Midi Health CEO on closing the menopause care gap

Executive overview

For 20 years, a flawed 2001 study scared doctors and women away from hormone therapy, halting research and leaving millions undertreated. The study used the wrong age group, the wrong progesterone, and the data was misread — women within 10 years of menopause on estrogen actually had a reduced breast cancer risk.

Joanna Strober co-founded Midi Health after struggling to access hormones herself. Midi fills the gap as the only national virtual menopause clinic covered by insurance, and has had to build its own clinician training from scratch because the average OBGYN receives two hours of menopause education.

Untreated menopause is a workforce, health, and equity crisis — and insurance-covered virtual care is the lever to fix it.

Why hormone therapy was abandoned for 20 years

• The 2001 Women's Health Initiative study used women mostly over 65 — the wrong population
• The progesterone used is no longer prescribed; modern formulations differ significantly
• Reanalysis of the same data showed estrogen reduced breast cancer risk in younger women
• The panic around breast cancer stopped all research; no new data was collected for two decades
• Many consider it one of the biggest miscarriages of healthcare in the last 25 years

What perimenopause actually looks like

• Menopause = no period for one year; perimenopause begins around age 35
• Hormone fluctuations cause sleep disruption, mood changes, brain fog, and anxiety — often misdiagnosed
• No reliable test exists; symptoms are the signal, not a blood result
• 50% of women consider leaving their jobs due to symptoms; 10% actually do
• Women are routinely told to accept the suffering — Strober argues this is a cultural failure, not a medical inevitability

How estrogen affects the whole body

• Bone loss is directly halted by estrogen — established, not speculative
• Vaginal wall thinning causes pain during sex for ~80% of women; estrogen treats this directly
• Skin thinning with age is also estrogen-related; topical estrogen shows early evidence for wrinkle reduction
• Cardiovascular risk in women may be linked to declining estrogen — research now beginning
• Brain health and Alzheimer's prevention are emerging areas of study

Midi's business model and competitive edge

• Only national virtual clinic with insurance coverage — 70% of commercially insured women covered by end of 2024
• Competing platforms sell patches or run concierge models; Midi focuses on democratizing access
• Clinicians are trained in-house because no pre-trained specialist pipeline exists
• Expanding into weight loss (GLP-1s), testosterone, and an estrogen-based skincare product
• Testosterone is not FDA-approved for women but is prescribed off-label in compounded form

Fundraising lessons for women founders

• Strober's early pitches were criticized for failing to convey the scale of the opportunity
• The reframe: every woman in the country goes through menopause; the TAM is the entire female population
• Women founders tend to pitch margins and operations — investors need the billion-dollar narrative first
• After reframing, Strober raised $60M Series B; subsequent rounds driven by growth metrics, not storytelling
• The funding gap in women's health is stark: $100M in government research vs. a single month of erectile dysfunction marketing spend