The Funding Gap That Left 1.2 Billion Women Behind. Follow the money. It will tell you everything.
By Delaney | You're Not Crazy... You're Menopausal
You went looking for answers.
That is what makes this story so infuriating — not that you were lazy, or passive, or unwilling to take charge of your own health. You did exactly what a responsible woman is supposed to do. You noticed something was wrong. You wrote down your symptoms. You sat in the waiting room. You opened your laptop at eleven at night and typed your symptoms into a search bar and read until your eyes burned.
And you came up empty. Contradictory advice. Supplement ads dressed up as science. A forum full of women as lost as you were. A doctor who had nothing to offer you but a shrug and a prescription for something that was never designed for what you actually have.
And you concluded, quietly, that you must not be looking hard enough.
You were looking hard enough. The answers were never funded into existence.
This is the part of the story nobody tells you — the part that comes before the exam room, before the dismissal, before the antidepressant. It happens in budget meetings and grant committees and venture-capital pitch rooms, decades before you ever get sick. It is a story about money. And once you see it, you cannot unsee it.
Follow the money. It will tell you everything you need to know about why nobody could help you.
One crumb on the plate
Start with the single number that explains most of your life right now.
By 2030, an estimated 1.2 billion women worldwide will be menopausal or postmenopausal. That is not a niche population. That is not a rare disease. That is roughly one in every seven human beings on the planet, moving through a biological transition that is universal, predictable, and — for many — genuinely debilitating.
In 2023, the National Institutes of Health spent about $56 million on menopause research.
That sounds like real money, until you learn the NIH’s total budget that year was roughly $45 billion.
Barely one-tenth of one percent. About 0.12%.
For a transition every woman who lives long enough will pass through.
Picture a banquet table. Groaning with food. Candles, crystal, more than anyone could eat. And at the far end, one plate — with a single crumb on it. That crumb is menopause research. And for decades, they handed it to a billion women and called it a meal.
Here is the detail that should make your jaw tighten: 2023 was the first year the NIH even tracked menopause as its own research category. Not the first year they funded it well. The first year they bothered to count it at all.
It is not just menopause. It is the whole pattern.
If menopause were simply unlucky — one condition that slipped through the cracks — that would be a tragedy. What it actually is, is a pattern. And the pattern has a shape you can measure.
In 2020, roughly 1% of global healthcare research and development funding went to women’s health conditions beyond cancer. One percent. For half of humanity, minus oncology.
Now put two conditions side by side.
Erectile dysfunction affects roughly 19% of men. Premenstrual syndrome affects up to 90% of women. Erectile dysfunction receives around five times the research funding that PMS does.
Read that twice. A condition affecting one in five men is studied five times more heavily than a condition affecting nine in ten women.
And when you follow the private money — where intentions get very honest very fast — it gets worse. In one recent year, startups working on erectile dysfunction attracted about $1.24 billion in venture and startup funding. Endometriosis — a brutal, frequently disabling disease affecting an estimated 190 million women worldwide, which takes an average of years to even diagnose — drew about $44 million.
A ratio of roughly 28 to 1. Twenty-eight dollars chasing men’s sexual comfort for every single dollar chasing a disease that leaves women doubled over on bathroom floors.
And it is not new. For years, one of the most-cited analyses of cancer funding found that prostate cancer received roughly $1.8 million in research funding per year of life lost to it. Ovarian cancer — a disease exclusive to women — received about $97,000. Same devastation. Same grief. Wildly different investment.
This is not a cartoon conspiracy with a villain twirling a mustache. It is something quieter and far more damning: a century of small decisions, made largely by men, about what counted as important enough to study. And the answer, over and over and over, was not us.
How the hole got dug
A funding gap this consistent does not appear by accident. It was built — deliberately, on the record, by policy.
From 1977 to 1993, the U.S. Food and Drug Administration formally recommended that women “of childbearing potential” be excluded from early-phase drug trials. The guidance was breathtakingly broad: it swept in women who used contraception, women who were single, even women whose husbands had had vasectomies. If you had a functioning uterus, you were, by default, out.
Sixteen years of the foundational research on the drugs still in your medicine cabinet — done almost entirely on men.
It went further than people. Even female laboratory animals were routinely excluded from studies, because their hormonal cycles were considered a complication that made the data messy. Researchers had a term for it. Your biology — the cycling, the fluctuating, the very thing that defines the female body — was formally classified as a confounding variable.
A nuisance. Something to be excluded so the numbers would come out cleaner. I hope that is settling in…
The 1993 NIH Revitalization Act finally required women to be included in federally funded research. That was the turning point — but a law does not conjure thirty years of missing data out of thin air. The hole had already been dug. We are still standing in it. Even by 2019, women made up only about 42% of participants in trials for cardiovascular disease, cancer, and mental health — three of the conditions most likely to kill or disable us.
And then came 2002, and the thing that set menopause care back a generation. A major analysis from the Women’s Health Initiative raised alarms about hormone therapy. The coverage was apocalyptic. Prescriptions collapsed. An entire generation of doctors was trained to fear hormones — and an entire generation of women was left to white-knuckle a decade of symptoms with nothing.
The findings have since been substantially reexamined and contextualized — the risks were widely overstated for younger, healthy women, and in 2025 the FDA moved to remove the long-standing boxed warnings from menopausal hormone therapy. But consider what those years cost. Two decades of women told to just get through it. Two decades of research money flowing elsewhere, because who funds a treatment everyone has been taught to be afraid of?
The gap did not just persist. It compounded.
The bill — and who actually paid it
Here is where the abstraction ends and your life begins. Because a funding gap is not a spreadsheet problem. It is converted, eventually, into human beings. Into you.
A Mayo Clinic study — more than 4,400 employed women — found that 13% had suffered an adverse work outcome because of menopause symptoms: missing work, cutting hours, being passed over, quitting, retiring early. The researchers estimated the cost of that lost work time at about $1.8 billion a year in the United States alone. Add the medical costs and the figure reaches roughly $26.6 billion.
Globally, an AARP analysis put menopause-related productivity losses at around $150 billion, with associated healthcare costs exceeding $600 billion.
But look closer at that last number, because it contains something quietly outrageous. Women are estimated to spend around $13 billion a year out of their own pockets — on supplements, on treatments, on copays, on the endless parade of things sold to desperate women — trying to solve a problem that nobody would spend the money to study properly in the first place.
They would not fund the research. And then they sold you the guesswork. And you paid for it — twice.
Now convert it into a life. Your life.
● The years you spent thinking you were losing your mind, because no one had written the map.
● The antidepressant you were handed when what you needed was honest information about your own hormones.
● The promotion you did not reach for, because the brain fog had you doubting your own competence.
● The marriage that strained under a rage you could not explain and no one would help you understand.
● The money you spent on supplements that had never been meaningfully tested — because the untested ones were all anyone was selling you.
● The nights you spent googling your own symptoms, because the person with the medical degree could not answer the question.
Nobody ever put that on a spreadsheet. So we are putting it on the record.
And here is the maddening part: it would pay for itself
You might expect a gap this large to at least be defensible on cold economic grounds. It is not. It is not even good business.
In 2024, the World Economic Forum and McKinsey Health Institute ran the numbers on what closing the women’s health gap would actually be worth. Their conclusion: at least $1 trillion added to the global economy every year by 2040.
A trillion dollars. Annually.
They also quantified the human side of the ledger. Women lose an estimated 75 million years of healthy life every year — to conditions that are underdiagnosed, undertreated, or simply never studied. Not lost to death. Lost to living badly: in pain, in fog, in exhaustion, in a body nobody bothered to understand.
So the world was not even being ruthlessly, coldly rational. Ignoring us was not the profitable choice. It was just the habitual one.
But the wall is cracking
I promised you this would not leave you in the dark, and I meant it. Because something is genuinely changing — and it is changing for exactly one reason, which I want you to hold onto.
Not because the system developed a conscience. Because women refused to keep accepting the crumb.
The evidence is real and it is recent:
● Money is moving. In late 2024, Melinda French Gates committed $250 million through Pivotal Ventures specifically to improving women’s health and wellbeing — part of a broader $1 billion pledge. Private capital is finally following.
● Menopause is finally a category. The NIH is now actively building a dedicated menopause research agenda — for a subject that, until 2023, it did not even formally count.
● The economic case has been made, loudly. The WEF and McKinsey work put a trillion-dollar number on the table, and institutions that ignored the moral argument for a century are suddenly very interested in the financial one.
● The science is being corrected. The FDA’s 2025 move to remove the boxed warnings on hormone therapy is a formal acknowledgment that the fear that shaped two decades of care was overstated.
● The silence broke. Women started saying it out loud — in books, in parliaments, in workplaces, in comment sections, at kitchen tables. That is what forced every one of the changes above.
The wall did not crack on its own. Women put their shoulders to it and pushed.
What you can actually do with this
Righteous anger with nowhere to go curdles. So here is where to aim it.
● Stop blaming yourself for not finding answers. This is the first and most important one. You did not fail to find the information. The information was never funded. Put that guilt down; it was never yours to carry.
● Walk in armed. Track your symptoms and bring documented evidence to your appointments. A woman with two months of data is a very different patient from a woman with a vague complaint — and she gets treated differently.
● Find a menopause-trained provider. The Menopause Society keeps a directory of certified practitioners at menopause.org. Someone who has specifically trained in this will not need to be convinced your symptoms are real.
● Be skeptical of anyone selling you certainty. The funding gap created a vacuum, and the supplement industry rushed in to fill it. If a product promises what the research has not delivered, ask who paid for the study.
● Say it out loud. Talk to your daughters, your friends, your colleagues, your employer. Every single change listed above happened because women stopped whispering. Your voice is not a small thing — it is the entire mechanism.
The bottom line
You were not imagining it. You were not being dramatic. You were not failing to look hard enough.
You were underfunded. There is a difference, and it is the whole difference in the world — because one of those is a flaw in you, and the other is a flaw in a system that can be changed. And is being changed. By us.
The gap is real. But so is the movement closing it. And you are standing in it.
Get the free 7-Day Symptom Tracker + Doctor Visit Guide at HERE — and walk into your next appointment with evidence they cannot wave away.
You’re not crazy. You’re not alone. And you were never the problem.
— Delaney
Delaney Cassidy is the author of You’re Not Crazy... You’re Menopausal: Science, Strategies, and Swearing Through the Hormonal Apocalypse, available August 15.
SOURCES & REFERENCES
6. NIH Sex as a Biological Variable (SABV) policy — female animals in research
7. Women’s Health Initiative (2002) and the subsequent reexamination of hormone therapy risk
8. FDA action on menopausal hormone therapy labeling (2025)
9. Melinda French Gates / Pivotal Ventures — $250M commitment to women’s health and wellbeing
10. The Menopause Society — find a certified menopause practitioner
Note on figures: the ED-vs-endometriosis comparison ($1.24B vs $44M, ≈28:1) refers to startup/venture funding, not government research funding. The prostate-vs-ovarian per-year-of-life-lost comparison ($1.8M vs $97K) comes from a widely cited analysis of cancer funding and reflects the period it was drawn from. All figures were verified against primary sources before publication.
