Hormone therapy spent nearly two decades in the wilderness. After a 2002 study spooked patients and doctors alike into overestimating cancer risks, prescriptions cratered. Fast forward to 2026, and the pendulum has swung so hard that perimenopause has become one of the hottest categories in American telehealth — a rare zone where medical experts, feminists, and Make America Healthy Again operatives all seem to agree on something.
The numbers tell the story. According to an analysis conducted by SimilarWeb for WIRED, four leading startups in the space — Midi, Winona, Alloy, and Evernow — saw a 490 percent uptick in web traffic from 2023 to 2026. SimilarWeb calls it an “organic demand surge.” A big catalyst came last fall, when the US Food and Drug Administration removed the so-called “black box” warnings that had long shadowed hormone therapy.
The market is enormous. More than 43 million women between the ages of 35 and 54 live in the United States, and virtual clinics are elbowing for position. Midi became the first “menopause unicorn,” while Alloy and Evernow have also raised capital. Larger players like Hers are muscling in, and “turnkey” services now let almost anyone spin up a hormone clinic online within days.
How you pay varies wildly. Midi is one of the few providers that accepts health insurance — though not Medicare or Medicaid. Many rivals are strictly out-of-pocket, charging subscriptions of up to $200 a month for custom formulations delivered as pills, patches, gels, and creams.
What’s driving all this? Partly a rebrand of biology itself. The industry attributes a staggering list of ailments to perimenopause. One Midi ad, featuring investor Amy Schumer, rattles off night sweats, low libido, and “random tears.” The company points to more than 100 possible symptoms, spanning body odor, forgetfulness, anxiety, asthma, recurring UTIs, sensitive teeth, and dry skin. Winona even sells an estrogen-containing skincare product it claims reduces wrinkles.
That expansiveness is exactly what worries some clinicians. There’s no lab test that confirms perimenopause — erratic hormone fluctuation is its defining feature — so diagnosis leans heavily on how patients describe feeling. Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health and medical director of the Menopause Society, says the hype “has gotten completely out of hand.” Yale gynecologist Mary Jane Minkin, an enthusiastic educator on the topic, shares the concern that marketing is convincing broadly healthy women their hormones are the culprit.
The risks, while long overstated, are real: side effects can include vaginal bleeding, breast tenderness, and bloating, and people with histories of breast cancer, blood clots, or liver disease are advised against the drugs. Still, the momentum runs the other way. Alicia Jackson, founder of Evernow and now director of ARPA-H, argues that “the earlier that you start hormone therapy, the greater the benefit” — a philosophy that neatly aligns commercial ambition with the new regulatory mood.
