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Menopause: A Woman’s Final Frontier

Embr Labs CEO Liz Gazda

I’ve decided that the very best moment of a woman’s life may be the age of ten.  

I don’t mean that literally, of course. But there was something powerful about looking ahead at life from the perspective of a ten-year-old. At ten, girls have passed through the challenging stages of learning how to navigate the world. They have found themselves firmly in control and  understand their environment. If you’ve ever seen a group of ten-year-old girls, they are confident, sassy, and ready to conquer anything that comes their way.

According to Piaget, the mid-century child development specialist, the ten-year-old girl has found herself in the “concrete operational stage,” the third stage of Piaget's theory of development. This stage is marked by using logic for the first time. The ten-year-old girl can now utilize observation and reasoning to make a generalization. I remember my own ten-year-old generalization. It went something like this: “I can do anything. There’s no difference between opportunities for boys or girls—we both have a shot of achieving anything we want.”  

How different it would be. The next 40 years of my life would be marked by moments of  head-shaking dismay at trying to understand why the demands of my biology put me in second place—especially in light of a woman’s biological responsibility to conceive, carry, birth, nurse, nurture, and raise the next generation. As I type these words, I realize that equality is probably a low bar—perhaps hazard pay is in order.

You see, being a girl ain’t easy. Soon after the wonder years of Piaget’s Operational Stage, it gets very complicated. At puberty, a girl begins 35 to 40 years of menstruation. On average, that’s about 451 menstrual cycles in a lifetime, adding up to 35 years of menstrual activity, which includes planning, procuring expensive products, and laying in pain medication, as over 80% of women experience pain during their cycle with 20% experiencing pain so severe that it results in lost sleep and absenteeism from school and work. With menstruation being a fact of daily life for women, one would expect feminine products to be available everywhere—like toilet paper in a public restroom—right? Wrong. Unlike toilet paper and soap, feminine or “sanitary” products are considered “luxury goods” and are either nonexistent in a public toilet, or locked away in an non-functional machine that demands 25 cents or you’re out of luck. “BYOT” or “Bring your Own Tampon” is par for the course for working women in most businesses.

According to the website Dollars and Sense, the total financial cost that a woman will outlay to manage her period over 33 years is $17,556 at minimum. And there’s more. Feminine care products are classified by the FDA as "medical devices," BUT the IRS does not acknowledge this classification, which prevents women from using pre-tax dollars in health savings accounts or flexible spending accounts to purchase the products they need. (Neither Viagra or Rogaine is taxed, by the way.)

Menstruation brings other responsibilities, like birth control and STI prevention. Despite young men and women having equal engagement in sexual activity, the responsibility of protection and the HPV vaccination falls largely to young women. Women are often obligated to undergo a pap smear or pelvic exam before they are prescribed birth control; but there is no such demand for men. Until the Affordable Care Act (ACA), birth control pills were not covered by insurance, forcing women to pay out of pocket to prevent pregnancy or to use the same medication to help control painful menstrual periods. In fact, prior to the ACA, just being a woman was considered a “pre-existing condition”—primarily because we give birth.

It goes on from there. Women carry a baby to term and sacrifice careers to step away and attend to children during a child’s most formative years, which we now know are critical to child development, yet the United States does not require businesses to provide paid maternity leave. For those who are able to take time off, once they return to work, they face the most basic postpartum challenges. (Good luck finding a place to pump your breasts and store breast milk!)

If a woman does go back to work, the next decades of raising children can be taxing, to say the least. According to Forbes, women take ten times as much temporary leave from work as men,  are eight times more likely than men to look after sick children, and 21% of women said they were paid less for doing the same work they did before they took time off to care for their children. Throw in additional factors such as caring for elderly parents and taking time to do more of the household chores, and a woman will have earned a cumulative $1,055,000 less than her male counterpart by the time she reaches retirement age.

As women age and chronic conditions set in, the healthcare system does not often succeed in supporting women. Drugs and medical devices work differently in women than in men, yet many are never adequately tested in women. According to the FDA’s Office of Women’s Health, women have twice the risk of developing an adverse drug reaction compared to men. In fact, until 1988, clinical trials of new drugs were conducted on predominantly male subjects, although women consumed 80% of the pharmaceuticals in the U.S. at the time. 

One might surmise that this biological inequality ends once a woman reaches menopause. Menstruation is over. Reproduction is done, and there is no chance of getting pregnant. But as other biological responsibilities diminish, the decline in estrogen kicks a woman’s body into a state of chaos: hot flashes, headaches, anxiety, and insomnia are just a few of the challenges that women face as they enter the final stage of their reproductive life. Some women will remain in a menopausal state for decades, with a subset experiencing up to 20 hot flashes a day. Women who experience a greater number of menopausal symptoms have been found to be significantly associated with a lower quality of life

While the social and cultural impacts of menopause have been examined academically (though probably not enough) and anecdotally through the lived experiences of women for generations, the other impacts of menopause—particularly the economic impact—have not been researched as thoroughly. One study showed that women dealing with extensive menopause symptoms have approximately 40% higher overall costs than those who don’t, stemming from both medical needs and work absence. Another study showed that women suffering from hot flashes had to pay an additional $1,649 of medical services per year, not including prescriptions or alternative medicine.

But the tide is turning: By 2025, there will be over 1.1 billion women experiencing menopause globally—12% of the entire population—and the market has taken notice. Menopause-related products and services are growing at a rapid pace and investment in new companies is quickly following. The global menopausal hot flash market is projected to reach a whopping $16B by 2027...so finally, impossible to ignore.

The time is right for innovation. Until now, the standard of care to manage menopause has been hormone replacement therapy (HRT), but the potential risk factors (including blood clots, strokes, and some cancers) have left many women searching for natural alternatives, like the Embr Wave. The Wave is a noninvasive option has been validated to help with hot flashes and sleep by balancing the body’s autonomic nervous system. There are also companies like Gennev, a woman-run company founded by former Microsoft executive Jill Angelo, who has dramatically innovated menopause support and treatment from both a solution and coaching perspective. 

In 2020, women’s health is finally emerging as something that we can all talk about. Just last month, former First Lady Michelle Obama spoke candidly about her experience with hot flashes on her podcast and Viola Davis appeared on Jimmy Kimmel and explained to him what menopause feels like. Next year, Hulu will release the highly anticipated series Nine Perfect Strangers, which prominently features Melissa McCarthy playing a romance novelist managing hot flashes.   

As innovation accelerates and the stigma of menopause is being taken down by prominent voices, we know we have finally arrived. Soon enough, that ten-year-old feeling will be carried with us through every stage of our lives, and we will believe again that we can conquer anything.

 

Liz (left) circa age 10.