Compiled 19 September 2026
The female health gap
A missed period, a blood test, and the answer "idiopathic, probably stress." This guide maps why that answer is still so common, and every lab, startup, funder and government trying to change it.
$2.5BGates Foundation women's health pledge to 2030, its largest ever
19.6%of Indian women aged 18–40 meet PCOS criteria (ICMR, 2024)
7–10 yrsaverage wait for an endometriosis diagnosis
~13%of 600,000 tracked cycles were actually 28 days long
<5%of clinical trials include pregnant women
~2×more adverse drug reactions in women, from male-set doses
The short version
- Research funding is starting to close the gap. Big philanthropy (Gates, Pivotal, Wellcome Leap) moved in 2024–25.
- Menopause and endometriosis get most of the attention. PCOS and everyday cycle problems get the least.
- PCOS has a new name: PMOS. The Lancet, May 2026. It reframes the condition as metabolic and hormonal, not an ovary problem.
- Venture money is shrinking. Femtech funding fell while health-tech overall grew.
- The missing piece is data over time. Hormones move by the hour; clinics measure them once.
In this guide
02HistoryWhy women were kept out of drug trials
03GapsWhat's actually missing, and what's still unfixed
04BreakthroughsWhat changed in 2025–26
05MoneyPhilanthropy, venture capital, public funds
06GovernmentsCountry by country
07IndiaData, policy, institutes, startups
08LabsWho is doing the science
09StartupsSorted by evidence, not hype
10TrackingLogging your own cycle
02 · History
Why the gap exists
Two drug disasters made regulators afraid of harming unborn babies. Researchers already saw hormone cycles as noise. The result was a rule that treated every woman as potentially pregnant.
| When | What | What happened |
|---|---|---|
| 1957–61 | Thalidomide | Sold as a sleeping pill and morning-sickness drug. Caused severe limb defects in about 10,000 babies. The US was largely spared because FDA reviewer Frances Kelsey refused to approve it. |
| 1940s–71 | DES | Given to millions of pregnant women to prevent miscarriage. In 1971 it was linked to a rare vaginal cancer in their daughters, decades later. |
| 1977 | FDA exclusion rule | "Women of childbearing potential" kept out of early drug trials, including women on contraception, single women, and women whose husbands had vasectomies. |
| 1980s | The cost shows up | Aspirin for heart-attack prevention tested on 22,071 men and no women. When women were studied in 2005, aspirin didn't prevent first heart attacks under 65, but did reduce strokes. The opposite pattern to men. |
| 1985–91 | Pressure builds | A 1985 federal task force flags the gap. A 1990 audit finds NIH ignoring its own inclusion policy. In 1991 Bernadine Healy, the first woman to lead NIH, launches the Women's Health Initiative. |
| 1993 | NIH Revitalization Act | NIH-funded trials must include women. The FDA withdraws its 1977 rule the same year. Industry trials are not covered. |
| 2001 | The audit | 8 of the 10 prescription drugs withdrawn in 1997–2000 posed greater risks to women. |
| 2013 | Ambien | The FDA halves the zolpidem dose for women. They clear it more slowly and were impaired the next morning, including while driving. |
| 2016 | Sex as a biological variable | NIH requires animal and cell studies to consider sex. Female rodents had been avoided as "too variable"; a 2014 meta-analysis found they aren't. |
Still unfixed. The 1993 law covers only NIH-funded trials. Many trials include women but never analyse results by sex, almost none record cycle phase, and pregnant women are still largely excluded.
03 · Gaps
What's missing
We mostly don't lack treatments. We lack the data, the subtypes and the models. "Idiopathic" usually means one of these was missing.
1Continuous hormone data
Hormones like LH and prolactin rise and fall within hours. Clinics measure them in one blood draw on one day. Diabetes has the glucose monitor; hormones have nothing like it yet.
2Diagnosis by mechanism
PCOS, endometriosis and hypothalamic amenorrhea are diagnosed by checklist and exclusion. That says what is happening, not why.
3Population cycle data
The 28-day cycle is largely a myth. ACOG calls the cycle a vital sign, but no health system records it like one.
4Research models
Mice don't menstruate. Very few animals do, so most lab biology doesn't transfer.
5Non-invasive diagnostics
Endometriosis has needed keyhole surgery to confirm. Saliva and menstrual-blood tests are only now being validated.
6Funding by burden
Conditions that mainly affect women get less money relative to the harm they cause (Mirin, 2021).
7A care loop
A 10-minute visit, one test, one prescription, "follow up as needed". Nobody checks whether it worked.
8Everyone else's data
India, Africa and Latin America are barely in the datasets that set the reference ranges.
Where the next decade has to come from
| Frontier | Where it stands | What's hard |
|---|---|---|
| A glucose monitor for hormones | Sweat and microneedle prototypes (Caltech, 2023; four-hormone patch, 2026) | Very low hormone levels, sensor fouling, matching blood values. Nothing clinically validated. |
| Subtypes, then targeted drugs | Four PCOS subtypes; 80 endometriosis risk regions | Turning subtypes into non-hormonal or repurposed drugs, beyond pill-or-surgery |
| Doses set on women | Known since at least 2020 (86-drug analysis) | Most labels still use male-derived doses |
| Pregnant women in trials | International draft rule (ICH E21), due around 2028 | Liability fear; fewer than 5% of trials include them |
| The rest of the world | Little primary research from India, Africa, Latin America | Reference ranges built mostly on European and East Asian data |
04 · Breakthroughs
Breakthroughs, 2025–26
The last 18 months moved more than the previous decade.
| Finding | Published | Why it matters |
|---|---|---|
| PCOS becomes PMOS | ||
| The rename to Polyendocrine Metabolic Ovarian Syndrome | The Lancet · May 2026Endocrine Society | Led by Monash (Helena Teede) after 11 years, 22,000 respondents and 50+ organisations. Reframes it as metabolic and hormonal. |
| Four PCOS subtypes | Nature Medicine · Oct 2025Nature Medicine | Karolinska with Shandong University, 11,908 women: high-androgen, obesity, high-SHBG, high-LH/AMH. Each with different outcomes. |
| AMH replaces the ultrasound | Fertility & Sterility · 2025PubMed | AMH at or above 3.2 ng/mL can stand in for the ovarian ultrasound finding. |
| Endometriosis without surgery | ||
| ACOG allows clinical diagnosis | Feb 2026Healio | US doctors can diagnose from symptoms and start treatment without surgery first. |
| Saliva test (Ziwig Endotest) Disputed | NEJM Evidence · late 2025France24 · NICE | Reported 97.3% sensitivity in 971 women. French experts question the samples; UK approval is still a draft. |
| 80 genetic risk regions | Nature Genetics · Apr 2026Medical Xpress | 1.4 million women, 37 new regions. Overlap with autoimmune disease points at drugs that already exist. |
| Menopause | ||
| Hormone therapy warnings removed | FDA · Nov 2025FDA | Most boxed warnings removed. Endometrial cancer warning stays on estrogen-only products. |
| Elinzanetant (Lynkuet) | UK, US, EU · 2025Bayer | A new non-hormonal drug for hot flashes. |
| Estrogen receptors in the living brain | Scientific Reports · 2024Scientific Reports | Weill Cornell: receptor levels rise across menopause and track memory and mood symptoms. |
| Menstruation in a dish | ||
| Organoids that cycle | Cell Stem Cell · 2026Cell Stem Cell | Basel with Cambridge: first lab tissue that goes through a full cycle, showing how the lining regrows without scarring. |
05 · Money
The money
Philanthropy is filling the space government and venture capital left.
Philanthropy and public research funds
| Funder | Amount | Focus |
|---|---|---|
| Gates Foundation | $2.5B to 2030 | Endometriosis, heavy bleeding, menopause, contraception, maternal health. About 70% to R&D. |
| Pivotal (Melinda French Gates) | $1B pledged | About $600M deployed; $215M in Jun 2026 for reproductive and midlife health |
| Wellcome Leap | $250M+ | Heavy menstrual bleeding ($50M), stillbirth, women's heart disease, Alzheimer's risk |
| ARPA-H (US government) | ~$110M | 23 projects (2024). No new rounds since its director was fired in 2025. |
| NIH women's health office | ~$106M / yr | Raised 30% for FY2026 despite wider NIH cuts |
| Ainsworth family, UNSW | $50M | Endometriosis institute, the largest known endometriosis gift |
| EndoFound + Cold Spring Harbor | $20M | Endometriosis research centre (Apr 2025) |
Venture capital is contracting
| Year | Femtech venture funding | Note |
|---|---|---|
| 2024 | ~$1.2B | PitchBook. Women's digital health was 6.6% of all digital health funding (Rock Health). |
| 2025 | ~$478M | Down about 56% while health-tech overall rose about 30% (Deloitte / PitchBook). Broader definitions report up to $1.55B. |
| 2026 H1 | ~$239M | Same pace. Money concentrating in a few big rounds: Midi $100M, Evvy $40M. |
Totals vary widely because every tracker defines "femtech" differently.
06 · Governments
Governments
Most public money goes to care (clinics, drug subsidies), not research. PCOS and menstrual disorders have almost no dedicated public funding anywhere.
| Country | What's happening | Money | Direction |
|---|---|---|---|
| United States | White House research initiative and its $12B request are dead. 2025 NIH grant cuts hit women researchers hardest. Congress raised NIH's women's health office anyway.PNAS | ~$106M / yr | Mixed |
| United Kingdom | Renewed Women's Health Strategy (Apr 2026): one gynae referral point, faster endometriosis pathways. NIHR funding requires sex and gender analysis from Nov 2025.GOV.UK | £195M since 2020 | Growing |
| European Union | 1,000+ women's health projects. Sex and gender analysis required by default in Horizon Europe.European Commission | €2B+ | Structural |
| Australia | 33 endometriosis and pelvic pain clinics, Medicare rebates for menopause assessments, new drugs subsidised.ABC | A$573–793M | Growing |
| France | National endometriosis strategy since 2022. Free saliva tests for 25,000 women from Feb 2025.Ministry of Health | ~€25M research | Stalling |
| Canada | Women's health research initiative ends Mar 2027, no renewal found. Only ~6% of federal health grants 2006–2020 went to women's health.CIHR | C$27M | Ending |
| Japan | National women's health centre opened Oct 2024, modelled on NIH's women's health office. | Not disclosed | New |
| Sweden · Norway | Sweden funded three women's health centres in 2025. Norway has a 2024 strategy with little dedicated money. | SEK 30–80M / yr proposed | New |
| WHO | First global infertility guideline (Nov 2025, 40 recommendations). Pushing to include pregnant women in trials.WHO | No dedicated fund | Guidance |
07 · India
India
High prevalence, very little national data, and no national PCOS guideline yet.
19.6%PCOS prevalence by Rotterdam criteria, women 18–40
43%of women in the PCOS study had obesity; 33% fatty liver
0national endometriosis prevalence studies
Data and policy
| What | When | Detail |
|---|---|---|
| ICMR PCOS Task Force | Oct 2024 | 9,824 women across five zones, JAMA Network Open. 19.6% by Rotterdam, 7.2% by NIH criteria.JAMA Network Open |
| Endometriosis Estimate only | 2024 | The "42 million women" figure comes from a research brief, not a national survey. |
| Supreme Court ruling | Jan 2026 | Menstrual health in schools is part of the right to life (Article 21). Free pads, separate toilets, quarterly compliance reports.Down To Earth |
| Swasth Nari Sashakt Parivar Abhiyaan | Sept 2025 | 6.5 crore women screened for cancers. PCOS and endometriosis were not screening targets.DD News |
| National HPV vaccination | Feb 2026 | One dose of Gardasil-4 for 1.15 crore girls aged 14. |
| Ayushman Bharat | Ongoing | Covers gynae surgery. No package for managing PCOS or endometriosis. |
Institutes, startups and groups
| Who | Type | What they do |
|---|---|---|
| ICMR-NIRRCH, Mumbai | Research institute | Now the National Institute for Research on Women's Health. One-stop PCOS clinic, endometriosis pain project (HEAL, 2026), PCOS epigenetics.nirrch.res.in |
| AIIMS New Delhi | Research hospital | Hormone assays for the PCOS task force; PCOS drug research. |
| GARBH-Ini, THSTI | Pregnancy cohort | 12,000 women. India-specific pregnancy dating model cut error more than 3×.garbhini.thsti.in |
| Inito | Startup | Home hormone monitor. $29M Series B, Dec 2025. |
| Veera Health · Elda | Startups | Digital PCOS care and menopause care. Both still at seed stage. |
| Proactive For Her · Sirona | Startups | Proactive was sold in a distress deal. Sirona's founders bought it back at a lower price. |
| Societies and NGOs | Advocacy | Endometriosis Society India, Endometriosis Foundation of India, PCOS Society India, Myna Mahila Foundation, Goonj. |
08 · Labs
Labs to follow
Grouped by the question they're answering.
| Question | Who | Notable output |
|---|---|---|
| What genes drive endometriosis? | Oxford (Krina Zondervan), Yale | 42 loci (2023), then 80 (2026); autoimmune overlap |
| Can we treat it without hormones? | Edinburgh (Andrew Horne); UCSF–Stanford | Lesions have a cancer-like metabolism; data-driven drug repurposing |
| Can menstrual blood diagnose it? | Feinstein Institutes (ROSE study) | 3,700+ enrolled; test not yet validated |
| How do we model human tissue? | MIT CGR (Linda Griffith); Basel + Cambridge | Organs-on-chips; organoids that menstruate |
| What are the PCOS subtypes? | Karolinska (Elisabet Stener-Victorin); Monash (Helena Teede) | Four subtypes (2025); PMOS rename (2026) |
| How does the lining repair? | Edinburgh (Hilary Critchley); Sanger (Roser Vento-Tormo) | Low-oxygen repair signal; 313,000-cell endometrium atlas |
| What does menopause do to the brain? | Weill Cornell (Lisa Mosconi); UCSB (Emily Jacobs) | Estrogen receptor imaging; brain maps across pregnancy |
| Can we sense hormones continuously? | Caltech (Wei Gao) | Wireless sweat estradiol patch (2023) |
| What does a real cycle look like? | Apple Women's Health Study (Harvard) | 100k+ participants; PCOS and endometrial risk |
| Why do drugs hit women harder? | Zucker (Berkeley), Prendergast (Chicago) | 86 drugs: higher blood levels in women, more side effects |
| What about India? | ICMR-NIRRCH (Deepak Modi); THSTI | Endometrial stem cells; India's endometriosis research priorities (2025) |
09 · Startups
Startups, by evidence
Sorted by what their evidence supports, not by how much they've raised.
Solid peer-reviewed or FDA-cleared for what it claims
Promising real science, results pending
Hype risk claims ahead of evidence
| Company | What it does | Evidence | Funding |
|---|---|---|---|
| Qvin | Pad that collects menstrual blood for a lab HbA1c (diabetes) test. Hormone claims not cleared. | Solid | ~$12–24M |
| Mira | Urine LH, E3G, PdG, FSH. Ovulation within a day of LH peak in 96% of 121 cycles vs ultrasound. | Solid | Undisclosed |
| Proov | First FDA-cleared at-home PdG test confirming ovulation (2020). | Solid | ~$11M |
| Natural Cycles | FDA-cleared contraception app with ring and Apple Watch temperature. | Solid | $55M Series C |
| Evvy | Vaginal microbiome sequencing plus treatment, peer-reviewed. | Solid | $40M Series B |
| Daye | Diagnostic tampon for at-home HPV and STI sampling, peer-reviewed. | Solid | ~$24M |
| Inito | Urine hormone monitor read by phone. Class I registered, not cleared. | Promising | $45M |
| Gameto | Matures eggs outside the body; hormone stimulation cut to 2–3 days. Phase 3. | Promising | $127M |
| NextGen Jane | Endometriosis test from tampon samples. In validation. | Promising | NIH grants |
| May Health | One-time ovarian procedure for PCOS-related infertility. US pivotal trial. | Promising | $11.7M |
| Allara · Midi · Hertility | PCOS care, menopause care, UK hormone panels. Improve access; no new science. | Care model | Midi $1B valuation |
| Eli Health | Saliva cortisol and progesterone. "90% accuracy" is company-cited. | Hype risk | $20M |
| Clair Health | Claims four hormones from a wristband, no blood or urine. | Hype risk | $11.6M seed |
| Vivoo FlowPad | Pad that reads FSH from menstrual blood. No published validation. | Hype risk | Undisclosed |
| Ferta | "Root-cause" fertility coaching. Unsourced "80% metabolic" claim; no named clinicians. | Hype risk | Undisclosed |
| Elvie · Aspira | Elvie went into administration (2025). Aspira delisted, nearly out of cash. | Failed | · |
10 · Tracking
Tracking your own cycle
The system doesn't collect data over time, so you can.
| Device | Measures | Good for | Limits |
|---|---|---|---|
| Inito · Mira | LH, E3G, PdG, FSH (urine) | Seeing whether and when you ovulate | Class I devices; strips cost adds up |
| Oura · Apple Watch · Tempdrop | Skin or core temperature | Confirming ovulation after the fact | Disturbed by illness, alcohol, poor sleep |
| Proov · Oova | PdG, LH (urine strips) | Cheaper ovulation confirmation | Fewer hormones |
| LH-only strips | LH | Timing | In PCOS, LH can run high all the time and give false surges |
| Blood tests | Prolactin, TSH, testosterone, AMH, insulin | Everything a home device can't measure | One-off snapshots; no home option for prolactin |
Tests worth asking about for an irregular cycle
- LH and FSH
- Total testosterone and SHBG
- AMH (now accepted as a PCOS marker)
- Fasting insulin and glucose
- Prolactin, repeated if only mildly high, with a macroprolactin check
- TSH
This guide is a research summary, not medical advice. Take questions to your doctor.
11 · Sources
Sources
Primary papers and reports, plus the best books on the history.
| Source | Type | What it shows |
|---|---|---|
| Bull et al. 2019 | npj Digital Medicine | Real-world cycle lengths across 600,000 cycles |
| Dapas et al. 2020 | PLoS Medicine | PCOS splits into reproductive and metabolic subtypes |
| Zucker & Prendergast 2020 | Biology of Sex Differences | Sex differences in drug response across 86 drugs |
| Mirin 2021 | Journal of Women's Health | Funding versus disease burden |
| International PCOS Guideline 2023 | Monash | Current diagnosis and care standard |
| ACOG Committee Opinion 651 | Clinical guidance | The menstrual cycle as a vital sign |
| McKinsey Health Institute 2024 | Report | Women spend 25% more of life in poor health |
| Gates Foundation 2025 | Funding announcement | $2.5B women's health commitment |
| Wellcome Leap | Funder | Women's health programmes |
| ARPA-H Sprint | US government | Women's health awards |
| MIT CGR | Research centre | Gynepathology research and tissue models |
| Invisible Women | Book · Caroline Criado Perez, 2019 | The data gap across every field |
| Doing Harm | Book · Maya Dusenbery, 2018 | How medicine dismisses women's symptoms |
| Women and Health Research | Institute of Medicine, 1994 | The history of trial exclusion |
Figures marked as estimates or disputed could not be confirmed against a primary source.