreted using advanced statistical methods and analytical technology to help us understand its relevance to our health.
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Take The Lowdown, the world’s first contraceptive review platform, which aims to fill the information gap around contraceptive side effects. Founded by former marketing strategist Alice Pelton, The Lowdown collates and aggregates information about the types and severity of side effects felt per contraceptive method with a level of detail that has never before been collected nor accessible to the public, available via its website.
Peloton’s mission, to change the way that women choose, access, and use their contraception, is part of a broader societal shift of women critiquing and demanding more from their healthcare. “When women make their [health] decisions today, they take almost a buffet of data to consolidate their view on something,” she notes, adding that in the coming years, this buffet could include hundreds of health metrics that are monitored to provide a dynamic picture of a woman’s health, such as new types of biological information within bodily substances (think blood, fluids, and tissue)—molecules known as biomarkers. Unlike a routine physical exam, which assesses vital signs to check for general indications of disease, a biomarker test looks for a particular molecule—which could be a hormone, protein, enzyme, or gene—that gives a specific indication of either a change in a person’s health or their risk of disease.
Oova, a fertility technology company and leading diagnostic brand in biomarker health founded by Dr. Amy Divaraniya, is the first to measure quantitative levels of both luteinizing hormone (LH) and progesterone via an at-home urine test, which is analyzed to provide a personalized “baseline” of a woman’s reproductive hormones over a 15-day period. By creating a standard for what “normal” looks like for someone, Oova can identify fluctuations from that baseline and provide recommendations that help regulate hormone levels—which are typically only monitored at annual appointments or more frequently in the event of a medical issue—and improve chances of conception. “Every woman is unique,” explains Dr. Divaraniya. “Women are typically compared to a standard hormone trend to determine if everything is working properly, but these trends may not be normal for every woman. Personalized biomarker analysis is critical to be able to treat patients effectively and to provide insights on reproductive health.”
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Other biotech companies to watch in this space inlcude Evvy, an at-home vaginal microbiome test, co-founded by Priyanka Jain and Laine Bruzek, that identifies bacteria within the vaginal microbiome to indicate susceptibility to conditions such as UTIs, bacterial vaginosis, and yeast infections. Meanwhile AOA, co-founded by Oriana Papin-Zoghbi and Anna Jeter, is working on the first accurate early stage non-invasive ovarian cancer diagnostic test through the analysis of tumor markers in blood. Similarly, one team at the University of Hull, led by Dr Barbara Guinn, is currently developing a pregnancy-like test to diagnose endometriosis almost instantly by identifying a biomarker they believe to signify the presence of the condition. There is also current research interest into the potential of biomarkers in detecting Alzheimer’s and dementia, asthma, and heart disease—all of which disproportionately affect women due to hormone fluctuations.
Overall, at-home health monitoring is set to become both more advanced and commonplace. “There will be 500 different metrics that people will be tracking every single day,” says Partner and Global Client Leader for Healthcare and Life Sciences at Frost and Sullivan, Reenita Das. Health metrics like hormone levels will be combined with “real life” data such as the quality of air a person breathes, to give a complete picture of their health, she adds. “All of that data will be integrated, and we will rely more and more on that data which will be connected at all times to that person.”
As women’s health data increases, so too does the potential to create solutions that can be customized to their needs. This is the direction the market is going in, says Karen Groppe, senior communication director at Healthcare Information Management Systems Society. “Personalized medicine is going to be targeted and customized to cater to the specific needs of the individual.”
This could lead to innovation in the way drugs are prescribed and how care plans are developed, says Anya Roy, co-founder of the virtual women’s health assistant SORA by Syrona Health, which uses machine learning to analyze user data about endometriosis to provide unique, actionable insights and treatment plans relating to symptom progression. Currently, when a doctor prescribes a drug, they must weigh the potential risks and benefits based on information the patient gives them. But what if a woman’s information could be analyzed in relation to multiple data points from millions of different people to accurately predict how she will react to a certain medication?
“Having big data sets on an individual and their healthcare profile will be our standard.”Anya Roy, co-founder of Syrona Health
“Having those big data sets on an individual and their healthcare profile will be our standard,” Roy predicts, which will be used to create personalized treatment plans prescribed based on a patient’s particular makeup, marking a departure from the traditional pharmaceutical approach of assuming that one drug will work for millions of people. We’re already heading in that direction: precision medicine company adyn, founded by Elizabeth Ruzzo, a Ph.D. in genetics and genomics, has just closed a $2.5 million seed round to develop personalized birth control prescriptions. Meanwhile vitamin and supplement company Rootine uses at-home DNA blood testing to recommend optimal doses of 18 different nutrients, and Mirvie is developing a test that uses AI to analyze thousands of molecular markers within a pregnant woman’s blood to provide customized insight into the risk of pregnancy complications.
The study of genomics—a person’s DNA—is another research area that can help realize the potential of personalized medicine. Fem-tech company NextGen Jane, co-founded by Ridhi Tariyal, is developing “smart tampon” technology that, once a user conveniently mails in a sample of cells from the reproductive tract shed during menstruation, can analyze the genomic information within a person’s menstrual blood for signs of disease, including endometriosis.
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Like Oova, NextGen Jane’s technology platform will replace in-clinic, invasive diagnostic procedures (many of which involve surgery), allowing women to manage their health proactively on their own terms, directly moving the locus of power and health management from the clinic to the consumer. “COVID has shed light on the disparities in our healthcare system—consumers deserve solutions that give them clinical accuracy in their home,” says Oova’s Dr. Divaraniya. “Most women don’t want to go into the lab for testing and now with technology like Oova, we’re making it more accessible for both women and clinicians to monitor hormone levels daily, over a longer period of time. This provides both patients and doctors with critical information about how a woman’s body is functioning.”
For people with vaginas, menstruation and transitions between different life phases—puberty, pregnancy, menopause—are biologically characterized by shifts in hormone levels. But how hormone levels affect the body and influence health is another forgotten area of healthcare, thanks to women’s decades-long exclusion from medical research. In the absence of hormone data, women founders of fem-tech solutions are seeking to fill the gap.
“Hormones are at the root of so many conditions and transitions that women experience, yet hormones remain a black box,” says Marina Pavlovic Rivas Rivas, founder Eli Health, which is developing a tool to measure hormone levels in saliva and create a personalized hormonal profile that is tracked over time within an app. The app will provide insight on how hormone levels change and what this means in relation to health needs such as fertility and contraception. “A woman’s hormones do not remain at a constant level throughout her life, or even day to day,” notes Oova’s Dr. Divaraniya. “During each phase of a woman’s life, her hormones alter patterns driving critical changes. Understanding their behavior and levels can shed incredible light on the inner workings of a woman’s body.”
Understanding hormone behavior and levels can shed incredible light on the inner workings of a woman’s body.Dr. Amy Divaraniya, founder of Oova
Likewise, Modern Fertility, which delivers health insights based on hormone levels measured via a finger-prick test, offers users personalized reports relating to their fertility such as ovarian reserve, which is a measure of the body’s ability to conceive. Co-founder and CEO Afton Vechery hopes that hormone testing will become a more commonplace conversation and, one day, be covered by insurance—both factors that could make technology like Modern Fertility’s as routine as a pap smear.
And while Oova is currently focused on fertility, its hormone tracking technology has potential applications in other areas of health, including pregnancy, menopause, and chronic illness. Correlating changing hormone levels found in urine with symptoms could help detect disease and even inform prescription decisions—something Dr. Divaraniya says is starting to happen. “If a woman had a history of miscarriage and [doctors] see that her progesterone levels are low over a period of time…they can actually put her on progesterone supplements on specific days based off of Oova data.”
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To realize the full potential of hormone health, companies will need to work harder to connect data from the body with digital solutions, adds Eli Health’s Rivas. This could involve innovation in hardware, with wearable technology that’s able to monitor new types of biological information, such as electrical activity in the brain (called EEG waves) which may be able to predict hormone levels. Wearables are already tracking digital biomarkers—like body temperature changes in a woman experiencing menopause—and according to a 2020 Rock Health white paper, more consumers than ever are using digital tools to track their health. Fertility (83 percent) and heart rate (75 percent) are the most tracked metrics.
Dana Alloy, a women’s health researcher, predicts that demand will rise for solutions that track ovulation, as consumer knowledge of how this affects overall health becomes mainstream. “The most valuable innovation will be in solutions that can accurately track ovulation as a consistent metric like heart rate, VO2max [a measure of how much oxygen the body uses during exercise] or glucose, and pair this with wearable tech [and/or] health app use,” she says. In the future, wearables may also be able to assess and track endometriosis pain via monitoring of vital signs and track blood sugar levels, which may be useful for women suffering from PCOS.
The boom in available digital health data will spur the need for artificial intelligence (AI) solutions—both to manage large data sets and to make sense of it, says Reenita Das from Frost and Sullivan. “There’s just so much more data, it all needs to talk to each other about the patient.”
Machine learning, when a computer system is able to learn and improve without input or instruction from a human, is an application of AI that’s already emerging within the sector. Oova, SORA, and Eli Health are among a new wave of health technology to use machine learning to absorb large data sets and deliver personalized insights on them, such as establishing an individual risk profile that predicts the likelihood of a condition developing. However, the potential applications of machine learning are immense: from using image analysis to predict the risk of breast cancer from a mammogram to assessing embryo health and implantation potential for IVF patients.
Meanwhile AI-powered drug discovery and development is already underway. Take Insitro, founded by ex-Stanford computer scientist Daphne Koller, which recently closed a $400 million Series C funding round. The biotech company generates large data sets to create models that predict which drugs are likely to work for which types of patients, combining tests done in the lab (called in vitro) with computer-based modeling (in silico) to advance genomics research, develop new medicines, and streamline the drug design process. As Koller put it: “We are bringing transformative medicines to patients faster and with fewer failures.”
By 2030, AI healthcare systems will be able to predict an individual’s risk of certain diseases and suggest personalized preventive care measures, according to the World Economic Forum. We are well on our way there: AI systems can already identify precancerous changes from a digital image of a cervix—rather than from a swab taken during an invasive smear test—and predict menopausal status by analyzing the microorganisms present in the skin. AI will also transform the way that care is delivered by remotely monitoring data from wearables, smartphones, and apps, says Frost and Sullivan’s Das: “We’re building the superhighways.”
Monica Karpinski is a healthcare journalist who writes about the healthcare industry, women’s health, and health equality. She is founder and editor of The Femedic, a health media platform for women and people with vaginas.