Last week, menopause scale-up Midi Health co-founder and CEO Joanna Strober posted something that caught my attention. Hims & Hers had just announced their expansion into menopause care, and Strober responded:
“Every few months a new player ‘discovers’ menopause. Eight years ago, Hims started with men and ED drugs – you might remember the 🌵 campaign here. Now they’ve found their way to women in midlife. To which I say: welcome!”
She went on: “At Midi Health we didn’t have to pivot to women’s health. We were built for it… Because serving women isn’t our side hustle. It’s our purpose. We’ve been hers all along.”
As I mentioned in the intro of a previous Inner Circle brief, this pattern – new players discovering menopause every few months – is becoming familiar. But what struck me this time though was the specific matchup: A purpose-built specialist defending territory against a massive platform with proven distribution power.
And it made me think about a book I just finished reading.
The Ava Lesson
“Die Kindermacher” (The Baby Makers) by Stefan Mair tells the story of Ava, a Swiss fertility tracking wearable startup that raised around $50 million and pursued FDA clearance for their technology – the gold standard for medical validation.
One of the central tension points in the book and startup’s story: Building a medically validated, FDA-cleared product versus a consumer health product. After getting approval, they discovered consumers didn’t care as much about the medical validation as expected. Women often couldn’t tell the difference, or chose the most convenient or cheapest product, not the best validated one.
Ava struggled despite superior clinical validation. The medical credibility they worked so hard to build didn’t translate into market dominance.
Now, the Ava case isn’t a perfect parallel to Midi versus Hims & Hers of course – FDA device approval versus specialist clinical care are very different things. But it raised a question that feels relevant to me: Does deep expertise win in the market, or does distribution and convenience matter more?
Two Different Bets
Let’s talk about who these players are.
Midi Health was founded specifically for menopause. Clinicians trained in 47+ symptoms. Over 200,000 women served. Insurance coverage, not just cash pay. Care teams, not bots. Purpose-built from day one.
Hims & Hers started in 2017 with men’s ED, built a massive DTC healthcare platform, went public, and serves millions across multiple categories. Now they’re entering menopause with licensed providers and their existing infrastructure.
Both have significant resources. But one was purpose-built, the other is leveraging scale.
The Big Question
Midi is almost certainly better at treating menopause right now. More experience, more institutional knowledge, more refined protocols.
But is that what determines who wins?
Some reasons menopause might favor specialists:
- 47+ symptoms requiring nuanced clinical judgment
- HRT needs careful, ongoing management
- Insurance coverage matters for long-term care
Some reasons distribution might win anyway:
- Hims & Hers can hire excellent clinicians
- They’ve already built trust in sensitive health categories
- Millions of existing customers to cross-sell to
- Convenience matters to consumers – a lot
What We’re About to Learn
The Ava story suggests that even when you’re clinically superior, you can lose to more convenient, cheap, or easy to use alternatives. But menopause care is more complex than fertility tracking. The question is whether it’s complex enough that expertise becomes a real moat.
For founders in specialist spaces: Being first and being best might not be enough if someone with better distribution enters your market.
For investors: Watch who consumers actually choose, not who should win on paper.
The menopause market of course is large enough for multiple winners – 1.3 million US women experience menopause annually, and most are underserved. But the Midi versus Hims & Hers matchup will test something important about what actually matters in healthcare: Specialization or scaled accessibility. Deep or wide.
Midi may have “always been hers,” but Hims & Hers has always been about distribution, convenience, and consumer trust.
And maybe we’re all about to learn what matters more.
