The perimenopause boom: how hormone therapy became a booming US tech industry

Demand for hormone therapy aimed at easing perimenopause symptoms has surged sharply in the United States. According to a SimilarWeb analysis conducted for Wired, four leading telehealth startups in the space—Midi, Winona, Alloy, and Evernow—saw web traffic jump 490 percent between 2023 and 2026.

Several factors converged to drive the shift. Last fall, the FDA removed the "black box" warnings that had discouraged both doctors and patients from pursuing hormone therapy since a 2002 study led to overestimated cancer risk concerns. Health and Human Services Secretary Robert F. Kennedy Jr. framed the move as a return to evidence-based medicine. Meanwhile, the pandemic-era rise of telehealth and growing public comfort with compounded medications—driven partly by cheaper off-brand GLP-1 drugs—made it easier for people to accept hormone prescriptions delivered entirely online.

The potential market is enormous: more than 43 million American women are between the ages of 35 and 54. Venture-backed virtual clinics are competing for dominance, with Midi becoming what's described as the first "menopause unicorn," while competitors like Alloy and Evernow have also raised significant funding. Most providers operate out-of-pocket, charging subscriptions of up to $200 a month.

Companies in the space attribute a sweeping range of symptoms to perimenopause—over 100 by some counts, including hot flashes, mood swings, forgetfulness, weight gain, and sleep trouble. Because no lab test can definitively confirm perimenopause, diagnosis often relies heavily on how patients describe their own symptoms.

Some prominent experts, including Mayo Clinic's Stephanie Faubion, warn the surrounding hype has "gotten completely out of hand," with too many unrelated symptoms being pinned on perimenopause. Others, such as Yale gynecologist Mary Jane Minkin, support raising awareness of treatment options but caution that marketing and media hype may be convincing people that ordinary stress or poor sleep are hormonal problems when they may not be.