Lisa Schrenk had set out late at night with a hiking group, climbing Virginia's Old Rag Mountain in the dark to catch the sunrise over the Blue Ridge range. While a photo from the summit showed her smiling with her hair in a ponytail, the reality was starkly different as she had been contemplating suicide and organizing her financial affairs. Her pivotal moment did not happen at the peak, but rather on the way back down when she overheard fellow hikers discussing hormone therapy for intense anger, anxiety, and exhaustion.
Schrenk had previously tried to convince her primary care doctor to consider hormone therapy, suspecting her treatment-resistant mood issues were tied to the hormonal shifts of perimenopause. However, her physician dismissed the idea and prescribed an oral contraceptive instead, which failed to alleviate her worsening depression. After hearing her hiking companion's positive experience, Schrenk turned to Midi, a telehealth startup focused on women's midlife care, and booked a virtual consultation where a nurse practitioner agreed to switch her treatment to hormone therapy.
The Telehealth Boom and Changing Regulations
Over the subsequent five months, regular adjustments to her medication dosages yielded a dramatic improvement in her mental health. Around the time of Schrenk's personal realization, access to hormone therapy was undergoing a massive shift nationwide. Decades after a 2002 study created widespread fear of cancer risks among patients and doctors, medical professionals and policymakers began viewing that prescribing trend as overly restrictive, leaving millions of menopausal individuals to suffer unnecessarily from hot flashes and mood swings.
Following the removal of black box warnings on hormone therapy by the US Food and Drug Administration, demand surged dramatically. An analysis conducted by SimilarWeb showed a 490 percent increase in web traffic across four leading perimenopause startups from 2023 to 2026. With over 43 million women aged 35 to 54 living in the United States, virtual clinics are aggressively competing in this burgeoning market, offering subscription-based custom formulations delivered in patches, gels, and pills.
Expansive Symptom Lists and Medical Debate
The vast market potential is driven in part by the extensive list of ailments attributed to perimenopause, ranging from night sweats and low libido to bloating, anxiety, and skin aging. Because unpredictable hormone fluctuations make definitive lab testing difficult, clinicians rely primarily on patient-reported symptoms. Prominent medical figures, including Mayo Clinic's Stephanie Faubion and Yale School of Medicine's Mary Jane Minkin, have expressed concern that marketing campaigns are attributing too many general life stressors and aging signs to hormonal imbalances.
Furthermore, the surge in popularity has created supply chain bottlenecks, particularly for estrogen patches, as manufacturers were unprepared for the massive influx of younger patients staying on the treatments for extended periods. Beyond hormone replacement therapy, major telehealth platforms are expanding their product lines to include supplements, prescription skincare, and GLP-1 medications, signaling a broader shift toward a highly commercialized, preference-driven healthcare model for midlife care.
