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The Paradox of Choice: A theory loses favor

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A famous experiment, published in 2000, points to something called the Paradox of Choice: more choices lead to lower overall sales. That makes no sense in the narrow rationality often used in economic models, and some evidence suggests it might not actually be true.

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In 2000, Professor Sheena Iyengar from Columbia University famously conducted the ‘jam study’ as an exploration of choice and decision making. In the study, Iyengar and her researchers first displayed 24 jams in a busy supermarket, encouraging free tasting. This abundance of choice saw 60% of customers stopping and tasting the jam, but only 3% making a purchase.  Next, the researchers set up the display with 6 jam jars. This time there were fewer customers stopping, only 40%,

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The rise of e-commerce has been accelerated by several factors, including shifting consumer behaviors and technological advancements. Among the most prominent trends in this landscape are social commerce and live commerce. Live commerce, as the name implies, utilizes video content on digital platforms to promote or sell products and services in real-time. Unlike traditional home shopping TV, this format is entirely digital, enabling two-way, interactive communication and facilitating swift purchases for users.

From China to the world

Although live shopping was already popular in China before the COVID-19 outbreak, pairing entertainment with e-commerce was the magic formula for its take-off during periods of strict confinement. In 2023, China's live-streaming commerce market hit nearly five trillion yuan, a twelvefold rise from before the health crisis. That year, approximately six in ten Chinese online shoppers engaged in live commerce, with forecasts suggesting over 430 million users by 2026.

It did not take long for China's success story to pique the interest of retailers and consumers across the globe. While Indonesia and Vietnam show significant social media user engagement in live shopping streams, India and Thailand have also embraced live commerce, nearing China's levels in completed purchases.

Beyond the Asia Pacific region, live shopping is rapidly gaining traction in the United States. Estimates reveal that livestream e-commerce sales in the U.S. reached 50 billion dollars in 2023 and are projected to grow by 36 percent over the next three years. Brazil is at the forefront of Latin America's interest in live commerce, while Europe still lags, mainly using live shopping for fashion inspiration and purchases.

Social shop 'n' stream

Live shopping events can be held across various channels, including dedicated streaming platforms for live commerce, e-commerce websites, or social media platforms. The latter, owing to its intuitive interfaces and extensive user base, has witnessed growing popularity for hosting such events.

Globally, Meta's Facebook and Instagram stand out as the most used social networks for purchasing products during live-streaming events. Additionally, alongside Douyin's remarkable success in China, which saw a 40-fold increase in live commerce transaction value between 2019 and 2022, its international counterpart, TikTok, is increasingly focusing on e-commerce. This is evidenced by the integration of TikTok Shop features, enabling direct in-app purchases.

While the accessibility of social networks presents opportunities for the adoption of live commerce, this format does not appeal to everyone. In Italy and Spain, nearly half of the individuals interested in attending live shopping sessions reported refraining from making purchases through these platforms and expressed skepticism towards products endorsed by influencers.

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Discover all statistics and data on Livestream commerce now on statista.com!

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The Paradox of Choice - The Decision Lab

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The paradox of choice suggests that an abundance of options actually requires more effort to choose and can leave us feeling unsatisfied with our choice.

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In 2021, it is estimated that more than 7 out of 10 internet users from the 12 months prior to the survey (hereafter referred to as "internet users") made online purchases in the same period.

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Boost your seller performance by learning the most important Amazon advertising stats of 2025 like Amazon CTR, CPC, CVR, ACOS, CPM, and more.

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Fashion or fantasy? AI hallucinations, explained

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When it comes to AI-generated content, looks can be deceiving. As brands test the technology, they must also create systems for distinguishing fact from fiction.

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This website is using a security service to protect itself from online attacks. The action you just performed triggered the security solution. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data.

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Are digital models about to become the industry standard?

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As artificial intelligence infiltrates fashion, brands face a reckoning over ethics, artistry and employment.

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Generative AI hits a fashion acceleration point

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The Era of Generative AI is Distorting Consumer Trust – Here’s How to Adapt Effectively

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It’s no secret that generative AI (gen AI) is disrupting the retail industry. From reshaping the customer experience through AI-guided product personalization features to increasing shopper touchpoints to bring patrons […]

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Allen Kopelman is CEO of Nationwide Payment Systems Inc. and host of B2B Vault: The Biz-to-Biz Podcast.
The shopping cart icon reflects our collective journey from physical pushcarts to digital commerce. Even the phrase "shopping cart" has become synonymous with e-commerce checkouts and the ever-present challenge of cart abandonment. In 2024, the Baymard Institute cited an average cart abandonment rate of 70.1% based on an analysis of 49 e-commerce studies.

Researchers acknowledged that not all customers are serious shoppers; some place items in carts to see a final price with tax and shipping. Others may quit checkout due to a declined payment or concerns about privacy, delivery cycles and return policies, some of which are challenges they claim can be solved by designing better checkouts.

After reflecting on recent studies and my own observations as a merchant services provider, I've highlighted four ways to help solve shopping cart abandonment and create enjoyable, repeatable and fulfilled customer journeys.

1. Embrace multiple payment methods.

In the digital-first era, businesses are beginning to see the expanding role payments play in driving conversions, acceptance rates and lifetime customer value. As merchants expand globally, they will need to support an increasing number of apps, channels, devices and payment methods to meet customers who shop digitally across borders.

Cross-border payments grew in 2022. In addition to cross-border growth, the use of digital wallets and payment methods, such as Apple Pay, Google Pay and Amazon Pay, has been increasing at a faster rate than traditional credit cards and gift cards, according to the third edition of Saleforce's State of Commerce report. "This trend is reflected by the share of commerce organizations accepting the most dominant player in digital wallets-Apple Pay-which ticked up by 10 percentage points since 2022," the report said. J.D. Power also reported growth in U.S. digital wallets, particularly in online and mobile channels.

Merchants can capitalize on this trend by displaying digital wallet icons on point-of-sale screens and checkout pages to encourage customers to use their favorite payment methods. I also recommend incorporating local currencies and payment methods when expanding into new regions. Open banking, for example, is popular in Europe, where pay-by-bank has become a default payment method for many consumers.

2. Display trust signals on websites.

McKinsey's research has highlighted the importance of trust and reassuring customers that businesses respect their communications, privacy and data. E-commerce websites can do this through things like SSL and authentication icons, security badges, positive customer reviews and transparent policy disclosures.

Based on a 2022 survey of 1,333 senior executives in 20 countries, the McKinsey article described digital trust as a pillar of the customer experience, and 85% of survey respondents said knowing a company's privacy policies was a key factor in their purchasing decisions. "When it comes to how organizations are performing on digital trust, consumers express a surprisingly high degree of confidence in AI-powered products and services compared with products that rely mostly on humans," the article also said.

Verifying and authenticating e-commerce customers is also a way to build trust, decrease churn and protect against threats. Multifactor and strong customer authentication methods can make customers feel safer when transacting digitally in apps and websites, as well as help businesses separate legitimate customers from synthetic identities and fraudsters.

3. Protect customers from fraud.

Fraud-fighting tools and chargeback alerts can help merchants monitor, detect and remediate fraudulent activities.

Ethoca's 2024 Outlook Report estimated that global card-not-present fraud losses could exceed $28 billion by 2026. The report recommended implementing chargeback alerts to respond to inquiries before they become chargebacks. Verifi's 2024 Global Fraud and Payments Outlook identified refund/discount abuse and first-party misuse as the "most common forms of fraud." (Registration required for both reports.)

These post-purchase threats occur when customers or fraudsters attempt to obtain free goods or services online. "Thwarting these forms of fraud requires merchants to apply multiple tools and tactics pre- and post-purchase," according to the Verifi report.

Examples of fraud-fighting tools include virtual agents that respond to customer inquiries in real time and in their own native languages. These always-on, always-available digital assistants can furnish precise transaction data on demand to discourage fraudsters from initiating chargebacks and help legitimate customers recognize unfamiliar transactions to prevent first-party misuse. In addition, merchants can consider using artificial intelligence-powered fraud-fighting tools to continuously monitor transactions and notify merchants of anomalies and suspicious behaviors.

4. Optimize the checkout experience.

Salesforce research pointed out that e-commerce can take place beyond a website or mobile app. "The bulk of organizations now incorporate transaction functionality into the flow of business across sales, service, and marketing touchpoints," researchers wrote.

Making e-commerce checkout available on multiple channels can increase conversion by making payments available anywhere on any device. This capability can transform any touchpoint into a decision point. For example, 51% of global companies surveyed accept payments on social media; 48% in marketing emails; and 53% give service agents order-on-behalf-of capabilities, according to Salesforce.

While I agree that it's important to make checkouts easy, simple and frictionless, I also encourage business owners to think holistically about the entire customer journey.Ideally, using advanced authentication techniques to identify customers at the beginning of the shopping journey will set the stage for a secure and personalized experience. Personalized offers that occasionally appear that invite shoppers to accessorize recently viewed items can also enrich the customer experience.

In short, by welcoming new customers and recognizing and rewarding returning customers, merchants can make every touchpoint of the customer journey matter.

Forbes Business Council is the foremost growth and networking organization for business owners and leaders. Do I qualify?

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Four Tips To Solve E-Commerce Cart Abandonment

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Here are four ways to help solve shopping cart abandonment and create enjoyable, repeatable and fulfilled customer journeys.

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The Minimalist 30 Day Rule That’s Making My Life Easier

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Spring cleaning might have more mental wellbeing benefits than previously thought.

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Decision Fatigue: How Businesses Can Simplify Choice

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Today’s consumers crave the simplicity of a streamlined choice experience.

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Julie Bornstein raises $50 million for AI fashion search startup

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The co-founder of The Yes and former COO of Stitch Fix is building a platform that applies generative AI to a curated fashion catalogue.

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Amazon’s Rufus Shows The Future Of AI Shopping, Warts And All

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Amazon’s Rufus AI shopping assistant, offers an early glimpse into how artificial intelligence could reshape product discovery and purchase behavior online.

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Julie Bornstein's New AI Start-Up Raises $50-Million Seed Round

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The venture is a search and discovery platform for fashion that's built around the capabilities of generative AI.

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How To Maintain Consumer Trust In The AI Era

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By protecting consumers’ right to transparency and information, leaders can ensure their AI strategies withstand the test of time.

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Here's the challenge facing brands and retailers: Communicate clearly with a vast array of consumers who speak thousands of languages, hail from countless different cultures and socioeconomic backgrounds, and make purchasing decisions based on highly personal preferences. It's no easy feat to reach all of these consumers on a broad scale in an authentic way.

For some time now, companies have been trying to address customer needs through personalization, using data and analytics to craft more relevant consumer experiences. The goal is to present consumers with compelling offers and tailored, resonant messages at the right time. Today's customers want more of this. As previous McKinsey research revealed, 71 percent of consumers expected companies to deliver personalized interactions, and 76 percent got frustrated when it didn't happen. When companies get it right, however, they can create significant value.

Companies often deploy tactical, manual, and stand-alone solutions to engage their customers. But retailers are now entering a promising new era of personalization. To reach consumers where they are and how they want to be met, marketers can embrace two powerful innovations: AI-driven targeted promotions, and the use of gen AI to create and scale highly relevant messages with bespoke tone, imagery, copy, and experiences at high volume and speed.

These innovations lay the groundwork for growth. Using improved analytics models, brands and retailers can better provide valuable offers to microcommunities wherever they want to engage. Meanwhile, gen AI enables marketers to create tailored content that is relevant to those groups. Brands and retailers can better connect with customers by using language that speaks to them and by providing communications that resonate and give consumers a reason to engage.

To unlock the potential of targeted promotions and content, marketers should prioritize efforts to boost their underlying marketing technology stack. A robust framework built on better data, decisioning, design, distribution, and measurement is essential. With improved analysis through technology, marketers can gain deeper insights into customer behaviors and preferences, provide improved personalized experiences, and incorporate tactics that feed into a long-term personalization strategy for growth.

The promise of targeted promotions

For both companies and customers, the old way of managing promotions-blunt offers to large groups of people-is no longer cutting it. Retailers face pressures due to economic uncertainty, changing consumer preferences, and, in some cases, declining profits. Meanwhile, previous McKinsey research suggests that 65 percent of customers see targeted promotions as a top reason to make a purchase.

Many retailers view AI and gen AI as a way to reverse the downward trends and accelerate growth. An increasing number are starting to experiment with AI to improve mass promotions. But companies can be more strategic by employing AI for targeted promotions, using data to tailor discounts based on people's shopping preferences or their affinity for different types of offers (see sidebar "What customer segmentation can look like"). With a more granular approach to customer segmentation, retailers can craft promotions that target specific customer life cycle stages (such as new-customer acquisition, customer retention, repeat purchase, or risk of churn) or specific business objectives (such as promoting a particular brand or category or encouraging cross-selling).

In a world saturated with promotions, companies can use targeted offers to stand out. Retailers that get this right can help ensure a better shopping experience while also enjoying better margins from saving on promotional costs and fueling more conversions. Ideally, marketers can develop a program of targeted offers at scale that accomplishes the following:

applies business rules and algorithms to determine offerings and timings of delivery

builds flexible, fit-for-purpose coupons (such as tiering discount rates so that those who buy more save more, limiting usage to certain categories or time periods, or designing offers that include or exclude certain premium categories or brands)

delivers targeted promotions through all available marketing channels, such as through a company website or app, push notifications, text messages, or emails

activates personalization with an always-on cadence where relevant

accompanies offers with clear, highly relevant communications, such as with dynamic recommendations that update in real time for individual customers based on their purchasing or browsing history

With this variety of targeted offers, marketers can create a seamless omnichannel experience for customers, in which they receive targeted, streamlined promotions without conflicting or overwhelming information from other places. Companies should be smart about how much margin they're giving away when and where, encourage specific objectives rather than overly broad ones, and ensure that promotions are offered at the right time to the right people (see sidebar "How one retailer unlocked growth by launching targeted offers"). From what we've observed, companies that push incremental sales through targeted promotions can see a 1 to 2 percent lift in sales and a 1 to 3 percent improvement in margins.

Relevant marketing through gen AI-enhanced personalized content

To truly enhance the impact of targeted promotions, companies can use gen AI to highly tailor copy and creative content that resonates more strongly with groups and subgroups of consumers than traditional marketing communications. Marketers have long aimed to improve the customer experience and influence consumer decisions by creating convenience or offering better prices. The next step is to make the buying experience even more convenient or enjoyable through greater relevance.

Traditionally, addressing small consumer groups with customized content has been cost-prohibitive and practically infeasible. Generative AI allows marketers to develop such content at scale at lower cost. While many marketers are currently piloting gen AI programs for this purpose, most are doing so manually with one-off experimental tools and use cases; they are not automating or integrating to reduce the bottlenecks of operational inefficiencies, nor are they evaluating content performance.

Smarter use of gen AI can help unlock more cohesive personalization opportunities with touchpoints and interactions more tailored to what customers want. Currently, there is no consolidated suite that does this end to end. But with thoughtfully integrated solutions that align people, processes, and platforms, marketers can deliver more rigorous content creation, smoother orchestration across teams, and seamless implementation of targeted promotions and content.

While content creation today is highly manual, gen AI can accelerate and magnify the entire process, helping channel operators, creators, and analysts become more productive. As more marketing material gets fed into a robust, foundational content data model, gen AI can learn from a feedback loop and create more copy that can be tailored for personalization. One important thing to note: As organizations increasingly use gen AI, it is critical that they build models to validate and govern gen AI-created content in order to establish guardrails against bias, toxicity, and hallucinations, and to ensure that content is in accordance with enterprise standards and design systems.

To see what's possible for better workflow in the future, it helps to look at how the ecosystem operates-both today and in the future-across the three stages of content production (table).

Our experience so far shows speedy results. We've seen some marketers deploy gen AI to personalize content development 50 times faster than a more manual approach (see sidebar "How a European telecom used gen AI to enhance marketing materials").

Technology as a foundational differentiator

To better target promotions and gen AI-boosted content, companies can turn to a tech stack that brings everything together. In 2019, McKinsey published " A technology blueprint for personalization at scale," which described a "4D" strategy (data, decisioning, design, and distribution) for marketing technology. We add one more critical element to this: measurement (exhibit). (It's not a "D," but it's just as relevant.) Marketers can establish a solid foundation for growth through personalization by ensuring these five elements use the latest technological innovations and integrate with each other seamlessly (see sidebar "A tech-enabled evolution from mass discounts to targeted offers").

Data

By improving data collection and analysis, marketers can gain deeper insights into customer behaviors and preferences. And while many enterprises have invested in data lakes (storage platforms that hold, process, and analyze structured and unstructured data) and customer data platforms (software that centralizes and unifies customer data from multiple sources to create a single view of each customer), better targeted offers and content requires expanding data architecture in five categories:

a promotions subject area that includes the history of offers and redemptions

a content subject area that includes the history of content delivery and engagement

universal (and potentially gen AI-enabled) metadata and taxonomy, which can improve the flow of automation

a robust analytics infrastructure and MLOps (machine learning operations), with dedicated feature stores to rapidly deploy and scale ML models

new data pipelines and integrators, prompt stores, and vector databases to build or customize large language model implementations

Along with granular transaction data, these additional data assets are the backbone of AI-powered decisioning to predict customer behavior in any channel and can be a true differentiator in today's market.

Decisioning

To develop new targeted promotions and content through more robust targeting, companies can also benefit from refreshing their decision engines with new AI models. Their tasks include the following:

Promo propensity predicts the likelihood of a customer making a purchase due to a promotion, based on previous customer purchasing and engagement behavior. This can lead to better customer satisfaction and targeting with the right level of discount to improve margins.

Promo uplift (or promo effectiveness) predicts promotion ROI (uplift) by analyzing customer behavior during promotion and no-promotion periods.

Content propensity predicts the likelihood that a customer will respond to a piece of content. Propensity scores enable the automated delivery of the best content that will encourage a customer to respond to a call to action.

Content effectiveness measures the effectiveness of content by analyzing customer response. Highly effective content can be reused or thematically replicated in future campaigns.

Model outputs are then fed to a decision engine that ranks and determines the best offer and content to show a customer at a given point in time.

Design

Innovative design ensures that content is both engaging and relevant. A sophisticated design layer that oversees two critical workflows (offer management and content production) helps manage the process, fueling both operational excellence and agility.

Targeted offers work best with an integrated offer management system to catalog, manage, deliver, and redeem them across any channel, including e-commerce and point of sale. Meanwhile, content management begins with gen AI tools for creating copy and developing creative assets, handling versioning, and auto-formatting content as varied as billboards and mobile devices. Digital assets are stored in a single, centralized digital-asset-management (DAM) system.

It's crucial that both the offer management and DAM systems are well integrated into all downstream channels. This enables easy search, reuse, and dynamic delivery of assets.

Distribution

Achieving true, real-time personalization requires sophisticated architecture that delivers seamless and consistent messaging to the right audiences at the right time as customers traverse channels.

This critical infrastructure combines core capabilities:

instant processing of customer signals, fed to journey orchestration and decisioning platforms to optimize the right message and channel across customer touchpoints

front-end tools that support a company's website, app, and email (such as content and campaign management systems, as well as dynamic content optimization), built with dynamic modular templates and API integrations to render personalized content in real time

interoperability and integrations across multivendor platforms

Measurement

A comprehensive marketing technology stack requires thorough measurement to facilitate ongoing optimization and improvement. To validate the ROI of personalization efforts, rigorous incrementality testing, standardized performance metrics, and measurement playbooks are essential.

Businesses need actionable intelligence for continuous improvement. Marketers can implement closed-loop measurement by aggregating data from all channels into a centralized reporting engine that produces self-serve dashboards for distinct stakeholders-from executive leadership tracking revenue and margin impact to marketing operators optimizing campaigns in real time.

To unlock the next frontier of gen AI-enabled personalization, marketers can begin with a thorough assessment of their opportunities by making the following moves:

mapping out the areas where targeted offers and more relevant content can drive the highest value

identifying the lifetime value events that they want to encourage

conducting a tech diagnostic to identify missing tools

reconfiguring processes in areas such as talent, data, tech, analytics, and marketing operating models to optimize for targeted promotions and content development

Excellence in execution sets the leaders apart from the followers. Success hinges on seamlessly integrated platforms backed by well-trained teams that can fully maximize investments. To improve performance, marketers can focus on operational efficiency, eliminate redundant systems, and establish robust governance. This can help bring together disparate tools into a unified engine for more relevant and personalized customer engagement, contributing to real growth.

We are celebrating the 60th birthday of the McKinsey Quarterly with a yearlong campaign featuring four issues on major themes related to the future of business and society, as well as related interactives, collections from the magazine's archives, and more. This article will appear in the third themed issue, on the Future of Growth, which will launch in May. Sign up for the McKinsey Quarterly alert list to be notified as soon as other new Quarterly articles are published.

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Unlocking the next frontier of personalized marketing

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At last, menopause is having its moment-but sometimes journalist, writer and menopause advocate Tamsen Fadal still can't believe it.

"The fact that we're having this conversation, you and I, that blows my mind," she tells me via Zoom on the cusp of her latest book, How to Menopause: Take Charge of Your Health, Reclaim Your Life, and Feel Even Better Than Before, coming out on March 25. "It blows my mind that we're all having this conversation. I'm telling you, three, four, five years ago, nobody would talk to me about it. Nobody."

She's not wrong. Actress Naomi Watts-who has herself become a menopause advocate, founding a skincare line, Stripes, specifically designed for menopausal women-wrote in her recently released book Dare I Say It: Everything I Wish I'd Known About Menopause, "I'd been warned ever since I started acting that calling attention to your age-when that age was not 23 or younger-would be career suicide. I was told I would never work again if I admitted to being menopausal, or even perimenopausal. Hollywood's lovely term for such women was 'unfuckable.'"

But times are changing. As Watts wrote in her book, which hit shelves January 21, 2 million American women enter menopause each year-almost 6,000 women daily. There are, as Watts writes, a billion menopausal women worldwide. And yet, when her own menopausal journey started, she continued, "I felt completely alone."

It's not as though menopause is a new concept-but what is new is high-profile women like Fadal and former Marie Claire editor-in-chief Anne Fulenwider (who co-founded the menopause startup Alloy in 2020) pivoting from successful careers to that of menopause advocates; the ushering in of a generation of actresses-turned-advocates like Watts, Halle Berry, Brooke Shields and Drew Barrymore, who have been vocal about menopause in recent years; and doctors like Dr. Lisa Mosconi (who wrote the foreward for How to Menopause), Dr. Mary Claire Haver and others making menopause something spoken about freely and publicly, taking menopause out of the shadows of doctors' offices and firmly into the public arena.

On March 31, Oprah Winfrey will bring the hour-long program The Menopause Revolution to ABC, which will address what Winfrey called "the inevitable phase of life every woman will face: menopause," per The Hollywood Reporter. ("This show starts the revolution of answers for millions of women throughout this country," Winfrey said. "We discuss what you need to know to best advocate for yourself when it comes to mental health, sleep, weight, sex and your brain, so we can ultimately see how freeing menopause can be in your life, with the best yet to come.")

"Listen, I think that we are tired of suffering," says Fadal, who, in addition to her book, produced the PBS documentary The M Factor: Shredding the Silence on Menopause, in 2024. "I think there's increased awareness and advocacy. There's obviously this growing movement to destigmatize it and address it openly. And yeah, I was scared to address it openly first. Initially when I went out the door, and it was several years ago, somebody said to me, 'You are going to ruin your career talking about menopause, because that basically equals old age.' And unfortunately, we have had that problem. And that leads me to cultural shifts, society's attitudes towards aging, particularly women's health and wellness. We're seeing a shift in that, which is great. We're seeing people embrace aging as something to aspire to, as a place for wisdom, as not something to be feared or hidden."

"This should be a celebration," she adds of menopause and aging. "This shouldn't be anything to fear."

'If You Start A Menopause Company, People Are Going To Think You're In Menopause'

Anne Fulenwider was at the top of the masthead at Marie Claire, rising to the ranks of editor-in-chief after also serving in the same role at Brides magazine and editing such boldfaced names as Dominick Dunne, Fran Lebowitz and Buzz Bissinger while working as a senior editor at Vanity Fair. After taking over the top job at Marie Claire in 2012, Fulenwider left in 2020 to start Alloy Women's Health, a startup dedicated to helping women receive safe, effective treatment for the symptoms of menopause, with co-founder Monica Molenaar. With a goal of making healthcare surrounding menopause accessible, the two women sought to give the millions of women entering menopause each year the healthcare solutions they need after finding that only 6% of women seeking treatment for their symptoms actually get it.

It was, admittedly, a gamble that didn't make sense to some of Fulenwider's colleagues in the magazine industry at the time.

"When I did tell some of those people in fashion and beauty at the beginning that I was leaving to start a menopause company-I mean, the looks and the responses that I got from some of the more, let's just say fashion- and beauty-related people, I mean, one of them was even like, 'But Anne, if you start a menopause company, people are going to think you're in menopause,'" she tells me via Zoom, as if that declaration was basically declaring the end of one's life.

Fulenwider's career pivot-which shook the magazine industry when it happened five years ago-was multifactorial: she had lost her mother suddenly to a heart attack, coincidentally not long after Marie Claire published a story titled "Being a Woman Is Killing You."

"And one of the examples was when women-because women's bodies have not been included in almost any medical research-the symptoms of a heart attack, for example, what everyone knows is the symptoms of a heart attack are really the symptoms of a heart attack in men," she says. "And so that was also a very specific example that hit home for me."

Her daughter was going through some health issues, she adds, which got her thinking even more about women's health. She also felt called, she says, to help women from the inside out rather than reporting on it from the outside in, as she'd done in her magazine career. In co-founding Alloy, she wanted to close what she calls "a giant gap" in access to expertise.

"And so I sort of thought, well, I had been doing magazines for a long time and I was at a phase in my life where I really wanted to be intentional about what I did next," she tells me, adding that the work of Alloy "was a much bigger project than I had thought I was heading off to do when I left Marie Claire."

In the beginning of her startup career, "I wasn't exactly sure what we were going to do to help with menopause," she says. "And I did think it was more kind of content and nutrition and sort of lifestyle changes-and all of those things are important. But what we finally realized, having done some digging-why is everyone suffering from this so badly and why isn't anyone talking about this, and what are the real solutions that work? And we did some digging. We realized that there's a study that came out 20 years ago that really put into hiding the most accessible FDA-approved solution, which is hormone therapy, which is much safer."

The Alloy platform connects women to a menopause-specialized doctor that provides ongoing care and education and helps the right medicine get delivered directly to a woman's door. The company started with the aforementioned menopausal hormone therapy, and since then has created more lifestyle products in the realms of hair, skin and sexual health.

Oprah Winfrey will host a special about menopause on March 31, 2025, one of the many voices speaking ... More
Getty Images for Santa Barbara International Film Festival

"What we realized was [there are] between 55 and 85 million women in perimenopause and menopause, depending on your source, and under 2,000 certified menopause practitioners," Fulenwider says. "We just really knew that that was a problem that only could be solved by technology."

What Fulenwider and her team learned was staggering, and a bit scary-that women's bodies weren't included in clinical trials until 1993, for example, and even since then "we're barely included," she says. Or how no one teaches menopause in medical school, she adds, "which is insane. How is that possible? How is [it] possible [when] 51% of the population is going to experience this?" There's also the need to clear up misinformation about hormone therapy, along with misinformation about menopause in general, debunking outdated and incorrect studies, research and information.

"And so I think one of the reasons, and there are many, but one of the reasons women have been suffering from menopause symptoms in silence or just without the health that they need is because it has not in recent years been addressed as a health issue," Fulenwider says. "So I think this is a biological change in your body for which there is very safe, FDA-approved treatment that is not reaching the people for whom it is approved and safe and will not only improve the quality of their lives, but also really help them have longer and healthier health spans."

Of menopause's emergence into the forefront as of late, "the movement has taken a life of its own because women everywhere are finding this great sense of community or sense of belonging or sense of being seen, which is a huge part of our mission at Alloy," Fulenwider says, adding that "doing this work has meant so much to me. It's been a tremendous privilege and an honor to be able to educate women about menopause and get them the relief that they need. It is such satisfying work. As much as I absolutely love my 25 years in magazines, this means something to me in a different way."

It was a gamble to leave a career she'd known for a quarter-century and step into a world that, even five years ago, was still largely shrouded in secrecy, but "it's the most satisfying and most meaningful work I've done in my life," she says. "And there's so much more to do. But I think that's really my message."

'This Has Been The Biggest Story Of My Lifetime At This Point'

Tamsen Fadal thinks that menopause is having its moment for a few reasons-first of all, online platforms and social media are allowing women to experience this transition together, having conversions, sharing stories and finding community. In the work she's doing as a menopause advocate, "We're not trying to fix menopause," she clarifies. "We're not trying to rebrand it, necessarily. We are trying to shred the silence that has surrounded this time in life."

"I think that conversation has helped shift this narrative, which has been menopause equals death," she says, adding, "We're living longer than we have before. We didn't really have a roadmap for this. It's been shrouded in silence because we didn't know. And then once we thought we knew, we stopped talking about it because we thought it was something that was to be ashamed of."

Fadal says of her own menopause experience, "I suffered. I went through it." Admittedly, she says, "I never said, 'Hey, you know what might be a good thing to do? Let's talk about menopause for the remainder of your career.' It wasn't a thing that I planned, but I couldn't stop researching it, looking into it, going down this rabbit hole."

"I think for me, it is following my curiosity as a journalist and the need to reveal stories that haven't been told," she continues. "And this has been the biggest story of my lifetime at this point."

How to Menopause is filled with information about the experience, including what society's gotten wrong about it. "I think the most misunderstood part is that this is something to dread and there are no gifts of it, and I don't agree with that," Fadal says. "I think there are some real gifts in this period of life. And in fact, when I was writing the book, I thought, well, we have to say that there's gifts in this. And then I thought, well, you need to make sure that you know what those gifts are, and that's really what we did. I wanted to make sure that there were the facts, there were the fears, because they're real. We're not going to pretend there's not fear of it. I'm not going to pretend it's just, like, the easiest thing in the world. I'm not going to pretend that it doesn't come with its share of a little bit of grief and a little fear of loss. But I will say this-I will say that I have had transitions in this part of my life that I could have never, ever, ever imagined. I've met people that I could never [have] imagined. I'm having conversations openly about things that I've whispered about in the past. And so I hope that young women do not have a fear, but have an awareness. That's the difference. We have to shift those words."

Though work has been done, there's much more to do. Case in point? As Fadal writes about in her book, in 2024, $5 billion in federal funds were allocated towards women's health, but menopause only received $15 million of that pie. "Isn't that embarrassing?" Fadal asks me.

"We're fighting on a lot of fronts," she adds. "We're fighting on getting research dollars. We're fighting for women in midlife. We're fighting to make sure that women have access at work so they can have some help there. And then we're making sure that they're not being discriminated against as a result of their age or this period."

She continues that the biggest obstacle of the work is that it's a cultural shift, one that both women and men must take part in-from seeing age as a matter of lack and less than, or that once a woman reaches menopause that her best years are behind her. "There are cultures that revere age," Fadal says. "We have to get there."

"I feel like there's still so much more to do," she adds. "I had no idea how badly this was needed until I went through it. And yeah, I do feel like it's the work of my life, and I feel like I'm just getting started."

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Why Women Are Leaving Top Careers To Advocate For Menopause

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A new wave of menopause advocates, from journalists to founders, is pushing for change-challenging stigma and reshaping the conversation on women's health.

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‘She secretly wonders if she has dementia’: Menopause awareness online is translating back to the office

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TikTok influencers are providing tips about how to talk to employers about menopause in the workplace, boosting awareness.

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How beauty players can scale gen AI in 2025

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Beauty is no longer in the eye of the beholder. It’s at the fingertips of the gen AI prompter. We look at why scaling these experiments will be challenging.

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Generative AI hits a fashion acceleration point

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The buzzy tech has moved beyond its 2024 hype cycle into real-world implementation. We spoke to retailers who are seeing results.

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Even as long routines and more involved treatments push us to the brink, pain powers beauty, argues Jessica DeFino.

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If life-expectancy trends continue, that future may be near, transforming society in surprising and far-reaching ways.

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Womaness plans to grab a chunk of that spending. The e-commerce site raised funds last year, and recently completed a seed round to bring its total capital raise to over $5 million. The company offers a full suite of products-13 items-for changing skin, supplements, sexual wellness, and personal care items.

"We're accessibly priced and that really differentiates us from our competitors," said Mueller, a former executive at Target, whose co-founder, Michelle Jacobs, was the editor of Real Simple and other publications. The brand is also sold at the mass retailer. "We chose to go into retail right away and many of our competitors are only doing e-commerce. We've only been around since March and we're definitely doubling in size next year."

Stacy London, the former co-host of What Not to Wear, a makeover show on TLC, attacks menopause with humor and with products on her e-commerce site, stateofmenopause.com. "It would be so useful to know things before they happen like: flossing is good for you, having 3 cats is way more than 2, Santa does not exist, and algebra is entirely useless," she says on State Of. "Around the age of 47, my body started to ache. I couldn't sleep. I couldn't remember words like pencil or orange. I'd cry constantly. My skin (and nether regions) dried up like the Sahara. I was always itchy. I suddenly had cystic acne and gray chin hair. I was anxious and grumpy."

London offers private-label products, including rejuvenating face oil and skin hair and nail supplements, and bundles such as The Hydration Edit, extreme hydration for menopausal skin, and The Body Edit, which provides the sensation of hot-flash relief with products to cool skin down.

Saks Fifth Avenue launched a Wellness Shop earlier this month with products such as Hot Flash patches, a four-piece set that treats menopause's everyday ailments with 15mg of premium Hemp Extract, Black Cohosh, and other key ingredients.

Nicole Winnaman and Abra Potkin, founders of NOW/With, a platform that combines the heady element of celebrities with product recommendations and social commerce, touts a product line called Pause, which tackles the changing complexions of women going through menopause, including a mist to squirt on your face to quell hot flashes.

US department stores are also getting into the act. Bloomingdale's launched a sexual wellness offering online last May, harnessing the opportunity to provide a curation of elevated essentials. Elizabeth Miller, Vice President and Divisional Merchandise Manager for Cosmetics, said that over the last couple of years it's become even more important to consider every aspect of well-being, including mental wellness, intimacy, and self-love. "The pandemic certainly intensified our customers' needs for these products at home. Fortunately, there's a lot of innovation."

Bloomingdale's is working with brands that are female-led or -founded, body positive, and balance innovation with self-love. The retailer will add postpartum and menopausal products "as women seek wellness solution throughout all life changes. We want to support their evolving needs," Miller said.

Tatiana Birkelund, Vice President and General Business Manager of beauty and jewelry at Neiman Marcus, said the retailer sells everything from ingestibles to home fragrance to CBD products, and more. "I find that every time I turn around there's a new subcategory to wellness," she said. "It's even permeated categories outside of beauty."

"What's really exciting is that we have permission to talk about menopause and we feel more comfortable talking about it," Birkelund said. "There are so many different ways to go about wellness that the dialogue is very interesting. It's not something we have on the shelves quite yet, but the overall opportunity to talk about it in an open forum will certainly help guide us in what the consumer deems as important. I have young daughters, we're a little soon to be talking about menopause, but there's certainly more of a forum for us to talk about it and for them to be empowered to ask questions."

There's even more open discussion and activity around menopause in the UK. "It's not just a US thing. Menopause affects every woman in the world," Mueller said. "The UK is definitely at the front of the race. They're more advanced, there's legislation around menopause and so many people are starting businesses around menopause. There's more awareness around this subject."

Closer to home, sites such as Womaness and State Of are trying to change the perception of a woman in menopause and they're charting their own course. Interest among luxury department stores also bodes well for the category. All the interest is redefining what a woman in menopause can accomplish. "It doesn't mean that she's old," Mueller said.

"We don't have to take the same path that our mothers took," Neiman's Birkelund said. "We don't have to suffer in silence, whether it's the footwear we wear or the changes of life."

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Womaness plans to grab a chunk of that spending. The e-commerce site raised funds last year, and recently completed a seed round to bring its total capital raise to over $5 million.

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Over the past two centuries, the rise in life expectancy-for both men and women-has been a tremendous success story. Global life expectancy increased from 30 years to 73 years between 1800 and 2018. But this is not the full picture. Women spend more of their lives in poor health and with degrees of disability (the "health span" rather than the "life span"). A woman will spend an average of nine years in poor health, which affects her ability to be present and/or productive at home, in the workforce, and in the community and reduces her earning potential (see sidebar "Terminology used in this report").

Critically, better health is correlated with economic prosperity. The women's health gap equates to 75 million years of life lost due to poor health or early death per year (Exhibit 1), the equivalent of seven days per woman per year. Addressing the gap could generate the equivalent impact of 137 million women accessing full-time positions by 2040. This has the potential to lift women out of poverty and allow more women to provide for themselves and their families. Addressing the drivers of this gap-namely, lower effectiveness of treatments for women, worse care delivery, and lack of data-would require substantial investment but also reflect new market opportunities.

While improving women's health has positive economic outcomes, it is foremost an issue of health equity and inclusivity. Addressing the women's health gap could improve the quality of life for women, as well as creating positive ripples in society, such as improving future generations' health and boosting healthy aging.

The challenges women face when seeking healthcare play out in multiple different ways and in different diseases and sectors of society. In terms of the potential economic impact of addressing these challenges, all age groups and geographies could benefit, with most of the potential coming from women of working age (Exhibit 2).

Embracing the full definition of women's health

Women are most likely to be affected by a sex-specific condition between the ages of 15 and 50. Other conditions occur throughout women's lives, but nearly half of the health burden affects women in their working years, which often has an impact on their ability to earn money and support themselves and their families (Exhibit 4).

Health equity encompasses access to the interventions and options that are right for each individual, regardless of their gender, sex, sexual identity, sexual orientation, age, race, ethnicity, religion, disability, education, income level, or any other distinguishing characteristic. For women, this can start with a better understanding of and access to interventions that lead to the best outcomes.

How to read this report

The analysis presented in this report includes an assessment of the health burden associated with the women's health gap as measured in potential years of healthy life. This health improvement potential was then translated to economic potential, measured as contribution to gross domestic product (GDP). Sections 2 through 4 of this report focus on health improvement potential (measured in DALYs), broken down by three root causes related to disparities in science, data, and care delivery. The economic value of this combined health improvement potential is presented in section 6, where economic impact is measured in terms of additional GDP.

While this report focuses on the potential economic benefits of closing the women's health gap, there is also a moral imperative to close the women's health gap and to improve the lives of millions of women worldwide.

Effectiveness of and access to medical therapies may vary

There are well-known cases where women and men experience important differences in the uptake or effectiveness of a medicine designed and approved for use in both sexes. This is true, for example, for some therapies used in asthma and cardiovascular disease. Analysts looked at 183 of the most widely used interventions across 64 health conditions representing roughly 90 percent of the health burden for women, reviewing more than 650 academic papers, to assess the extent of this phenomenon. Of the interventions studied 50 percent reported sex-disaggregated data. In cases where sex-disaggregated data was available, 64 percent of the interventions studied were found to put women at a disadvantage due to lower efficacy, more limited access, or both, while for men this was the case only for 10 percent of interventions (Exhibit 5).

Examples include:

Asthma is a common respiratory condition affecting men and women at similar prevalence rates. Acute asthma exacerbations present as symptoms such as shortness of breath, wheezing, cough, or chest tightness. A mainstay of treatment is inhaler therapy with bronchodilators and corticosteroids, but studies indicate that this treatment is around 20 percentage points less effective in reducing exacerbations in women than in men.

Cardiovascular and cerebrovascular disease-particularly ischemic heart disease and stroke-is the biggest single contributor to disease burden globally for both men and women, accounting for 16 percent of DALYs globally for men and 14 percent for women. One German study found that, despite identical technical success of a percutaneous cardiac intervention for men and women, the age-adjusted risk of death or of cardiac events was 20 percent higher in women than in men.

Research in women's health primarily focuses on diseases with high mortality, overlooking diseases leading to disability

One way to assess research priorities is through pipeline assets. There is up to a tenfold higher volume of new therapies in development for some of the most common women's cancers compared with debilitating gynecological conditions (Exhibit 6). One possible reason is the higher mortality rate of oncologic conditions. The solution is not to trim cancer funding, but to recognize the possibilities for advances in research related to other women's health conditions-in particular, menopause, premenstrual syndrome, endometriosis, and polycystic ovary syndrome.

In all, when tackling women's health, the solution is not to divide more slices of one pie: it's to make more pie.

How the lack of sex- and gender-specific data and research affects safety

The research conducted indicates that systematic lack of disease understanding created a women's health gap of 40 million to 45 million DALYs per year, or four days per woman per year. This is equivalent to around 60 percent of the total gap due to sex-related biology differences (see Exhibit 1 above). This estimate includes the known gap for conditions that affect both sexes and an estimate of the gap represented by the average lower effectiveness for women-specific conditions relative to men. It also includes the "unknown" gap: this is where no sex-disaggregated evidence is available for specific conditions that could, if evidence existed, potentially demonstrate levels of effectiveness difference comparable to conditions where sex-based analysis is available. The longevity of women cannot explain the disparity, and the effectiveness gap has a disproportionate impact on women and girls between ten and 40 years old and in certain regions (Latin America and Central Asia).

Shining a light on the interventions for which this information was not reported would benefit both men and women by enabling innovators to develop interventions that are better suited for specific subpopulations.

Gaps exist across the data value chain

Stage 1: Pre-data generation

The data gap starts at the very definition of women's health. There is a lack of consistent and aligned definitions and measurement scales for conditions and symptoms affecting women. For example, definitions of health-related burden associated with menopause or menstrual syndromes differ, and pain instruments and scales lack consistency.

Stage 2: Data generation

Stage 3: Data aggregation

Stage 4: Data analysis

Women can face barriers to timely and accurate diagnosis

Gaps in understanding the effectiveness of health interventions

Ensuring sex-differentiated results

Representative clinical studies capable of producing stratified results may involve larger and longer clinical trials, increasing costs and extending time to market. However, the results would likely lead to more effective interventions with higher uptake among patients. The risk/reward equation for investors becomes more balanced if payers (governments, insurers, and patients) and regulators insist on evidence for cohort-specific impact.

Today, some conditions, such as leukemia and meningitis, are believed to affect men and women equally. But the research to identify potential differences is lacking. Stakeholders may explore how a systematic and proactive approach to designing and reporting clinical outcomes could take sex and gender into account.

Inequalities exist throughout the full pathway of care

The care pathway runs from awareness of a health issue to access to services and preventive care, timely and accurate diagnosis and effective treatment and follow-up. At each segment of this pathway, inequalities exist, especially for women who are disadvantaged in ways beyond their gender (see sidebar "Intersectionality and health outcomes").

Awareness and prevention

The importance of increasing awareness goes beyond patients. Many doctors are unaware of how diseases can affect or manifest differently in women, so they are unable to provide proper care to many patients.

Accessibility and affordability of care

Timely diagnosis

Choice of treatment

Creating solutions to tackle care disparities

Overall, the gap in care delivery contributes 34 percent to the women's health gap (see Exhibit 1 above). Consider how sex- and gender-appropriate care delivery could reduce the women's health burden by 25 million DALYs per year globally, corresponding to 2.5 days per woman per year.

Improvements in the diagnostic tools available would represent a major step forward for patients. Yet even without innovative tools, it would be possible to improve care and bridge the gaps in diagnosis with more consistent and standardized screening and data collection. Earlier diagnosis and a more holistic, patient-centric treatment approach could help improve disease and symptom management, prevent uncontrolled progression and resulting complications, and reduce unnecessary treatments.

At a global level, AI, unbiased data sets, and interoperable electronic records are potential options for enhancing care delivery. Ultimately, a combination of innovation, investment, and ability to scale could unlock better care delivery solutions for women.

There has been a historical underinvestment in women's health research from the public, social, and private sectors. Funding sources typically overlook the fact that many conditions manifest differently in each sex, creating variances in outcome.

Closing the health gap will require increased investment not only for understanding sex-based differences but also for addressing unmet needs in women's health. Further, additional funding and new business models could support sex- and gender-appropriate care.

Research funding neglects women's health

Private equity/venture capital investors are increasing investments in women's health, with excitement about digital health solutions

Given the large unmet need and resulting opportunity, those who continue to forgo investing in women's health may find themselves left behind by the players that tap into this high-potential market.

The disparities in women's health affect not only women's quality of life but also their economic participation and ability to earn a living for themselves and their families. Health is intricately linked to economic productivity, prospects for prosperity, and contribution to economic output. Economic growth over the past 70 years has been closely tied to women's increased labor force participation. Therefore, it is not surprising that the gap in women's health results in lost economic potential.

Addressing the health gap women face could boost the global economy by adding at least $1 trillion to the global economy by 2040. This means a 1.7 percent increase in the average per capita GDP generated by women.

Women's economic participation has been and will be a major driver of economic growth

Addressing the gap could generate the equivalent impact of 137 million women accessing full-time positions by 2040. This would enable women to secure an income to support themselves and their families and has the potential to lift more women out of poverty.

Better health often enables individuals to work more effectively

Looking at the different channels affecting GDP, the largest impact, amounting to around $400 billion or avoiding 24 million years with disability, would be created through fewer health conditions (Exhibit 9). Expanded participation and increased productivity could each contribute more than 20 percent of total impact.

Treating ten health conditions would contribute more than half of the economic impact

The conditions having the greatest economic impact in different countries will differ from one geographic region to another based on each region's disease burden and healthcare status. The examination of economic impact, rather than DALY impact, gives more weight to conditions that affect people during years of working age, as that is when economic contribution is highest. Conditions such as ischemic heart disease may affect more people, but if the burden of morbidity and premature mortality happens after the usual age of retirement, the economic impact is more limited.

Generally, a reduction in health conditions is tied to a woman's economic potential, with allowances for regional socioeconomic and healthcare factors (Exhibit 11). The top two conditions by contribution to GDP impact of the women's health gap are always a combination of two of the top four global conditions: PMS, depression, migraine, or other gynecological conditions. Larger differences among regions are observed when looking at the top ten or more conditions.

Across the four channels, the highest GDP impact relative to women's GDP is observed in HICs and LICs (Exhibit 12). For LICs, most of the impact comes from fewer early deaths and fewer health conditions. Both upper-middle-income (UMIC) and lower-middle-income (LMIC) regions exhibit an overall lower projected GDP impact.

Investing in women's health shows positive return on investment (ROI): for every $1 invested, approximately $3 is projected in economic growth

The expected economic return varies by region. The ROI is greatest in higher-income settings, where it is around $3.50 returned for every $1 invested. More investment is probably needed in some LICs to establish the basic health infrastructure required to support low-cost delivery of high-quality health services, as well as to create better and more rewarding economic opportunities for women. Still, the analysis indicates that the overall benefit would exceed the costs even in these settings, at a rate of around $2 returned on $1 invested.

The analysis examines only the direct costs of addressing the gaps in care delivery identified. In the longer term, a range of greater positive returns is possible, given that improvement in the lives of women influences the health and resilience of their families and communities.

Where to start tackling the women's health gap to reap the greatest benefit for all

Globally, the top ten conditions by economic impact account for more than 50 percent of the total GDP impact. This highlights areas with high unmet needs and potential, aiding decision makers in prioritizing efforts to address health disparities. Specific conditions and their socioeconomic contexts vary among regions, influencing their contribution to the economy. This information could guide tailored strategies toward health equity.

The content and sequence of each action will need to be tailored to regional conditions. Building on the knowledge developed throughout this report, a fact-based strategic assessment can lead to better health equity for each country.

As noted in this report, women's health has been under-researched, and women face different challenges from men in affordability and access to treatment. This health gap creates unnecessary suffering and preventable economic losses.

It does not have to be this way. Through collaborative efforts on five fronts, a more equitable and healthy future is possible. There is an opportunity to close the women's health gap by (1) investing in women-centric R&D, (2) strengthening the collection and analysis of sex- and gender-disaggregated data, (3) enhancing access to gender-specific care, (4) encouraging investments in women's health innovation, and (5) examining business policies to support women.

Invest in women-centric research to fill the knowledge and data gaps in women-specific conditions, as well as in diseases affecting women differently and/or disproportionately

The women's health gap could be narrowed by increasing funding to achieve equality with investments in funding for men's health and using protocols that set standards of equity and diversity. Scientists, life science companies (pharma, biotech, medtech), healthcare providers, and others in the healthcare ecosystem may consider how the traditional understanding of disease is focused primarily on the male body. A more in-depth understanding of these differences would enable more effective care interventions and improved health outcomes. One example of venture-capital-backed funding addressing this disparity is Repro Grants, which allots up to $100,000 for research projects aimed at deepening understanding of female reproductive biology.

For conditions that affect women differently or disproportionately, more effective interventions start with clinical trials designed with inclusivity at their core, informed by preclinical research using female animal models. Specifically, there should be stronger diversity, equity, and inclusion guidelines for clinical trial design. Guidance could incorporate male versus female disease prevalence mix and use sex-specific thresholds for biomarkers to yield an adequate patient representation in clinical trials.

Systematically collect and analyze sex-, ethnicity-, and gender-specific data to have more accurate representation of women's health burden and the impact of different interventions

The prevalence of conditions such as endometriosis and menopause is underestimated, leading investors and life science companies to underestimate the market potential of these conditions and underinvest. By accurately assessing and reporting on the prevalence of such conditions, national health institutes and other authorities may direct additional funding to the research and treatment of these underserved conditions.

Biotech, medtech, and FemTech enterprises also have exciting opportunities related to AI and ML, which ensures that these models do not exacerbate existing biases or violate patient privacy rules. Developing robust, secure, and holistic data sets could enable companies to differentiate in an overcrowded marketplace.

Enhance access to gender-specific care, from prevention to diagnosis and treatment

Women deserve the same high-quality level of care from their healthcare providers as men, which doesn't mean the same care per se. There is a pressing need to redesign medical curricula as well as residency and fellowships to reflect sex and gender differences. In addition to medical schools, continuing medical education organizations and credentialing entities could assess whether healthcare providers are receiving the latest information and training on the women's health gap and sex- and gender-based differences. Current and future healthcare professionals of all specialties must be equipped with accurate and updated knowledge of biological differences, including sex-specific manifestations of symptoms. Future certification or tests could include questions meant to address whether providers have internalized this knowledge.

Governments, educational bodies, philanthropic institutions, and many other stakeholders can use this moment to raise awareness of the sex-specific manifestations of disease-for example, ensuring that newly diagnosed endometriosis patients have access to up-to-date resources, including which trials they could potentially participate in. Healthcare entities, philanthropic organizations, or community health workers could start or reinvigorate in-person support groups for conditions such as endometriosis or menopause or for mental health support. Collectively, better education and resources, plus new diagnostics, are among the ways to potentially elevate the quality of healthcare women receive.

In addition, two things to enable closing the gap include:

Create incentives for new financing models to close the women's health gap

Historically, given lower levers of investments overall for women's health under the traditional financing model schemes, new financing models have a critical role to play. These models can accelerate innovation. One example is the advance market commitment (AMC) geared to COVID-19 vaccine development and deployment.

Research and reliable data on the women's health landscape can help spur investment. For investors, the gender-based healthcare landscape presents a mosaic of unexplored opportunities. By pivoting toward this opportunity, investors can channel funds into high-impact areas, bridge the data gap, and enable more investment and innovation.

Governments could explore policies that encourage sex- and gender-responsive health research and services-for example, by earmarking funds, providing tax incentives, lowering application fees, and expediting the drug approval process. Philanthropic organizations, donors, and international bodies could offer grants and prizes at a national or local level to spur innovation while supporting capacity building in regions where gender-based health disparities are highest. Examples might be launching a grant or award program geared toward reducing rates of respiratory illnesses in areas where there is a high percentage of women smokers, or toward a technology-based solution for women in vulnerable populations to access transportation to healthcare services.

With collaboration, stakeholders have the potential to encourage investments and inspire the development of innovative financing models in women's health.

Establish business policies that support women's health

Data-driven, scalable actions to improve women's health may vary widely, but the critical component is to determine how each stakeholder can contribute to narrowing the gap.

If health equity efforts sit within a tree of principles, they can be watered by research, flourish in the sun of business investments, and grow far-reaching branches that stretch into the economy.

Achieving health equity is a collaborative and ongoing endeavor that relies on the active participation of governments, healthcare institutions, nongovernmental organizations, individuals, and all stakeholders vested in this cause. Tackling the women's health gap depends on addressing the interconnected factors outlined in this report: the deficit of women-specific knowledge in science, the glaring data gaps, the disparities in healthcare delivery, and the insufficient investment in women's health.

Recognizing the vast potential to improve the lives and livelihoods of half the global population while boosting the economy serves as the catalyst for closing the women's health gap. Every facet of this gap, from limited education to suboptimal treatments, offers an opportunity for transformation with the active involvement of governments, life science innovators, educational institutions, philanthropists, activists, and more.

In this endeavor lies an opportunity of $1 trillion in economic potential driven by improved women's health and economic participation. The question is not whether this wealth of opportunities exists but rather who will take the initiative to seize it and drive change.

Women's health is not a stand-alone issue; it is a cornerstone of societal well-being and progress. Better health and well-being for women creates a ripple effect that extends to families, communities, and nations. This holistic approach, supported by collective action and sustained investment, will not only narrow the health gap but also contribute to the betterment of a shared global future.

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Closing the women's health gap: A $1 trillion opportunity to improve lives and economies

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Investments addressing the women's health gap could add years to life and life to years-and potentially boost the global economy by $1 trillion annually by 2040.

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"We propose that a 2 month, 10 man study of artificial intelligence be carried out during the summer of 1956 at Dartmouth College in Hanover, New Hampshire." One of the first uses of the term "artificial intelligence" came in this 1955 proposal for a summer research project. At that point, artificial intelligence (AI) was still a relatively young development in society: one that wouldn't enter healthcare for another 20 years.

Now, artificial intelligence - or the combination of computer science and datasets to stimulate human intelligence and skills - has a variety of applications in healthcare, such as automating specific tasks, analyzing medical information, or making a diagnosis. Algorithms, chat boxes, smart assistants, and other forms of AI are able to perform these tasks - and then improve their own performance - based on data. They're given data, analyze it, and get feedback to reinforce their correct answers, decisions, and information and to discourage - and therefore limit - any incorrect ones.

However, in women's healthcare in particular, AI can lack data - and a result, lack effectiveness, whether in correctly transcribing the terms for women's anatomy or recognizing sex differences across health conditions. For context, women weren't allowed to participate in clinical trials until 1993; findings from clinical trials prior to that year were based on men and generalized to women. While women's participation in clinical trials has increased in the past 30 years, the studies that analyze data by sex has not. An article published in 2018 found, on average, only about 34% of studies - across healthcare conditions like cardiovascular disease prevention, depression treatments, and emergency medicine - analyze data by sex.

Artificial intelligence is now a part of healthcare, as seen here in Unfallkrankenhaus Berlin as a ... More
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Without sex-disaggregated data, humans - and by extension, AI - don't have the information they need to diagnose correctly, recommend appropriate and effective treatments, or even save patients from a preventable death, especially if those patients are women. For example, the most recognized symptoms of heart attacks, such as chest pain, shortness of breath, and lightheadedness, are usually typical for men. Women's symptoms can include chest pain but also back pain, flu-like fatigue, nausea, night sweats, and stomach pain. Because men's symptoms, though, are the default, women are 50% more likely to be misdiagnosed following a heart attack and 50% more likely to die within the year after a heart attack than men are. AI that is trained to recognize an imminent heart attack might only perpetuate these same human errors.

The relative lack of information around women's healthcare is not the only bias that can hamper the usefulness and effectiveness of AI, though. Developers, who are usually white and male, may unknowingly ingrain their own subconscious stereotypes, such as those around sex, gender, and gender roles, into these tools. AI can thus internalize biases (such as that men are the physical norm and females are abnormal, that female test subjects are more variable than male ones, or even that men are the doctors and women are the nurses) and present them as facts.

Artificial can perpetuate gender stereotypes in healthcare, such as that men are doctors and women ... More
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As Dr. Helena Deus, Director of Disruptive Technologies at Elsevier, summarized in one of her presentations, "AI is only as good as the data used to train it". Data that is incomplete (due to the lack of sex-specific healthcare data) or incorrect (due to biases around women and health) can not only limit the usefulness of these tools but also increase their ability to be dangerous to patients.

Despite its challenges, artificial intelligence in women's health can have positive effects. Over the past few years, AI has helped accurately flag any precancerous changes in a woman's cervix, reduce false positives and false negatives when reading mammograms, identify at-risk pregnant women in their first trimester, or, in the case of Wellen, increase the accessibility of information about osteopenia and osteoporosis.

Wellen, which is founded and led by Priya Patel, aims to provide services for healthy living and active aging, starting with personalized fitness programs for those with osteopenia and osteoporosis. Osteopenia is the initial stage of bone loss and leads to osteoporosis, which affects about 10 million Americans over 50, 80% of which are women. Women can lose up to 20% of their bone density in the five to seven years following menopause - and every 10% drop in bone density increases their risk of fracture by two to three times. In fact, half of women over 50 years old will suffer from an osteoporotic fracture.

Wellen's exercise programs focus on strength, balance, and posture to help improve bone health, prevent falls and broken bones, and mitigate some of the effects of osteopenia or osteoporosis. The company also offers the experimental Wellen Chat: a chat-box that helps answer users' questions about bone health. Users can type their question - such as "What exercises can I do to prevent osteoporosis?" - into Wellen Chat, which will give them both an answer and a link to at least one piece of Wellen content that contains additional relevant information.

Ms. Patel calls AI an "amazing tool in the toolkit" but also recognizes its limitations, noting that chat boxes that utilize this technology, like ChatGPT and like Wellen Chat, need guardrails. Wellen Chat, as a result, pulls its answers to users' questions from Wellen's content, which is written by doctors and physical therapists. That way, users can take advantage of AI's efficacy - they don't have to read through every piece of Wellen content themselves to find the answer to their question - while also trusting that the information they're receiving is science-backed and expert-approved, rather than pulled indiscriminately from the internet.

While Wellen Chat is available for anyone to use, it does specifically target a demographic that Ms. Patel notes has been historically "underrecognized and underserved" in healthcare: women over 50. These women can face both sexism and ageism when seeking medical advice. While AI without any guardrails has the potential to learn from, feed into, and perpetuate these biases, well-trained AI, like Wellen Chat, can operate outside of human prejudices. In the process, it can fulfill Ms. Patel's goal of improving the healthcare experiences - and outcomes - of these patients.

As an article published in 2015 summarized, "Longstanding efforts to improve the health of women have called for increasing the representation of women in clinical studies, analysis of research results by sex or gender, and awareness both within the research community and the public about the essential need to study the influence of sex and gender on health." With the rise of AI tools - including those in healthcare - that learn from this type of data, correct and complete information becomes increasingly important both to get the most accurate and unbiased information for users and to improve the patient experience. At Wellen, Ms. Patel and her team implemented guardrails on Wellen Chat from the beginning to reap the benefits of AI tools while limiting their ability to harm. This tactic, among others, can help make AI a positive healthcare tool for users around the world, whether they are looking for information about osteoporosis or simply looking for a transcription services that correctly recognizes and transcribes the words for women's anatomy.

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The transition to menopause starts, on average, at age 45.
Lalena Kennedy via Canva

For the first time in recent memory, corporations are starting to support women during one of the most prevalent yet debilitating stages of a woman's life: menopause. Companies have bent over backwards to support various segments of their workforce, yet middle-aged women have historically been neglected. As leaders, we understand that fostering a supportive and empowering work environment for every individual is not only a moral imperative but also a strategic necessity.

Menopause impacts half the population for a significant portion of their lives. You probably know dozens of women right now grappling with the issue. This life transition, marked by hormonal changes and physiological adjustments can significantly impair a woman's professional trajectory. It may prevent her from fully engaging at work, thereby limiting her ability to lead effectively and mentor future leaders.

Historically, menopause has been considered a topic relevant only to older women. The reality is that the transition starts on average at age 45 for most women & in large countries like India, far earlier. By many accounts, nearly 55% of the female workforce is either in the menopause transition or firmly in menopause itself.

The Impact of Menopause On The Economy

Few conditions rival menopause in terms of its prevalence and predictability, with only diabetes and cancer coming close, although neither affects as large a portion of the population. Recent studies reveal the economic impact of menopause in the United States amounts to over $26.6 billion. This figure encapsulates direct healthcare costs as well as indirect costs stemming from lost productivity and absenteeism.

A significant portion of these financial effects-approximately $ 1.8 billion-can be attributed to lost productivity. Menopause symptoms, ranging from hot flashes to mood swings, profoundly affect an individual's work performance. Decreased efficiency, cognitive fog, and emotional fluctuations hinder output, impacting overall workforce performance.

Kate Renwick-Espinosa, President of VSP Vision Care affirms, "As leaders, it's essential to acknowledge the invisible challenges our team members may face during life's transitions, including menopause. Fostering workplace compassion and destigmatizing women's health topics empowers people to navigate life changes with confidence - so they can realize their full potential."

Adding to the complexity, recent research shows that 1 in 10 women in the U.S. leave their jobs due to menopause symptoms that disrupt their daily life. These menopausal women, often in senior roles, hold substantial responsibilities; their absence can profoundly impact the business's structure and operations. The urgency for organizations to address menopause-related challenges and provide better support for women is clear.

Menopause Symptoms And Workplace Implications

Women today, fueled by workplace equality and flexibility, are reaching for new heights. As organizations embrace remote work, flexible schedules, and inclusive policies, women are seizing opportunities to advance their careers. This shift is truly exciting, as it propels women toward leadership positions and reshapes the corporate landscape.

Menopause often coincides with this critical career stage, typically occurring between ages 45 and 55. As this phase of life generally lasts between seven and fourteen years (with some symptoms persisting indefinitely unless treated), millions of postmenopausal women are assuming management and top leadership roles while experiencing a range of symptoms.

Despite affecting nearly half of the global population, menopause remains a taboo topic in many workplaces. McKinsey's Women in the Workplace study sheds light on an often-overlooked aspect of the workplace menopause experience-microaggressions. These subtle forms of bias, such as dismissive comments, jokes, or patronizing attitudes, trivialize the legitimate physical and emotional experiences associated with menopause.

The McKinsey study also reveals that many women self-shield at work due to the fear of being perceived as weak or vulnerable, which prevents them from sharing their needs openly. Consequently, women may avoid discussing menopause symptoms out of concern for judgment or misconceptions about their competence in the workplace.

The Increasing Need for Support

According to the World Health Organization, in 2021 women aged 50 and over accounted for 26% of all women and girls worldwide, an increase from 22% a decade earlier. Additionally, a new demographic is entering this life stage: millennials. This generation, known for transparency and speaking about issues openly, are now confronting perimenopause-the transitional phase before menopause-which can begin as early as the mid-30s or early 40s. Surprisingly, it is during this transitional period that the effects of hot flash and mood disruption can be most acute and debilitating.

This generation is known for prioritizing factors such as mental and physical health, work-life balance, and a supportive workplace culture. As they navigate the perimenopausal stage, their expectations from employers extend beyond traditional benefits. They seek workplaces that understand and accommodate the unique experiences and challenges that accompany menopause.

By 2025, over 1 billion people globally will be in menopause, with many reporting high levels of symptom intensity. "Given the magnitude and severity of the challenge, there are startling few trustworthy resources available to women," says Deborah Anderson-Bialis, co-founder, CEO, of Inflection. "Through our education, women feel empowered to get the care they deserve and actively participate in 'shared decision-making' with their doctor. We are also seeing many of the "Best Places To Work" organizations lead the way with more holistic Menopause support."

From Silence to Support: Cultivating a Community of Confidence

The medical profession lacks a holistic approach to addressing menopause-most medical residency programs provide little to no instruction on how to assist patients in navigating this transition. This gap compels women to seek information and advice from sources beyond traditional healthcare systems.

Hot flashes and physical discomfort during work can undermine confidence and focus. To address this, companies can create a supportive environment by allowing flexible dress codes, providing personal fans or temperature control, and permitting breaks as needed.

Dr. Nick Panay, President of the International Menopause Society, advises organizations to "give license to women to talk about their symptoms freely. Silence helps nobody. Line managers can open the dialogue through leveraging education. "

By fostering open conversations through webinars, workshops, and informational sessions, companies can break down stigma, normalize menopause discussions, and create a supportive network for women at all career stages.

Awareness: Younger women need accurate information about menopause. By discussing it openly, they can better understand what to expect and how to manage symptoms when the time comes.

Preparation: When younger employees are aware of menopause, they can prepare themselves and their partners. This proactive approach reduces fear and anxiety associated with the unknown. For instance, many women are wrongly led to believe their bouts of "brain fog" are early harbingers of Alzheimer's or Dementia.

Support Networks: Women's leadership and Employee Resource Groups (ERGs) can create supportive networks that allow women to share experiences, seek advice, and learn from one another. Older colleagues can offer insights, while younger ones bring fresh perspectives.

A Call to Action: Creating a Supportive Culture around Menopause

The urgency to address menopause-related challenges cannot be overstated. Waiting for explicit data in engagement surveys is a luxury businesses can no longer afford, especially when 55% of women are at menopausal age and 60% are grappling with acute symptoms. Tackling these needs is not just an HR consideration; it's an important aspect of leadership.

As we prioritize employee well-being within our business strategies, the lack of support for menopause remains a persistent gap. Engaging all C-suite executives is a strategic imperative, aligning our commitment to ESG goals with the creation of an inclusive environment that recognizes and actively addresses menopause challenges.

This unified effort breaks down barriers to propel organizations toward a future where leadership reflects the diversity of talent, experiences, and perspectives within their ranks.

We must lead with empathy, recognizing that women's experiences are diverse, and their needs vary. Let's encourage open conversations about menopause, dispel myths, and foster understanding. Considering the financial implications, we can drive the necessary changes to foster a culture that supports women navigating menopause while maximizing the potential contributions of a diverse and empowered workforce.
C200 member Mary Tinebra has led teams in establishing world-class people strategies for G500 employers at Mercer, as well as implementing emerging Health and Cloud technologies at Compaq Computer. Recognized as one of Consulting Magazine's Top 25 consultants in 2015, she has a history of optimizing the intersection of employee needs and technology. Mary currently serves as an Officer for Inflection, a leading global health digital education platform helping employees to navigate life's inflection points.

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