It’s been a Barbie world this summer with crowds of pink-clad moviegoers flooding the cinemas. Simultaneously, we’ve been witnessing a rush of ‘pink’ fundraising for women’s health start-ups. From pre-clinical to clinical: more companies are entering the field and developing solutions for women’s unique needs. But is their focus broad and innovative enough? And are pharma companies paying attention?
Historically, women’s health concerns have often been overlooked or underestimated, leading to gaps in research, diagnosis, and fewer treatments for female-specific conditions. Our understanding of sex-specific responses to treatments has been further deepened by the historical underrepresentation of women in clinical trials. Men and women differ in the way they metabolize and process drugs, as pharmacokinetics in women are often affected by lower body weight, different hormones, slower gastrointestinal motility, less intestinal enzymatic activity, and slower kidney function. The historic bias against female clinical trial participants has therefore led to many treatments being less effective or having specific side-effects in women. An example is Sanofi’s sleep medication containing zolpidem, where the recommended dose for women was corrected as it was belatedly found to be too high for women.
Despite these shortcomings, the women’s health sector has gained significant momentum in the few past years, with remarkable breakthroughs and novel applications being introduced that are tailored to women’s unique physiology and healthcare requirements. These advances are starting to extend beyond fertility and pregnancy, embracing a wider range of women’s health issues including conditions primarily affecting women (such as endometriosis, polycystic ovarian syndrome, menopause, and ovarian cancer), conditions that affect women differently to men (such as cardiovascular disease, pelvic health, and thyroid disorders), or in disproportionate numbers (such as Alzheimer’s Disease, osteoporosis, coronary heart disease, migraine, and multiple sclerosis).
Not a niche field
The historic sidelining of women’s health as a ‘niche’ field is in stark contrast with reality. Women outnumber men on earth, and the market size for women’s health is starting to reflect this fact, displaying an immense growth potential: the global femtech market alone is projected to exceed USD 60 billion by 2027. This growth is in part being brought about by the increasing public awareness of women’s health which has skyrocketed in past years, leading to improved diagnosis of conditions that previously would have remained undiagnosed or ignored. Other contributing factors include rising infertility rates across the world, as well as the increased wealth and education of women who are now in a position to prioritize and spend more on their healthcare.
This burgeoning market has gained substantial attention from technology companies and entrepreneurs. However, despite the rapid expansion of the women’s health industry, ‘me-too’ solutions currently dominate the landscape, which could benefit greatly from more innovation approaches and foci. Existing women’s health products are predominantly wearable technologies, period-tracking apps, telehealth services, personalized treatments, access to health coaches, monitoring of post-partum depression, and over-the-counter products for women undergoing hormonal changes. These advances are necessary for improving awareness and diagnosis, and play an important role in facilitating the enrolment of women in clinical trials for biotech solutions that address these indications. But when delving a little deeper into the developments of women’s health therapeutics, it is easy to see that the advances have been very gradual and some indications (including those related to fertility and menstruation) have to-date received far more attention than others. It is high time that women’s health started looking beyond the uterus, developing truly innovative solutions for the whole female body.
The beginnings of progress
There are numerous initiatives starting up to advance women’s health innovation, from national policies such as the UK Women’s Health Strategy, to actions by incubators such as the BioInnovation Institute’s Women’s Health Initiative and charities such as the Bill and Melinda Gates foundation Global Grand Challenge, and many more. This growing support is contributing to the increasing number of women’s health start-ups that have been founded in recent years. It is also driving tangible progress for patients in a range of indications.
Perhaps the best evidence for the impact of women’s health progress can be found in the higher survival rates for breast cancer patients in recent years, largely thanks to improved diagnostics, innovative systemic treatments, and therapies based on the molecular characterization of the tumor. Another area that has seen a lot of innovation is stress urinary incompetence, with approaches ranging from sling surgeries to cell therapies such as MUVON Therapeutics and MyoPax, and RNA therapies being developed by Versameb. Unfortunately, progress has not been equal across all women’s health indications: with endometriosis, for example, significant advances have been made in awareness and diagnosis, but treatment options are still lacking (though some are currently in development).
Empowering women’s health
The progress in this field is not going unnoticed by pharmaceutical companies, though their appetite for participation has not yet been spectacular. Bayer recently announced it was moving away from women’s health in a strategic overhaul. Meanwhile, things are looking a bit brighter for companies such as Pfizer, Novartis, Eli Lilly, Amgen, Merck, and AbbVie, which all have a significant presence in the women’s health market. All the above are leveraging their expertise to develop innovative solutions for a range of women’s health issues, expanding their research and development efforts to provide better treatments. The M&A space has also been quite active: Organon (a Merck spin off) acquired Forendo pharma and its clinical-stage asset for endometriosis in 2021; Sumitovant acquired Myovant with approved drugs for uterine fibroids, endometriosis, and infertility in 2022; and Astellas acquired the Belgium-based biotech Ogeda for its nonhormonal treatment for menopausal hot flashes in 2017. In early 2023, Ferring – a leader in reproductive medicine and maternal health – announced that it had entered a strategic collaboration with the BioInnovation Institute (BII) to accelerate innovation in women’s health.
In terms of funding, VCs invested USD 2 billion in femtech startups in 2021, and USD 1 billion in 2021. This year, women’s health start-ups are still managing to close multimillion-dollar rounds, despite the generally challenging VC climate. Just to name a few 2023 examples: Pomelo Care raised USD 33 million in Seed and Series A rounds led by Andreessen Horowitz for its virtual maternity care program, and Caraway Health raised almost USD 17 million in a Series A round led by Maveron and GV (formerly Google Ventures) for its digital platform for health services. There remains a significant investment gap between the US and the rest of the world, although Europe is playing an important role in the women’s health industry, with EU countries accounting for five of the top nine countries for femtech funding, and Belgium listed as number four overall (after the US, UK, and Israel).
There’s clearly action brewing in the field, even if we have yet to see enough solutions hit the market. Despite the growing appetite from pharma companies, many of the emerging start-ups in this field remain underfunded. What we now need is for enterprising investors to inject more funds into the early-stage companies with truly innovative tech and therapies, supporting a diverse range of start-ups for broader coverage of women’s health issues. At V-Bio Ventures, we are enthused by the progress in this field and are ourselves carefully looking for companies developing solutions to address women’s unique needs and help transform the landscape of women’s healthcare.
Note: In this article we aim to be gender inclusive, using the words ‘woman’ and ‘female’ to denote anyone who identifies as such.
