English translation of original interview given in November 2023
Tell about yourself
My name is Charlotte Nørgaard Langer, and I am an entrepreneur and innovation expert focusing on Women’s Health based in Copenhagen. Today, I lead Scandinavia’s largest investment group investing into Women’s Health and have founded and lead The Nordic Women’s Health Hub. I have a background in Management Consulting (BCG), Venture (KRING, Keystones), and various law firms, as I am originally a lawyer.
When I joined the Danish Venture Fund KRING, I initiated their focus on Women’s Health due to the significant business opportunity in this otherwise overlooked sector (and my personal passion for the topic 🚀).
I will discuss the business opportunity later, but my personal passion began about ten years ago when I realized that my own hormonal issues were not properly understood or taken seriously by the conventional healthcare system. Many symptoms that women experience due to our biology and sensitive cyclical hormonal system—PMS, blood sugar imbalances, acne (and the list goes on)—were treated as separate problems with medication, birth control pills, or painkillers as quick fixes. Ultimately, I had to educate myself to take care of my health, and now I believe that the vast majority of women deserve better knowledge about their health and bodies than the current system provides.
Let’s Define: What is Women’s Health? How do we distinguish between Women’s Health, Female Health, and FemTech?
Today, the terms Women’s Health, Female Health, and FemTech are often used synonymously, without much thought given to their differences. This is understandable, as the definitions are not 100% clearly defined anywhere. I use the following distinction:
Women’s Health is the broadest of the three terms, encompassing women’s overall health. This includes all relevant areas, including those unique to female biology, such as menstruation, female fertility, pregnancy, and menopause (typically referred to as Female Health), as well as areas that are also relevant for men but where women have different needs and challenges, such as autoimmunity, cardiovascular health, mental health, nutrition, etc. Women’s differing needs in these areas can be attributed to both biology and societal and cultural factors that influence our healthcare system. For instance, more women than men report that a healthcare authority ignores their symptoms ✋(source 1). Another example is that many female health products carry a pink tax (source 2), meaning they are more expensive than they should be. By using the term Women’s Health, we ensure that both biological needs and challenges, as well as societal and cultural needs and challenges, are addressed.
Additionally, “Woman” is a broader and more inclusive term than “Female,” which focuses mostly on the biological aspect, whereas “Woman” embraces the whole person. Therefore, Women’s Health includes individuals who identify as women, regardless of whether they are biologically born as women. This group also experiences many of the health challenges that arise from being a woman in today’s society—a society that is still largely structured around male perspectives (“the default male world”) 👤 (source 3).
Female Health, as a term, is a subset of Women’s Health that focuses on the health needs and challenges unique to female biology, such as menstruation, female fertility, pregnancy, and menopause. These topics usually are the ones that get the most attention. Other relevant areas include pelvic floor health, sexual health, etc. Because the term Female Health is typically associated solely with reproductive health and focuses heavily on the biological aspect, many believe the term is too narrow to encompass the many facets of women’s health. As a result, there has been a shift in the startup and innovation environment in recent years, where Women’s Health is preferred as the term.
Lastly, we have FemTech (short for Female Technology), which primarily describes a category of solutions within Female Health. In other words, it can be seen as the solution-oriented counterpart to the term Female Health. In FemTech, the concept of technology should be understood broadly, covering both digital solutions and innovations, such as apps and wearables, as well as physical products, such as medical devices and “simple” consumer products that address a need within Female Health. In recent years, many have moved away from using FemTech as a term, as it does not correspond to the broader, more inclusive concept of Women’s Health. Instead, we are increasingly hearing the term Women’s Health Tech.
Why are we only now starting to talk about Women’s Health?
We’ve already touched on “the default male world,” which points towards the fact that the world has largely been structured around male perspectives until recently. I want to emphasize that this is not meant to cast blame on men it is simply a fact. Yes, Danish women gained the right to vote in 1915, but that was only about 100 years ago. This is not much considering that European societies have been male-dominated for at least 2500 years prior (source 4). Men have been the inventors, investors, and decision-makers for a very long time resulting in the female perspective and female challenges being largely overlooked or misunderstood. Innovation in health has generally been based on male biology with the assumption that men and women have similar biology. For instance, it was not until 1993 (🤯!) that the FDA (the U.S. Food and Drug Administration) allowed women of childbearing age to participate in studies testing medications (source 5) resulting in a significant knowledge gap regarding how medications affect women.
Another example is found in PubMed, the largest health sciences database globally where studies are published. Searching for typical Women’s Health challenges shows that serious research in these areas has only increased in the last two decades. Although things have improved, there is still a long way to go concerning the distribution of research, both in terms of focus on Women’s Health topics and the inclusion of women in broader studies. For instance, a Harvard study has shown that 70% of those experiencing chronic pain are women, yet 80% of the research on chronic pain is conducted based on men (source 6).
In other words, it is only recently that we have begun to recognize and discuss that women face specific biological health challenges—challenges that require dedicated research and treatment. This conversation has been sparked by a general increase in awareness of women’s rights, illustrated by discussions surrounding #MeToo, female leadership (or the lack thereof), women in STEM, and various other topics within this category. The internet and social media have also played a crucial role in spreading information and creating a space for women to share experiences and seek knowledge.
I personally believe Birgitte Baadegaard captures it well with her statement, “Equal is not the same as identical” (source 7). Yes, women are now equal to men but many aspects of society are still structured around a male framework. We need a new discussion about “equivalence,” such as ensuring equal access to innovation addressing women's specific health challenges.
What is currently happening in Women’s Health in terms of startups and innovation? What do the data and research show? What trends do you see?
Fortunately, there is a lot happening! Both in terms of the number of new startups (the rate of innovation) and the amount of capital being invested (source 8). FemTech Analytics (an open data platform for FemTech that provides a good overview of Women’s Health) (source 9) shows that over the last two years alone, there has been approximately a 40% increase from around 1,300 startups to about 1,800 startups. This impressive growth indicates that more and more entrepreneurs are becoming aware of and want to address issues within Women’s Health.
The Most Mature Sub-Markets: Pregnancy and Fertility
Today, the largest sub-markets within Women’s Health remain Pregnancy and Fertility, which are the classic, most mature areas in this field. This is true both in terms of the number of startups (343 in Pregnancy and 296 in Fertility) and the amount of VC funding (980 million USD raised in Pregnancy and 828 million USD in Fertility) (source 11).
It’s not surprising that innovation began with a focus on these areas, as Pregnancy and Fertility captures the most evident biological differences. Additionally, there are significant pain points to address within these two domains, along with demographic trends underscoring the need for innovation. For instance, in the area of Fertility, the WHO recently estimated that 1 in 6 individuals globally will experience fertility issues at some point in their lives (source 12). Furthermore, problems related to Pregnancy and Fertility are more recognized than many other women-specific issues.
The First Unicorns in Women’s Health Are a Reality 🦄
In the last five years, the first Women’s Health companies have achieved unicorn status, primarily in the realms of Pregnancy and Fertility. The vast majority are from the U.S., such as Modern Fertility, Kindbody, and Maven, offering a virtual clinic experience that personalizes and digitally supports women from the start to the finish of their fertility journey.
“White-Space” Sub-Markets with Exciting Opportunities
At the same time, we are seeing a renewed focus on “white space” sub-markets within Women’s Health that are still in early development phases when considering the number of startups and funding. Examples of these sub-markets include Menopause, Pelvic Floor Health, Sexual Health, and women-specific Chronic Diseases (e.g., PCOS, endometriosis, etc.). In these areas, many issues have only recently begun to be understood and discussed. Moreover, there is still much we don’t know especially regarding Menopause, where an incredibly small amount of research is being conducted (as indicated by the PubMed graph earlier in the article).
The VC funds typically view the mature markets specifically Pregnancy and Fertility as particularly interesting due to the substantial amount of research paving the way for innovation, as well as the significant impact these areas have on individuals. These markets are well understood by society, consumers, and investors. However, investors are also closely monitoring the “white space” markets, especially in Menopause and women-specific Chronic Diseases, as it is believed that more significant research efforts will emerge in these areas soon. This research will lead to increased innovation. Furthermore, discussions over the past two years have started to shift toward these previously overlooked areas in Women’s Health, and I believe it’s only a matter of time before these “white space” markets attract the same interest from entrepreneurs and investors.
Currently Relatively Simple Technology
From a technological standpoint, it can be said that most Women’s Health startups today employ relatively simple technologies in their solutions. The majority of unicorns such as Modern Fertility, Kindbody, and Maven utilize straightforward digital platforms to enhance customer experience. This is typically combined with a community element and an educational component.
Of course, there are also highly technological companies using advanced AI or developing entirely new technologies, such as Phexxi, which has created a new type of hormone-free vaginal gel contraception. However, given the historically low level of innovation, one can achieve a lot with simple technologies in Women’s Health today.
How Much Funding Is Going to This “New” Category?
When looking at the investment side, Women’s Health has seen significant progress. A recent analysis from Silicon Valley Bank shows that investments in the Women’s Health sector set a record last year with 1.34 billion USD. In comparison, 288 million USD was invested in 2018, indicating a staggering 365% increase by 2022 (source 13).
In summary both the number of new startups and the funding are experiencing substantial growth in these years. There is certainly a reciprocal relationship where both positively reinforce each other. I believe we have only seen the beginning of developments in the Women’s Health market, where growth will accelerate further. This is due to the low baseline of innovation, the many issues still needing solutions, and the resulting “catching up” effect. In other words, the timing is “just right” for considering entering this market both as an entrepreneur and as an investor.
What Should Investors Look for in Women's Health?
The classic investment considerations are also relevant for Women’s Health, such as whether there is a strong team, a scalable business model, and significant market potential. To sharpen one’s Women’s Health investment strategy, one can also consider the following:
Sub-market: Which Women’s Health sub-market do I believe in commercially? Where does my personal interest lie?
Business Elements: Does the investment case include business elements that have proven particularly interesting within Women’s Health?
Let’s dive deeper into these two points below.
Personal Considerations Regarding Sub-markets
You should reflect on which sub-markets you find most interesting. Which markets do you believe have the greatest future potential? Where is your personal interest?
The more mature sub-markets Pregnancy, Fertility, and Menstrual Health will naturally be interesting for many investors, as they are the largest and show high growth. Most unicorns in Women’s Health come from these areas, serving as proof of the market's potential for VCs. However, competition is tougher in these markets, and the demand for innovation is higher to gain relevance as a startup.
The “white-space” sub-markets, which include Menopause, Women-specific Chronic Diseases, Sexual Health, and Pelvic Health, face less competition and have a lower innovation rate. Startups in these markets face a greater challenge in terms of education and raising awareness about the issues they aim to solve. Another challenge is the lack of research to support the companies in these sub-markets. It is risky to build a business without solid science to support the solution.
Generally, it can be said that Pregnancy, Fertility, and Menstrual Health (the mature sub-markets) are "safe bets," while the "white-space" sub-markets come with higher risks but greater potential upsides. If a company in a white-space market hits the mark and the market matures, they can reap the rewards as a first mover.
Interesting Business Elements to Watch For
Going a bit deeper than sub-markets, we can look at business elements that often appear in successful Women’s Health companies. A market analysis we did at KRING showed that several elements are common among most successful Women’s Health businesses:
Good Digital Solution: Digital platforms and solutions are common across markets, and Women’s Health is no exception. Many successful Women’s Health companies are built on a digital platform that allows for scalability, user-friendliness, lower costs, and data collection.
Personalized Experience: Women today expect health solutions personalized to their unique situations and needs, determined by their genetics, environment, lifestyle, life situation, etc. This personalized approach, driven by increased awareness of health, greater access to information, and a stronger focus on preventing chronic diseases, is what unicorns like Modern Fertility, Kindbody, and Maven have succeeded with.
Education to Break Taboos: Most successful Women’s Health companies incorporate a significant educational element in their solutions to empower women in their self-understanding and decision-making. This has been necessary, as it is only recently that we have started talking about women-specific health, thereby breaking the taboos that have surrounded the female body and women-specific health challenges for centuries. This applies to everything from menstruation, women's sexual health and pleasure, fertility issues, and menopause.
Community via Community: Solutions that offer a community where women can ask questions, share, and find support around various women-specific health challenges have several advantages compared to those that just offer a product. Communities contribute to knowledge sharing and improved mental health for the women involved. Many successful Women’s Health companies have thus incorporated a digital community element, which, in addition to the above benefits, is an excellent way to attract new customers and retain current ones.
One-stop-shop (integrated customer journey): Women’s health needs are not only unique compared to other women but also vary throughout their lives; at one point, menstruation challenges may dominate, then fertility, and finally menopause (with many possible issues in between). If a company can successfully create an integrated 'one-stop-shop' solution relevant for women throughout their life journey, with offerings from fertility to menopause, they significantly expand their market segment and enhance customer retention (an example of a company that has succeeded in this is unicorn Maven). Many Women’s Health companies aim to become a platform offering this integrated customer journey, often starting with a focus on a single sub-market.
Considering the above regarding which sub-markets and business elements you particularly believe in is a good starting point if you are a newcomer to the Women’s Health market.
Where Can You Be a First Mover in This Investment Category?
Which areas within Women's Health are not yet crowded but hold great potential?
Menopause, Women-specific Chronic Diseases, and Sexual Health are all interesting “white-space” sub-markets with significant potential. Let’s delve deeper into why:
Menopause is an intriguing sub-market, as all women spend a third of their lives in perimenopause and post-menopause a life stage that often brings about different physical and mental challenges than women are typically accustomed to. Attention to menopause and the associated symptoms has increased significantly recently. At the same time, research in menopause is on the rise but still in its infancy. Therefore, there are many problems to solve that could make a difference for women in this life stage. When considering women in this stage as a customer segment, they are often resourceful and have a high willingness to pay. I believe that menopause startups that succeed with a '360-degrees' personalized approach focusing on diet and lifestyle will be the long-term winners.
Women-specific Chronic Diseases, covering diagnoses such as PCOS and Endometriosis, are also interesting sub-markets. For example, considering PCOS and Endometriosis, it's important to remember that these umbrella diagnoses are very broad, covering complicated biological imbalances that can manifest in many ways and with varying severity. This complexity presents one of the challenges with Women-specific Chronic Diseases—they are extremely complicated, and we actually know very little about them due to a lack of research. For instance, it takes between 7 to 10 years to receive a diagnosis for Endometriosis. The symptoms impact women's quality of life and fertility, presenting significant problems to solve in Women-specific Chronic Diseases. If a company can find a solution that makes a real difference for these women, the potential is vast.
Finally, I want to highlight the most taboo sub-market within Women’s Health: Sexual Health. Women are eager for knowledge and education on the subject, as women's sexual health and pleasure are still topics that are rarely discussed. This is illustrated by the success of companies like OMGYES, a digital orgasm-education platform supported by research. In addition to knowledge, women are also seeking more feminine perspectives on sexual health and pleasure, as this sub-market has largely lacked a female viewpoint until now. All indications suggest that the demand for information and innovative solutions aimed at women will only increase in the future.
What Challenges Does the Sector Face?
There is no doubt that the Women’s Health market is gaining momentum. At the same time, the market still faces several challenges that will impact both its future success and the overall health and well-being of women in society. These challenges primarily concern investment, research, and a lack of education (due to taboos).
Lack of Investment: Women’s Health startups see a lack of investment as the biggest challenge in the market. ~70% of Women’s Health companies have at least one female founder an impressive figure compared to the average of ~20% for new companies. However, only 2% of VC funding goes to female founders, and this dynamic explains some of the investment shortfall in Women’s Health. Until recently, investments in startups were a 'Boys' Club,' and today, only between 5-15% of angel and VC investors are women. This is problematic, as it can be difficult for men to understand and relate to the issues Women’s Health startups are trying to solve. However, development is moving in the right direction; both men are acknowledging issues in Women’s Health, and the number of female investors is increasing (supported by initiatives like Angella Invest 😉).
Research Challenges: Innovation is driven by research, and if there is a lack of research, it poses a challenge for the market. As previously described, health innovation has generally been based on male biology, with the assumption that men and women have similar biology. Furthermore, it is only in the last two decades that research into Women’s Health has truly accelerated. This means there is a lack of knowledge across nearly all women-specific topics, such as female hormones, menstruation, menopause, and women-specific chronic diseases. This affects startups trying to solve issues within these areas, as they require evidence to support their solutions. Although progress has been made in relevant research, there is still a long way to go both in terms of further researching women-specific topics and including women in studies while considering biological differences in analyses. Today, only a third of studies that include both genders take biological differences into account.
Lack of Education: Most topics within Women’s Health remain taboo, such as menstruation, fertility, menopause, and sexual health. This stems from a lack of education and open dialogue, resulting in uncertainty and myths both for women and men. If we perceive these topics and any related problems as shameful or embarrassing, we do not talk about them. Especially not with our friends and family, but perhaps not even with our doctor. For generations, women have unconsciously internalized shame surrounding women-specific topics and have simultaneously normalized symptoms that should be addressed. Severe menstrual pain or menopause symptoms are examples that have been normalized among women over generations. If women genuinely have a problem but either hesitate to talk about it or have normalized it, it becomes much harder for a company to solve the issue. Today, a significant part of the educational burden, breaking taboos, and fostering open dialogue lies with the startups operating within Women’s Health, which takes time and resources.
It is a societal task to address these challenges within Women’s Health, and everyone has a role to play: politicians, researchers, educational institutions, investors, startups and you and me. 🙋♀️
Do You Have Tips for Resources to Learn More?
If you are an investor and a member of Angella Invest, you should definitely join Angella Invests Women’s Health group 😉
If you are a startup or another stakeholder, I recommend the following resources and sources for keeping up to date on the Women’s Health market. Additionally, you can keep an eye on relevant Women’s Health events hosted by various stakeholders. Many of us are passionate about Women’s Health and want to connect with like-minded individuals 🤩
Resources to Learn More:
Nordic Women’s Health Hub: https://nordicwomenshealth.com
FemTech Insider (weekly newsletter): femtechinsider.com
FemTech Analytics (publishes annual reports and continuously updates their industry overview): femtech.health
Silicon Valley Bank, Healthcare Investments & Exits Mid-Year 2023 report (read the Women’s Health section): svb.com
BCG, Investing in the Next Generation of Women’s Health, 2023: bcg.com
McKinsey, The Dawn of the FemTech Revolution, 2022: mckinsey.com
Thank you for reading! 🤩
Sources:
https://evidence.nihr.ac.uk/collection/womens-health-why-women-feel-unheard/, https://www.northwell.edu/katz-institute-for-womens-health/articles/gaslighting-in-womens-health
https://www.weforum.org/agenda/2022/07/what-is-the-pink-tax-and-how-does-it-hinder-women/
https://www.weforum.org/agenda/2018/08/why-male-is-our-default-gender
Probably much longer, but if we take as a starting point the social structure of ancient Rome.
It should be noted that data on Women's Health will always vary somewhat, as it depends on how the chosen source views the market.
https://www.femtech.health/open-access-analytics, https://www.svb.com/globalassets/trendsandinsights/reports/healthcare/2023/mid-year/healthcare-investments-and-exits-mid-year-2023.pdf
https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility
KRING analyse
https://www.endometriosis-uk.org/it-takes-average-75-years-get-diagnosis-endometriosis-it- shouldnt + https://www.yalemedicine.org/conditions/endometriosis
KRING analyse
https://www.mckinsey.com/industries/healthcare/our-insights/the-dawn-of-the-femtech- revolution
Women and Biometrics: Harnessing the Potential of Gender-Specific Health & Wellness Data, Evie, 2023
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