Underappreciated. Underserved. Underfunded. Women’s health has come up against a number of challenges in the past, but is now gaining recognition, momentum and investment.

Women’s health encompasses all diseases, disorders and conditions that are specific to women (e.g. uterine fibroids, endometriosis, premenstrual dysphoric disorder), that are more common in women (e.g. breast cancer, osteoporosis, migraines) or that are significantly different in women (e.g. cardiovascular disease, autoimmune disorders, Alzheimer’s disease)* [1].

Women’s health has faced significant underfunding, from both public and private sources, resulting in considerable gaps in research, treatment, and services. According to PitchBook, only 4% of all healthcare research and development is specifically targeted at women’s health issues [2]. However, current market tailwinds and specific companies are generating excitement and opportunities in the women’s health ecosystem which could be accelerated by more private equity involvement.

A Slow Flow of Capital: Historical Funding Barriers

Historically, there have been three principal barriers to private equity investment in women’s health.

1. Lack of awareness about the existence or significance of women’s health concerns

Within countries, cultures and communities, women’s health has often been a taboo topic. Conversations have been especially stunted in sub-segments that may be considered too uncomfortable, inappropriate or shameful to discuss (e.g. menstrual, sexual or reproductive health). A recent survey of 5,000 people across different geographies found that 36% feel their “culture places a stigma on people experiencing fertility challenges” [3]. The problem is that these discussions have not only been avoided in social situations, but also in medical settings and workplaces. This has prevented a proper gauge on the prevalence and impact of women’s health conditions, in turn reducing the focus on them.

2. Lack of understanding about the cause and treatment of women’s health concerns

Medical research used to focus on men as the norm for physiology, health and disease. It was only in 1993 that the FDA and NIH in the US mandated that clinical trials should be run on both men and women [1]. This has translated into inadequate understanding of conditions that differentially affect the sexes and an increased likelihood of misdiagnosis and mismanagement. Following a heart attack, women are 50% more likely to be misdiagnosed [4] and two to three times more likely to die than men (even after adjusting for confounding factors), with the “atypical symptoms of myocardial infarction in women” cited as a likely contributor [5].

Where sex-specific research has been conducted, it has been biased towards men. An analysis of NIH-funded research on diseases primarily affecting one sex found that the funding pattern favoured males nearly 75% of the time [6]. Similarly, erectile dysfunction (ED) had 5.8x as many publications than all of female infertility in 2019 [7] and start-ups in ED received 28x more funding than in endometriosis from 2019-23 ($1.24bn vs. $44m) [4]. As a result, there has been limited progress in understanding the biology behind many women’s health conditions as well as how to address them.

3. Lack of opportunities to invest in companies focused on women’s health concerns

There has been a significantly smaller number of women’s health companies compared to other healthcare areas. They have also tended to be earlier stage, due to infancy or a lack of venture capital funding, making them less attractive opportunities for private equity investment. Where suitable opportunities have existed, it’s possible they have been overlooked or undervalued due to the aforementioned lack of awareness and understanding, likely more pervasive in low gender diverse investment committees. In 2021, women only occupied 14.2% of decision-making roles at US VC firms [8] and, between 2012-22 in the UK, VC firms with mostly male decision makers were responsible for 97% of the capital invested [9]. Median pre-money valuations for seed stage companies have been consistently and significantly lower for women’s health compared to healthcare overall, with an average difference of c.30% from 2018-23 [10]. These factors have culminated in fewer and less attractive investment targets within women’s health for private equity.

Fertile Ground: Strong Market Drivers

Despite (or perhaps because of) previous barriers, there is now a combination of strong, growing, and diverse drivers making the women’s health market more commercially attractive.

Figure 1: Drivers of Women’s Health Investment

SOURCE: Fairgrove Research

Rising awareness: there is mounting recognition of the myriad health conditions that women face, fuelled by advocacy, destigmatisation and prioritisation. Many more discussions about patients’ stories and reports about the industry are emerging, including an uptick in coverage by leading media outlets (e.g. The New York Times, Forbes, BBC) and social media platforms. Coining of the term ‘FemTech’ in 2016 has aided awareness by providing alternative language to describe the technology-enabled products and services for women’s health, simultaneously adding a sense of legitimacy and excitement.

Advancing knowledge: more research and development initiatives are progressing our understanding of the underlying cause of conditions, and how to address them. Pre-eclampsia, a severe pregnancy complication, is now understood to be a leading cause of maternal and foetal mortality and morbidity worldwide. In July 2023, the first blood test to predict the risk of developing the condition and support its management was approved by the FDA [11], helping to safeguard the health of women and their babies.

Improving acceptance: as conditions and treatments become more understood and normalised, there is more acceptance of support and care. This can be seen with hormone replacement therapy (HRT) for menopause symptoms, where uptake has been steadily rising and 29% more patients were prescribed HRT in 2022/23 compared to 2021/22 [12]. Acceptance of HRT can be attributed to a variety of factors, including awareness as well as affordability; in April 2023, the HRT pre-payment certificate was introduced which effectively halves the cost [13]. DAME (producer of sustainable and organic period products) understands the need for activism to improve acceptability of its products. The start-up created the world’s first reusable tampon applicator and ran an advertising campaign across 200 London buses featuring a self-portrait by a customer with a visible tampon string, “normalising periods by bringing them out of the shadows of the 20^th Century” [14].

Increasing demand: in addition to more uptake of care resulting from awareness and availability, the need for certain treatments and services is also growing, such as due to sociodemographic trends and geopolitical dynamics. Fertility care represents an interesting example here, with a growing number of people requiring assistance to both cause or cease pregnancy. Women delaying motherhood and more LGBTQ+ couples choosing to have children are driving up need for assisted conception, while women in specific US states seeking to terminate pregnancy now require telehealth services to access abortion medication. Other areas of women’s health are also seeing increased demand, whether due to increasing penetration in existing populations (e.g. higher percentage of new mothers using electric breast pumps) or expansion of addressable populations (e.g. ageing population increasing the prevalence of geriatric gynaecological issues).

Expanding support: regulatory, social and workforce initiatives are enhancing the development of and access to solutions. Earlier this year, the US White House dedicated $100m towards women’s health R&D, and the NIH and Gates Foundation partnered on an Innovation Equity Forum to create a report on how to elevate female health globally. Several community organisations are helping to support the women’s health agenda, such as FemHealth Insights and FemInnovation in the US and FemTech Lab and Women of Wearables in the UK, by providing resources and opportunities for education, collaboration and innovation [15]. More employers are beginning to offer specific benefits to their female employees, such as financial assistance with egg freezing or time off for menstrual problems. Increased female representation in workforces and in decision-making roles (e.g. executives, entrepreneurs, investors) is aiding the delivery of this support.

Growing provision: in number and size, women’s health companies are increasing. There were a total of 1,416 active FemTech start-ups globally in 2023, of which half were established in the last 5 years [15]. This provides more opportunities for private equity involvement, especially as companies scale and expand into new products, markets or customer types. There has been a recent trend of menstrual health tracking apps forming strategic B2B partnerships with wearable technology providers, such as the integration of Natural Cycles into Samsung and Apple watches or Clue into Oura’s smart ring. Further, the data gathered to track the cycles can be shared by individuals for clinical research [16], in turn fuelling the cycle of increasing awareness, knowledge, acceptance, demand and support.

“The Change”: Evidence of Increasing Investment

We can see these drivers correlating with an increased number of active investors, investments and exits within women’s health.

Women’s-health-dedicated investment firms are gaining more prominence (e.g. Portfolia, FemHealth Ventures, Goddess Gaia Ventures, The Case for Her, Avestria Ventures), as well as exclusive women’s health funds or grants (e.g. RH Capital by Rhia Ventures, Repro Grants by Fifty Years, AstraWell by Maroon Venture Fund and Wellbeing of Women). Investment is largely venture capital driven, including well established firms such as Lux Capital and Google Ventures, with the most active investor being Y Combinator with 49 FemTech deals. From 2018-23, the number of venture capital deals in women’s health grew by 314%, compared to a 28% increase in healthcare overall [10], and there has been a total of $22bn invested into FemTech [2]. Private equity houses are also making more investments in women’s health, especially within fertility services, such as outlined in Figure 2.

Figure 2: Private Equity Investments in Women’s Health

Non-Exhaustive; SOURCE: Fairgrove Research

Potential investors will be looking at evidence of successful past exits to assess future opportunities. As of 1^st March 2024, there had been a reported 15 IPOs and 149 M&As within FemTech specifically [15]. Exits have been stunted overall, and there is a suggested backlog of highly valued start-ups awaiting more favourable market conditions to IPO (e.g. Maven, Flo, Tia) [10]. Still, there has been some notable exit activity in recent years, from a variety of sources, as detailed in Figure 3.

Figure 3: Private Equity Women’s Health Exits

Non-Exhaustive; SOURCE: Fairgrove Research

Ova the hurdles? Final Thoughts

Women’s health appears to be overcoming the hurdles it has faced historically, and turning them into drivers. Private equity investment is enabling this and will further fuel the increasing awareness, knowledge, acceptance, demand, support and provision. Private equity firms have typically played in the reproductive health space, but there are increasing innovations and opportunities beyond this traditional view of women’s health, from menstruation and menopause to oncology and osteoporosis. There is a shift in both society and business where a focus on women’s health is being recognised as necessary, rather than niche. The business case is strong – a large and growing addressable market, the opportunity for early mover advantage, and rising demand from patients and organisations. Hertility (at-home fertility hormone testing provider) reports that for every £1 spent on their benefits, organisations see a £6 return in reduced absenteeism, presenteeism, and turnover. Similarly, analysis by McKinsey and the World Economic Forum identified a $1 trillion opportunity to boost the global economy by 2040 through addressing the disparities in women’s health [4]. In other words, the return on investment in women’s health will not only be rewarding for investors, but for society at large. Equity for equity.

“After a long history of stigmatization and under-investment, women’s health is at an exciting inflection point with increasing awareness, investment and innovation. There are significant needs – and therefore whitespace opportunities – everywhere you look, from reproductive health to broader conditions that affect women. The potential for outsized returns makes women’s health attractive not just for health equity, gender equity and overall social impact, but financial returns as well.” Alice Zheng, Principal at RH Capital [10]

Our Experience

The Fairgrove team has worked with investors, corporates and SMEs in women’s health and adjacent segments, such as assisted reproductive services, employee benefits, home-to-lab health tests, and mental health platforms. Whether you are looking for transaction support, strategic advice or commercial insight within the women’s health ecosystem, please reach out to Georgina here to find out how Fairgrove can support you.

* In this article, we use the term women to refer to people with female reproductive organs. We acknowledge that not all people with female reproductive organs identify as women, and vice versa.

1. National Institutes of Health Revitalization Act of 1993 (1993)
2. Pitchbook: What is FemTech (2023)
3. Carrot: Global Fertility at Work Survey (2023)
4. McKinsey & World Economic Forum Report (2024)
5. European Society of Cardiology Press Release (May 2023)
6. Mirin, A.: Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health (2021)
7. Fifty Years Website: ReproGrants (2024)
8. Axios: Venture capital is still a boy’s club (2021)
9. The Alan Turing Institute: Rebalancing Innovation: Women, AI and Venture Capital in the UK (2023)
10. Silicon Valley Bank: Innovation in Women’s Health 2023 (2023)
11. Thermo Fisher Scientific: Press Release (2023)
12. NHS Business Service Authority: Statistics and Data Science: Hormone Replacement Therapy (2023)
13. Balance Menopause: Sharp rise in HRT prescriptions (2023)
14. Journey to Normal: The Story Behind that DAME Tampon String Advert (2020)
15. FemHealth Insights: 2023 FemTech Landscape Report (2024)
16. Medical Device Network: Oura Ring pairs with Clue to monitor temperature for period tracking app (2023)
17. Hertility Health Website (2024)