What does the latest research say about menopause hormone therapy, and how can women distinguish reliable medical evidence from commercial hype? In this live discussion, physician and Menopause Society Certified Practitioner Dr Deepti Gandhi joins investor and author Maryann Selfe to explore changing medical guidance, treatment choices and the rapidly growing menopause industry.

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If you’ve been following the news about menopause lately, there’s a lot going on. Just this past week, two stories caught my attention.

On 5 November, The Washington Post reported on new research suggesting that lifetime estrogen exposure may be associated with better brain health in later life. The findings raise intriguing questions about the role of estrogen in brain ageing (although they do not establish that hormone therapy prevents dementia).

Meanwhile, the FDA approved changes removing statements about cardiovascular disease, breast cancer and probable dementia from the boxed warnings of three additional estradiol patches. The decision follows earlier labelling changes and reflects an evolving approach to communicating the benefits and risks of menopausal hormone therapy.

Two developments, arriving within days of each other, adding to a debate that has been running for more than two decades…. and these are just two of the headlines.

So, the science is evolving. Medical guidance is changing. And women are being asked to make decisions about their health in the middle of it all. But here’s what I find interesting.

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For generations, menopause was something women were largely expected to navigate silently. There was little discussion, limited information and, for many women, inadequate medical support. Today, the pendulum seems to have swung in the opposite direction.

There are menopause specialists, clinics, digital platforms, hormone therapies, supplements, gummies, shampoos (I stumbled upon the shampoo in a grocery store and found it particularly intriguing… what’s it supposed to do? wash menopause away… but I digress!), podcasts and an expanding universe of products promising to help women navigate midlife.

We have gone from a shortage of information to an abundance of it. But does having more information necessarily mean we are better informed?

And perhaps more importantly, how do women distinguish between what the science actually tells us, what remains uncertain and what the rapidly growing menopause industry would like us to believe?

As someone investing in women’s health, I see the commercial opportunity. For too long, women’s needs were overlooked, and the emergence of new solutions is a welcome development. But I also find myself asking some uncomfortable questions.

• Is every new solution addressing a genuine unmet need?

• Is greater choice always better?

• And where do we draw the line between improving women’s healthcare and turning a natural life transition into another market to be monetised?

These are not straightforward questions.

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That’s why I’m delighted to be hosting Dr Deepti Gandhi for a live conversation here on The Billion Dollar Blindspot.

Deepti is a board certified family medicine physician and Menopause Society Certified Practitioner with over two decades of clinical experience. In her own private practice, she translates complex science into practical, evidence based and holistic midlife care.

We’ll explore the promises and contradictions of today’s menopause boom, what women should make of the competing messages about treatment, and something that receives far less attention: how our cultural attitudes towards ageing might shape the way we experience this stage of life.

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There’s another idea Deepti raised when we were preparing for this conversation that I have been thinking about.

Throughout our lives, we have people to turn to for guidance. Yet when menopause arrives, many women discover that even the women closest to them cannot necessarily help them navigate it.

Why is that? And what might change if we approached menopause differently? I want to explore these questions with her, and with you.

Join us live

With Dr Deepti Gandhi and Maryann Selfe

Date: 15th November 2026
Time: 18:00 CET | 12:00 PM EST | 9:00 AM PST
Where: Live on Substack, The Billion Dollar Blindspot

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If you’d like more conversations about women’s health and wealth, subscribe to our YouTube channel. Discover what new science is revealing about women’s health and wellbeing. Hear from women who’ve built businesses, created wealth and defined success on their own terms. We get into how they think, the habits that sustain them and the strategies they’ve used to win in business.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

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About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital, an investment platform backing exceptional managers and founders in women’s health. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

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The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

So why should you care about these numbers?

Because money shapes which women’s health problems get solved, which discoveries make it out of the laboratory, and which treatments eventually reach women.

It’s a side of women’s health we don’t talk about nearly enough.

I’ve spent more than two decades in investment management, and today, through Calabar Capital, I’m putting that experience to work investing in women’s health and healthcare innovation. So when I look at developments in women’s health, I’m looking at the science, policy, entrepreneurial activity but also looking (shamelessly primarily) at who’s putting money to work and what might those decisions tell us about where healthcare is heading?

That’s the perspective I bring: connecting the dots between science, healthcare and capital, and helping you understand why they matter.

And October gave us some interesting dots to connect. Below are five transactions that caught my attention this month. The full report can be accessed at: Women’s Health Capital Review: October 2026.

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Mergers & Acquisitions

Ferring agrees to acquire Gameto for up to $1.38bn

Ferring Pharmaceuticals agreed to acquire Gameto, the developer of Fertilo, an egg-maturation technology used in IVF. The deal was announced on 27 October at a headline price of up to $1.38 billion, which includes contingent milestones. It brings Gameto’s technology into Ferring’s fertility business.

What the technology does

Standard IVF needs about two weeks of daily hormone injections to ripen several eggs at once, and for many patients they are the hardest part. Fertilo collects eggs earlier, while still immature, and finishes ripening them in the lab alongside ovarian support cells grown from stem cells. Gameto says this removes about 80% of the injections.

The method is called in vitro maturation, or IVM. What is new is the support cells, which come from induced pluripotent stem cells, ordinary adult cells reprogrammed to a stem-cell state.

The first baby conceived with Fertilo was born in Lima, Peru, in December 2024. In the United States it remains investigational and a Phase 3 trial is under way.

Why the buyer wanted it

Ferring is a privately held Swiss company that has made fertility medicines for more than 50 years and brings what a start-up lacks: clinic relationships, distribution and regulatory experience.

What it could mean for patients

If Fertilo is approved, the first change would be to the experience of treatment: fewer injections, a shorter IVF cycle and, according to the company, a lower risk of the side effects that come with high hormone doses. It could also matter for egg freezing, which relies on the same stimulation.

Two things remain open though. Approval depends on the Phase 3 results, and cost and availability will not be known until there is a product to price. For now, this is a strategic investment in a technology.

What I find interesting

Gameto’s technology could reduce the hormone injections involved in IVF. Ferring sells fertility medicines, so buying it is a way for Ferring to own an innovation that could disrupt its own market.

Google invests in Flo Health

On 12 October Google Health made a strategic investment in Flo Health, alongside a multi-year partnership. The amount was not disclosed. The partnership connects Flo’s cycle insights with Google’s wearable data and personalised coaching.

What the companies do

Flo is a period tracking app with, the company says, more than 80 million monthly users. Google’s Fitbit wearables record sleep, heart rate, skin temperature and other body signals. From early 2027, users who opt in can send those signals into Flo to sharpen its cycle predictions, and Flo’s insights will inform Google’s paid AI health coach. A joint research programme will look for early signs of perimenopause and conditions such as PCOS and endometriosis.

Why Google wanted it

Body readings are not so meaningful for women without cycle context; skin temperature, for example, shifts across the cycle. Flo holds that context for a very large group of women. In this partnership, Flo gains sensor data it cannot collect itself and a featured place in the Google Health app and Google gets female-specific data.

What it could mean for users

For women who opt in, the practical change is predictions and coaching that account for their cycle.

The companies say they have safeguards in place: nothing moves between the apps without permission, given separately for each type of data and each purpose, users can withdraw it at any time, and Flo data shared with Google Health will not be used for advertising or sold. Those are the companies’ own commitments.

The research programme announced is the longer-term part. Earlier recognition of perimenopause or PCOS would matter to many women, but today (under the partnership), it is a plan and not a product.

What I find interesting

A wearable records sleep, temperature and activity, but hormonal changes help explain those readings. Flo adds that context, which could make Google’s products more useful to women. This goes to show that women’s health companies building products with specialist knowledge/edge can become valuable to a much larger platform, and this is a clear example.

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Allara raises $30m

Allara raised $30 million on 13 October, taking its total funding to $75 million. The company provides virtual care for hormonal, metabolic and reproductive conditions, including PCOS, and has served more than 120,000 patients.

What Allara does

Allara is a virtual practice for hormonal and metabolic health. A patient sees a women’s health clinician and a dietitian in one care relationship, billed to insurance, and the company says it is in-network with major insurers in most states. It treats PCOS/PMOS, thyroid disorders, endometriosis and menopause-related needs, and over the past year has added GLP-1 medicines and hormone replacement therapy.

Why investors backed it

Allara works with major commercial insurers and is increasing awareness among employers whose insurance arrangements already include its services.

What it could mean for patients

For a woman whose symptoms cross specialties, the appeal is one team with insurance coverage. Coverage depends on insurer and state, and some needs, such as an in-person exam, sit outside a virtual practice though.

What I find interesting

Women managing conditions such as PCOS/PMOS often see several specialists separately. Allara brings that care together, and the commercial opportunity is in solving a recurring problem for patients who need ongoing support rather than a single consultation. The round also carried the majority of the month’s venture capital investments. Allara accounted for 61% of disclosed venture dollars in October, and care delivery as a category for 66%.

Hologic agrees to acquire Reveal Genomics

Hologic announced on 19 October that it will acquire Reveal Genomics. Reveal is based in Barcelona and develops HER2DX, a genomic test that personalises breast cancer treatment. Terms were not disclosed.

What HER2DX does

About one in five breast cancers is HER2-positive, which grows faster and is usually treated with chemotherapy plus HER2-targeted drugs. HER2DX is run on a tumour sample. It measures 27 genes and combines them with clinical features such as tumour size to score two things: the risk the cancer returns, and the likelihood the tumour disappears completely after pre-surgery treatment.

Why Hologic wanted it

Hologic is known for mammography and breast biopsy systems, which find and sample cancers. HER2DX acts later, when oncologists decide how much treatment to give. Acquiring Reveal Genomics extends Hologic from detection into treatment planning. The deal still needs Spanish regulatory approval.

What it could mean for patients

A woman who scores low risk might be offered less chemotherapy and avoid its side effects, while a high score could prompt more intensive treatment. That depends on trials showing the approach is safe and on guidelines and insurers accepting it.

What I find interesting

Hologic went private under Blackstone and TPG in April, and it is still buying innovation in women’s health. That matters for founders and investors, because it shows an established strategic acquirer remains active.

Additionally, Reveal also gains access to Hologic’s commercial reach, while Hologic adds a specialist test to its breast cancer diagnostics business.

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Labcorp agrees to buy Myriad’s prenatal testing business for $210m

Labcorp announced on 20 October that it will buy Myriad Genetics’ prenatal business for $210 million in cash, plus inventory. The business covers prenatal and carrier-screening tests, among them Prequel, Foresight, SneakPeek and FirstGene.

What the tests do

Prequel screens for conditions such as Down syndrome using fragments of the baby’s DNA in the mother’s blood. Foresight checks whether parents carry gene changes that could cause an inherited condition. SneakPeek is an early blood test that predicts a baby’s sex.

Why Labcorp wanted it

Labcorp runs one of the largest clinical laboratory networks in the United States, with blood-draw sites and relationships with obstetricians. Prenatal testing needs exactly that: a clinician orders the test, a patients blood is drawn, a lab runs it and results return quickly. The price which was $210 million in cash plus inventory is for a business expected to bring about $160 million of revenue, or about 1.3 times revenue, according to Evercore.

What it could mean for patients

For most pregnant women nothing changes at first. But over time, a larger laboratory could mean wider insurance contracts and easier ordering, which affect out-of-pocket cost and who gets tested.

What I find interesting

Developing a test and distributing it at scale require different capabilities. Labcorp can add these tests to its established laboratory network. This demonstrates that a specialist business can be worth acquiring because the buyer can take it further.

Philanthropic Moves

Philanthropic, multilateral and public commitments reached about $444 million, higher than the month’s venture financing.

The three largest were:

• a Bangladesh and European Investment Bank women’s health initiative of about $292.5 million (EUR 250 million), which repurposes 2021 sovereign loan funds originally meant for COVID-19 immunisation and runs from 2027 to 2031;

• the $100 million Uzima programme for stillbirth prevention, with $50 million each from the Gates Foundation and Wellcome Leap;

• and a $50 million gift from Karen and Rob Hale to the Breast Cancer Research Foundation, which the foundation describes as its largest single gift.

What I find interesting

I wrote about Uzima earlier in October, and the point holds across the larger commitments: philanthropic and public money can support evidence and delivery that commercial investors are not yet positioned to fund.

What the developments tell us

Read these separately, and each layer gives a partial picture; venture shows a slower month compared to September, acquisitions show confident buyers, and philanthropy and policy show where attention is moving towards.

But read together, they show a division of labour. Venture pays for the earliest and most uncertain risk, acquirers pay when the technical risk has shrunk and the bottleneck is distribution (which is what Hologic, Labcorp and Google each bought) and philanthropy pays for evidence where no commercial buyer exists yet.

The full October report

The full report sets out each disclosed round with its stage and category, every acquisition and every philanthropic commitment, along with the platform and partnership news from the month. You can read it on the Billion Dollar Blindspot website: Read the full October report.

If you’d like more conversations about women’s health and wealth, subscribe to our YouTube channel.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

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About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital, an investment platform backing exceptional managers and founders in women’s health. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

Connect on LinkedIn · Discover the Book · Learn more about Calabar Capital

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

Sources

• Women’s Health Capital Review: October 2026

• Gameto announcement, Business Wire

• Ferring and Gameto, BioPharma Dive

• Ferring and Gameto, Bioxconomy

• Fertilo Phase 3 trial, ClinicalTrials.gov NCT06858111

• Google and Flo, The Next Web

• Google and Flo, HLTH

• Allara raises $30M, Femtech Insider

• Allara business model, AlleyWatch

• Earlier essay on Uzima, The Billion Dollar Blindspot

One day during the Christmas holidays, after school had closed, I came home and saw the purple tin on the kitchen counter. It was already open, so I was hopeful. I crept into the kitchen, lifted the lid, and much to my disappointment, I found my mother’s paper recipes in the tin. She had kept the old biscuit tin to store them.

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That day, the purple tin seemed to tell me everything I needed to know about what was inside. Its purple lid still carried the promise of what it used to hold, and I had believed that promise before I looked inside.

René Magritte played with a similar gap in The Treachery of Images. He painted a pipe, then wrote beneath it: “This is not a pipe.” At first, we see the pipe. Then his words make us notice that we are not looking at a pipe but at an image of one. Magritte makes that slippage in our thinking visible.

Psychologists Daniel Kahneman and Shane Frederick described a related move in our thinking as attribute substitution: when a question is difficult, we may answer an easier, related one instead, without noticing the switch.

Kahneman illustrated the idea with an experiment by Fritz Strack, Leonard Martin and Norbert Schwarz.

Students were asked how satisfied they were with life overall and how many dates they had had in the past month. When the life-satisfaction question came first, the answers had little connection to dating.

But when the question about dating came first, the two answers became much more closely linked.

The students had just been prompted to think about one part of life, and that feeling became an easy way to judge life as a whole.

In the same way, a headline figure showing that women make up 30 or 40 per cent of a study can have a similar effect. The presence of women in the study is easy to see, so we let that answer stand in for a harder question: was the research designed to tell us what happens in women? and/or what does that figure actually tell us?

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Rebecca Rechlin and her colleagues reviewed 3,193 papers from six neuroscience and psychiatry journals, comparing research published in 2009 and 2019. They looked at whether studies reported using both male and female subjects, and whether researchers tested if results differed by sex. The papers covered research with people, animals and cells.

By 2019, 68% of the papers reported using both sexes, up from 38% in 2009. Yet only 5% of papers in the 2019 sample tested whether the results differed by sex.

Imagine a study testing a new treatment in women and men. Researchers could calculate one average result for everyone, perhaps accounting for sex in their analysis.

Or they could ask whether the treatment works differently in women and men. Sex then becomes part of what the study is investigating. That is what it means to analyse sex as a discovery variable.

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A study of childhood asthma shows why this kind of analysis can matter. Tesfaye Mersha and his colleagues looked at genetic markers (small variations in DNA) in girls and boys with asthma. When they analysed the children together, they found 33 markers associated with asthma.

When they looked at girls and boys separately, they found 47 markers.

Additionally, the two analyses overlapped on only 21 markers which appeared in both. Twenty-six markers were not identified in the combined analysis.

These markers were associations, not proof of what caused asthma. And an important disclaimer is that this was one study of selected genes in children. But it does shows how a pattern found in one sex can be harder to see when results for girls and boys are combined.

This does not mean every study should be designed to find a difference between women and men. In their review of sex-difference research, neuroscientist Liisa Galea and her colleagues distinguish between including both sexes in a study and designing research specifically to investigate sex differences.

Including both sexes matters, but it does not automatically tell us whether the findings differ between them. To answer that question, researchers need methods and sample sizes that can detect a difference if one exists.

We should not assume in advance that women and men will always respond differently. But the possibility should be considered when a study is designed, so the evidence can show us whether sex matters in that context.

Research builds the evidence base on which science-backed product development depends. It helps establish what a condition looks like, whom a treatment or diagnostic might serve, and what remains uncertain.

When sex could affect the result but researchers have not examined it, that uncertainty travels forward into product development.

That is why I treat “science-backed” as a question to investigate, not a conclusion. What evidence supports the product’s central claim? How was that evidence generated, and what remains to be tested?

Watch the documentary Why Better Science Isn’t Enough to Improve Women’s Health. If you’d like more conversations with the people shaping women’s health, subscribe to our YouTube channel.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

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About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital, an investment platform backing exceptional managers and founders in women’s health. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

Connect on LinkedIn · Discover the Book · Learn more about Calabar Capital

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

The proposed acquisition is worth up to $1.38 billion, including payments dependent on development, regulatory and commercial milestones. The upfront payment has not been disclosed, and the acquisition has not yet closed.

Gameto’s lead treatment, Fertilo, is designed to help eggs mature outside the body using engineered ovarian support cells. The aim is to shorten hormonal stimulation before egg retrieval from roughly two weeks to between one and three days. Fertilo remains investigational in the US.

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Why the Gameto acquisition matters for women’s health investing

Here’s why I am paying attention to this.

IVF is an established treatment, but the experience still asks a great deal of women. Gameto is working on a specific part of that burden. Its commercial opportunity rests on whether better science can make treatment easier while delivering the outcomes patients and clinicians need.

That connection between an unresolved patient problem and a commercial opportunity is central to our investment thesis at Calabar Capital. I truly believe that an existing market can still contain substantial room for innovation.

The identity of the buyer matters too. Ferring already has a fertility business. My read of this deal is that it sees enough potential in a different treatment approach to bring it into its own portfolio. For a young biotechnology company, an established pharmaceutical business can also provide the expertise and reach needed to move an innovation towards wider use.

For investors, the proposed acquisition adds a concrete example of how a reproductive-health company could eventually find a buyer. These transactions matter because backing promising science is only part of investing: there also needs to be a clear exit strategy.

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What the $1.38 billion headline does and does not tell us

Still, the headline figure needs care. We do not know how much will be paid upfront or how much of the maximum consideration will ultimately be earned. It is too early to describe this as $1.38 billion returned to shareholders.

There are clinical questions ahead as well. Fertilo’s Phase 3 trial compares it with standard laboratory egg-maturation medium, rather than directly testing whether it matches conventional, fully stimulated IVF. Its eventual place in fertility care will depend on the evidence.

My view is that this is an encouraging, specific signal for the sector. A major fertility business is pursuing technology aimed at improving a difficult part of women’s treatment. The next things to watch are the clinical results, regulatory progress and whether clinics can translate that promise into a better experience for patients.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

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About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital, an investment platform backing exceptional managers and founders in women’s health. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

Connect on LinkedIn · Discover the Book · Learn more about Calabar Capital

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

I went looking for the people changing healthcare for women. We ended up talking about all the things that have to happen after the exciting bit.

There is a point in my conversation with Rute Fernandes where the promising healthcare company in my head runs into a fairly substantial problem. It has done the science, met its clinical endpoints and things are looking good.

But then, the people who are supposed to pay for the treatment look at the evidence and decide it hasn’t shown them what they need to see.

Urrgh!

All that work, and the company may still struggle to get its treatment to patients. Just because somewhere along the way, “does this work?” and “will a healthcare system pay for this?” turned out to require different answers.

I had asked Rute what it takes to turn a promising scientific insight into healthcare that reaches people…. Which sounds like one question, but apparently, it is several careers’ worth of questions wearing a coat.

Rute has spent more than 25 years across pharma and healthcare, including many years in rare disease. She knows the territory between an exciting result and a patient actually receiving treatment. And there is a lot of territory.

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I wanted to make this documentary Inside Women’s Health because I spend so much time talking about the opportunity in this sector that I wanted to get closer to the work itself - the people, their decisions, what they are trying to change and what keeps getting in the way.

We have become quite good at describing the gaps in women’s health; the missing research, the delayed diagnoses, and all the things women have been expected to put up with. Heck! I’ve written a book about them, so I am very much including myself here.

But once you have established that something needs to change… well. Someone has to change it. So I took my questions to Rute, and then to Professor Carolin Lerchenmüller at the University of Zurich.

Watch the documentary here →

With Rute, we kept coming back to the patient’s journey.

• What happens when symptoms first appear?

• Who recognises them?

• How does someone get a diagnosis?

• What treatment do they receive, and who decides?

These are things a healthcare entrepreneur needs to understand early before the commercial model becomes a slightly uncomfortable conversation everyone wishes they’d had two years ago.

And Rute insists that the patient needs to be involved in that understanding early enough to influence what gets built and what the company sets out to prove. It sounds obvious written down. A surprising number of important things do.

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Later I sat with Carolin to talk about gender medicine: how biological sex and gender influence health and disease, and what a better understanding of those influences could mean for care.

At one point, she described a patient who come to her in her role as a clinical cardiologist with stomach pain. She had already seen several doctors including a gastroenterologist and was still searching for an explanation as something didn’t still feel quite right.

Carolin is a cardiologist trained on sex and gender medicine. By listening carefully and asking pointed questions, she recognised something that pointed to coronary artery disease.

She was careful to explain that the doctors this patient had seen had meant well. She wasn’t interested in blaming them. Rather she was demonstrating that the information on how sex and gender can influence health and disease still has room to travel.

I kept thinking about that because if you spend enough time in women’s health, you hear certain examples of misdiagnosis or delayed diagnosis so often that you mentally file them under surely we all know this by now. But perhaps we still don’t.

Or perhaps some of us do know, but that knowledge still has a considerable journey ahead of it before it helps the woman sitting in the next consulting room.

Towards the end of our conversation, I asked Carolin what medicine would look like if her field succeeded in becoming part of everyday practice. She talked about it becoming more personal. About wanting, as a patient herself, to be recognised as a whole person.

After all our discussion about research, guidelines and education, we had arrived back at something very familiar. Sitting opposite someone while being unwell and hoping they understand enough about you to actually help you. That is where all this work has to arrive.

Watch Inside Women’s Health on YouTube.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

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About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital, an investment platform backing exceptional managers and founders in women’s health. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

Connect on LinkedIn · Discover the Book · Learn more about Calabar Capital

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

Each offers a different perspective on how capital can help bring healthcare solutions to women and the work involved along the way.

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OMass Therapeutics raises $310 million for endocrine and immunology medicines

OMass Therapeutics announced a $310 million Series C on 15 October, co-led by Bain Capital Life Sciences, Forbion and Novo Holdings.

The financing will support its lead drug candidate, OMS1620, through Phase 2 development in congenital adrenal hyperplasia and ACTH-dependent Cushing’s syndrome. It will also support initial clinical data for a separate programme targeting lupus and other immune-related diseases. Read More

What I find Interesting

This caught my attention because some of the science relevant to women’s health sits within broader areas such as endocrinology and immunology.

Cushing’s syndrome, for example, disproportionately affects women, although that varies depending on its underlying cause.

It is a reminder of why I find women’s health such an interesting area to explore. There are opportunities within conditions specific to women, but also within diseases that affect women more frequently or differently.

Those opportunities may not always appear in a women’s-health funding roundup. Sometimes we need to look more closely at the underlying science and the patients it could benefit.

OMass still has clinical work ahead. This financing gives the company resources to move that work forward, and hopefully bring us closer to understanding what these programmes could offer patients.

It takes hours each week to research, write, and produce at this level. Consider becoming a free or paid subscriber to support my work. Thank you.

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Allara raises $30 million to expand insurance-covered women’s healthcare

Allara has raised $30 million, bringing its total funding to $75 million. Participants included Index Ventures and GV, alongside Camino Partners, Foreground and Family Fund.

The company provides virtual hormonal, metabolic and reproductive healthcare. The funding will support its clinical infrastructure, enterprise partnerships and additional AI capabilities. Allara works with major commercial insurers and is increasing awareness among employers whose insurance arrangements already include its services. Read More

What I find Interesting

What interests me is the attempt to make connected care more accessible through insurance.

For a woman experiencing several symptoms, knowing where to begin can be difficult. Do you see a gynaecologist, an endocrinologist or someone else? And who helps connect the findings from those different appointments? There is value in making that experience easier.

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3. Gates Foundation and Wellcome Leap commit $100 million to stillbirth prevention

The Gates Foundation and Wellcome Leap announced a combined $100 million commitment to Uzima, a programme aiming to demonstrate that stillbirth rates can be halved over a decade in selected countries.

The initial three-year funding will help identify and validate technologies including AI-enabled ultrasound, diagnostic biomarkers, labour-monitoring sensors and decision-support tools. The programme expects to select an initial package of innovations by early 2027. Read More

What I find Interesting

What interests me here is the role philanthropic capital can play alongside investment capital.

There can be promising technologies that could make a real difference to patients, but are still too early or too uncertain for commercial investors. Funding the research, testing those technologies and understanding how they work in a healthcare setting can help them move forward.

We need this kind of catalytic capital in women’s health. There is so much we still need to understand, and investment capital cannot fund every part of that journey.

For me, this is why blended approaches to funding matter. Philanthropy, public funding and commercial investment each have a role to play. The challenge is helping those sources of capital connect, so that a promising innovation can continue moving towards patients.

The hope is that programmes like Uzima can help build the evidence and experience needed for other funders to support wider use. That possibility is what makes this announcement particularly interesting.

4. Aristo acquires the DonnaPlus women’s-health brand

Aristo Pharma Iberia has acquired DonnaPlus from Laboratorios Ordesa, according to Alimarket’s 14 October report. Financial terms were not disclosed.

DonnaPlus covers areas including menstrual pain, menopause and intimate health. Aristo highlighted the brand’s experienced team and established relationships with healthcare professionals and pharmacies. Ordesa described the sale as part of its strategy to focus on infant and adult nutrition. Read More

What I find Interesting

I was interested in how much attention Aristo gave to the team and relationships that come with the brand.

We spend a lot of time discussing products in women’s health. Understandably so. But helping those products reach people also requires knowledge of the market, trusted relationships and reliable distribution.

Those things take time to build. They can be valuable to a buyer that already has complementary products and the resources to support further growth.

We do not know the price paid, so there is little we can say about valuation or investment returns. Still, it is useful to see an established pharmaceutical company explaining why it wants to expand in women’s health and recognising the experience and relationships behind an existing business.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

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About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital, an investment platform backing exceptional managers and founders in women’s health. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

Connect on LinkedIn · Discover the Book · Learn more about Calabar Capital

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

The drug was zolpidem, better known by the brand name Ambien.

The reason was startling. After the medicine had been on the market for nearly twenty years, new evidence helped the FDA establish the risk: women cleared it from their bodies more slowly than men. A pill taken at bedtime could leave enough medication in their blood the next morning to impair driving even when they felt fully awake.

What interests me is what this revealed about the way we understand patients. The same medicine, at the same dose, could leave women and men facing different risks the following morning.

Recognising that difference changed prescribing. But it also raises a wider question: what else could we do differently if we understood the patient better?

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Sex is one part of that understanding. Another is biological time: how the same woman’s biology and healthcare needs can change through puberty, pregnancy, perimenopause and postmenopause. Healthcare has to recognise both who she is and what is changing.

We count our lives in years, but a birthday tells us only so much. Biological transitions can change the context in which symptoms, risks and treatment decisions need to be understood. Our history matters too: something that happened during pregnancy may carry information relevant to health years later.

Women’s health makes these connections visible. It asks us to look more closely at differences between women and men, changes within the same woman over time, and the experience of living with a condition.

That last part matters. Understanding a patient includes understanding what she needs from care: symptoms taken seriously, treatment she can manage, and appointments and services she can access alongside the demands of everyday life. Those experiences help define what a better solution needs to deliver.

When we understand a need more clearly, we can see what existing care is missing and what a business could do better.

That is the connection I am interested in as an investor. Better understanding can open the way to a more useful test, a more effective treatment or a service that reaches people existing care has struggled to serve. A company that delivers that improvement may build a lasting business around it.

I call that potential The Precision Premium.

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What is the Precision Premium?

The Precision Premium is the potential value created when a more precise understanding of biology, clinical needs and lived experience leads to better healthcare and durable businesses.

I coined the term to give this investment conviction a clear expression.

“Precision” can sound highly technical. It can bring to mind gene sequencing, sophisticated diagnostics or individually tailored treatments. Those are part of the opportunity. But the idea reaches further: understanding a meaningful difference well enough to act on it.

With zolpidem, the action was a change in dosing. Elsewhere, better understanding may enable a new diagnostic, a treatment, a device or a different way of delivering care.

Women’s health is a leading edge of this broader healthcare transition. The opportunity spans both conditions specific to women and the ways women experience diseases that affect both men and women.

For me, the investment question is: which businesses can turn that understanding into an improvement people will use and pay for?

A test has to help someone make a decision. A treatment has to offer a meaningful benefit. A care service has to fit into people’s lives. Each needs a credible route into use.

After more than two decades investing over $100 billion of client capital, I pay close attention to those connections. They determine whether an important idea can support a lasting business.

The benefits may accrue to different people. A patient may gain a better treatment choice. A hospital may avoid unnecessary costs. The company supplying the solution still needs a viable way to be paid. Understanding where value is created and how it is captured is part of the investment work.

That is what “premium” means in this thesis: the potential value unlocked by better understanding and effective action. Whether it becomes an attractive investment depends on the business, the risks and the price paid.

To make that thinking practical, I have developed The Precision Premium framework:

Need → Insight → Solution → Adoption → Value.

It follows the opportunity from what existing care is missing through to how a business can deliver and sustain an improvement.

I have published the full Precision Premium essay and framework on Billion Dollar Blindspot, bringing together the evidence, examples and questions behind the thesis.

The zolpidem story began with a medicine that was already widely used. Understanding a difference between patients changed how it should be prescribed. But there is still a lot of white space within women’s health to transform better understanding of the female biology into better care.

That is where I see the potential for The Precision Premium.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

Order Your Copy

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital, an investment platform backing exceptional managers and founders in women’s health. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

Connect on LinkedIn · Discover the Book · Learn more about Calabar Capital

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

Mine is to head straight into the engine room of any report or news story that catches my attention. I want to understand what sits behind the numbers: what businesses are being built, what investors are backing, and what has changed to make those opportunities possible.

So when I prepared my September review of capital moving into women’s health, those were the questions I brought to it.

Looking through the numbers, diagnostics attracted the most disclosed funding and accounted for the largest number of financings.

But “diagnostics” tells you only so much. Within that category, iPremom is developing a blood test to predict pregnancy complications, Evvy is analysing the vaginal microbiome to inform care, and Teal Health is bringing cervical screening into the home. Each addresses a different problem, with its own scientific evidence, commercial model and route to patients.

Looking across the rest of the month, the picture broadened further. There were therapeutic developments, consumer businesses and regulatory and reimbursement milestones that could influence how (and how quickly) new products reach the market.

Together, these developments offer a much richer picture of the opportunity than a headline funding total.

They also raise the questions I care about as an investor: where is the evidence becoming stronger, what is ready to scale, and what still has a substantial development journey ahead?

The September Women’s Health Capital Review brings those developments together: which companies raised capital, who backed them, where funding concentrated, and which clinical, regulatory and payment milestones could change their prospects.

Preparing the review also brought me back to the question behind Calabar Capital: why invest in women’s health now?

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Demographics: Where Women’s Healthcare Needs Meet Purchasing Power

In my last article, I wrote about the personal journey that led me to build Calabar Capital. But the decision to build an investment firm around women’s health also rests on a judgement about timing.

The unmet needs in women’s health have been documented for some time. The gaps between what women want and what the healthcare system provides are not new.

What gave me conviction was seeing changes in who was seeking care, what science and technology could offer them, and how businesses could reach them.

I explore this in greater detail in Chapter 4 of my book, The Billion Dollar Blindspot, where I describe the convergence of three forces: demographics, technology and culture.

Each influences the economics of women’s health. Together, they help explain why opportunities that once seemed difficult to serve are becoming more commercially viable.

Start with demographics. In the United States alone, 73 million Millennial women are now between the ages of twenty-eight and forty-three. Add the older edge of Gen X (women in their late forties and fifties) and you have the largest concentration of women in peak health-need years in modern history. These cohorts are entering their peak earning years precisely when their health needs are intensifying.

Reproductive challenges, perimenopause, menopause, thyroid disorders and autoimmune conditions: many of the most common women’s health issues emerge during the same decades when income, purchasing power and financial decision-making authority are at their highest. The result is a structural convergence: peak health need and peak spending power now occur at the same time.

This generation of women is also behaving differently from past cohorts:

• Higher educational attainment correlates with higher income and stronger expectations around healthcare quality.

• Delayed childbearing compresses reproductive timelines into shorter, more intense windows, increasing urgency and willingness to seek specialised care.

• Digital fluency removes many of the barriers that once slowed the adoption of remote care, diagnostics and digitally delivered services.

At the same time, the concentration of this demographic in professional sectors that provide comprehensive employee benefits creates a parallel demand channel.

Employers have an economic incentive to support services that reduce absenteeism, improve retention and manage long-term healthcare costs. Women’s health solutions are increasingly reaching the market through both employer benefits and direct consumer demand.

These conditions did not exist at scale for previous generations. Earlier cohorts had lower earning power, less decision authority, and healthcare systems built around episodic care rather than long-term management. The demand was always present, but purchasing power and market visibility were more dispersed.

Then there is ageing. I often tell people that much of the developed world is getting older and, at older ages, increasingly female. For me, that opens a much broader discussion about women’s health: what happens to cardiovascular health, bone health, sleep and cognitive function as women move through midlife and beyond?

In short, the demographic need gives businesses addressing these conditions a reason to exist. The next question is whether we now have the scientific understanding and technology to meet it more effectively. That is where the convergence becomes particularly interesting.

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Science and Technology: New Possibilities for Women’s Healthcare

The scientific and technological changes become tangible when you look at what they could make possible for a patient.

Consider a woman in the first trimester of pregnancy. She wants to know whether her pregnancy is progressing well. Her clinician wants to identify risks early enough to intervene. A blood sample that could reveal signs of a complication months before symptoms appear would give that conversation a different starting point.

That is the possibility iPremom is working towards. The company, which raised €15 million in September, analyses cell-free RNA (molecular signals circulating in maternal blood) to assess pregnancy-complication risk from the first trimester. Its platform drew on more than 26,000 samples linked to 10,000 pregnancies, with further validation and regulatory work ahead.

Several developments come together here. Research into pregnancy biology identifies signals worth measuring. Molecular diagnostics allow those signals to be captured in blood. Predictive modelling helps interpret them. The next step is establishing how that information can guide care reliably.

Evvy illustrates another part of this change. It combines vaginal microbiome testing with biological data, machine learning and clinician-directed care. The company reports serving more than 100,000 patients and 3,000 practitioners. Its September $40 million Series B will support further validation of new diagnostic and care models.

Testing generates information about female biology. Linking that information to symptoms and outcomes gives researchers material to investigate. Over time, those findings may help distinguish between conditions or support more targeted treatment. Better understanding can also change how existing treatments are used.

In September, AbbVie reported positive Phase 3 results for atogepant in menstrual migraine. The study evaluated an existing migraine medicine using a regimen timed around menstruation.

Here, the development begins with recognising a particular pattern of disease and studying a treatment approach around it. That opens possibilities within markets that already have clinicians, patients and established medicines. Innovation can involve a new molecule, but it can also come from understanding more precisely when and how a treatment should be used.

Across these examples, scientific understanding is becoming something a company can develop into a test, a service or a treatment approach. Each still has questions to answer. But they show how the convergence described in my book is taking shape in practice.

Culture and Narrative: How Women’s Health Needs are Becoming Visible Demand

For these businesses to grow, women also need to know that a solution exists, trust it enough to try it and have a way to access it.

What is changing now is how readily those needs can be recognised, discussed and connected to potential solutions. This is where the third force, culture and narrative, becomes economically important.

In the book, I describe how digital communities, more open discussion and employer recognition are bringing together experiences that were once largely private.

Symptoms women might previously have struggled to explain are becoming part of a shared conversation. For companies, that makes patterns of demand easier to identify. For women, it can make seeking help feel both more legitimate and more practical.

Think about sleep during the menopausal transition. A woman waking repeatedly through the night can now encounter others describing the same experience, explanations from clinicians and services addressing midlife health. She has more opportunities to connect what she is experiencing with a question she can bring to a healthcare professional.

That changes the starting point for a business offering an effective solution. It may be reaching a woman who already recognises the problem and is actively looking for help. The company still has to earn her trust and demonstrate value but the conversation can begin further along.

Narrative matters here because it shapes what people recognise as a problem worth addressing and how they value the available options. As awareness grows, credible explanations become increasingly important: what does a product actually do, what evidence supports it, and what benefit can someone reasonably expect?

Clear communication can help informed demand grow while challenging the misinformation and exaggerated promises circulating alongside it.This is the cultural change within the convergence.

Demographic trends are concentrating healthcare need and purchasing influence. Science and technology are expanding what companies can deliver. At the same time, women’s experiences are becoming more visible, expectations of care are rising, and businesses have more ways to reach people seeking solutions.

Those changes reinforce one another, improving the conditions for companies to serve needs that have existed for decades.

Where that gives me investment conviction

Looking across those changes, three areas stand out to me: AI-powered prediction and diagnostics, sex-specific therapeutics, and interventions that help women live more years in good health.

They connect directly to the convergence I have described:

• Better biological data and analytical tools create possibilities for earlier, more useful information.

• A more precise understanding of disease creates opportunities for treatments that account for female biology.

• Ageing populations and rising expectations of care create sustained demand for solutions that preserve health and function.

These are the areas where my conviction is strongest, and where we want to build exposure through Calabar Capital.

Conviction in an opportunity still has to translate into an investment decision. We want to understand the evidence, the team’s ability to execute, how the business will reach its customers and what will support its economics as it grows. The price we pay and the capital required to reach the next milestones also matter.

Time is part of that judgement. We are building a ten-year vehicle, so we need a credible path to realising value and returning capital within that horizon.

In my next essay, I’ll explain how we assess opportunities at different levels of maturity (from proven markets to emerging approaches and moonshot ideas) and how we decide what belongs in the portfolio.

For the transactions and developments behind this discussion, you can explore the September Women’s Health Capital Review. The underlying argument about demographics, technology and culture is developed in the book The Billion Dollar Blindspot.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

Order Your Copy

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital, an investment platform backing exceptional managers and founders in women’s health. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

Connect on LinkedIn · Discover the Book · Learn more about Calabar Capital

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

Sources and references

[i] Freddie Mac. “Millennial Household Formation — Potential for Another 2 Million Households.” U.S. Economic, Housing and Mortgage Market Outlook, October 2023, pp. 3–5. Read the report.

[ii] Selfe, Maryann. The Billion Dollar Blindspot, Chapter 4. The discussion of demographics, technology and culture draws on excerpts adapted from the book. Available on Amazon.

[iii] Selfe, Maryann. “Women’s Health Capital Review — September 2026.” The Billion Dollar Blindspot. Source for the finding that diagnostics accounted for the largest number of financings and the most disclosed funding in the September review. Read the review.

[iv] Amadeus Capital Partners. “iPremom raises €15m to transform pregnancy care with molecular diagnostics.” 2 September 2026. Source for the €15 million seed financing and the platform’s development using more than 26,000 samples linked to 10,000 pregnancies. Read the announcement.

[v] Evvy. “Evvy Raises $40M Series B to Scale AI-Powered Precision Diagnostics & Care Platform for Women’s Health.” Business Wire, 15 September 2026. Source for the $40 million Series B and the company-reported figures of more than 100,000 patients and 3,000 practitioners. Read the announcement.

[vi] AbbVie. “AbbVie Extends Migraine Leadership with Positive Phase 3 Atogepant Results in Menstrual Migraine.” 10 September 2026. Source for the Phase 3 LUNA results and the treatment regimen timed around menstruation. Read the announcement.

A woman I once admired had died shortly after undergoing surgery for fibroids. So decades later, when I received the same diagnosis, the word carried more than its clinical meaning. It carried a memory. I wanted to understand my options, and that search sent me down a rabbit hole that yielded more questions than answers.

Many years later, I discovered Sonata, an incision-free treatment that uses radiofrequency energy to treat certain fibroids. The procedure was developed by Gynesonics.

Learning that an alternative existed was reassuring. But it also raised a more troubling question: why had it been so difficult to find?

As I looked more closely at Gynesonics, I began to understand how long and uncertain the journey from healthcare innovation to patient can be. A company can develop a useful technology, produce strong clinical evidence and secure regulatory approval and still struggle to attract investors, gain adoption among clinicians and reach the patients who might benefit.

The problem was not simply whether better treatments could be invented. It was whether the companies building them could obtain the capital, commercial support and distribution required to survive.

I began to realise that this was also a story about how healthcare innovation is financed. That realisation eventually led me to write The Billion Dollar Blindspot.

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While researching the book, I encountered company after company addressing a different part of the same problem.

Some were trying to shorten the years women waited for a diagnosis. Others were developing treatments for conditions that affected millions of women but had attracted limited research and investment. Some were revisiting diseases in which differences between women and men had been poorly understood. Others had already built products that worked but were struggling to change established clinical practice.

Women’s health was frequently described as underfunded. That was true but it was incomplete. Underfunding described what had happened. It did not tell an investor what was becoming possible or how to participate in it.

Today, women’s health is already a substantial commercial market. PwC estimates that core women’s health and major adjacent conditions represent a global market of approximately $420–470 billion, projected to exceed $600 billion by 2030.

The opportunity extends far beyond fertility and maternal health. It includes conditions unique to women, conditions that affect women disproportionately and conditions that present differently in women. That means looking not only at fibroids, endometriosis, fertility and menopause, but also at cardiovascular disease, autoimmune disorders, migraine, metabolic disease, osteoporosis, dementia and other areas in which sex-specific differences matter.

At the same time, advances in diagnostics, medical devices, drug discovery, data and artificial intelligence are changing what can be detected, treated and delivered.

The gaps remain real. But those gaps are increasingly producing companies with real products, clinical evidence, intellectual property and commercial potential.

Once I became convinced that something important was happening in women’s health, I could not stop at saying that the sector deserved more capital.

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I have spent more than 20 years making investment and allocation decisions. During that time, I have assessed more than 1,000 managers and fund opportunities and sponsored more than 90 allocations across public and private markets.

Early in my career at Credit Suisse, I helped build a manager-selection and due-diligence framework that supported allocations to hedge funds, mutual funds and private-market funds. I did not know then how severely that framework would be tested during the 2008 global financial crisis.

The framework held up and I went on to evaluate managers and companies within Credit Suisse’s approximately $100 billion multi-asset-class platform and to structure investment solutions for high-net-worth individuals, family offices and institutional investors.

So as I looked at the women’s health opportunity, the allocator in me began asking a different set of questions.

• Should an investor back individual companies, specialist venture funds or some combination of the two?

• In a world where the top ~5% of investments drive ~90% of returns and in a world where at the earlier stages (until around Series B) the good companies look a lot like the bad ones, how do you build a portfolio that makes sense?

• How many underlying companies would be needed before the portfolio was genuinely diversified and where should an investor accept concentration because it reflects genuine conviction, and where does concentration simply create avoidable risk?

• How should exposure be spread across diseases, technologies, scientific disciplines, company stages, regulatory pathways and geographies?

They also became the questions at the heart of the firm we are building.

For the past several months, I have been quietly building Calabar Capital.

Calabar is based on a simple observation: many of the companies shaping the future of women’s health are being built in private markets, but access to them is fragmented.

The relevant companies sit across different clinical disciplines, technologies, stages and geographies. The managers with the deepest access to those companies are similarly dispersed. Even a sophisticated investor would struggle to capture representative opportunity through one direct investment or one venture fund.

Calabar is therefore being designed as a platform that offers access to specialist fund managers, direct co-investments and secondaries from early stage through to pre-IPO. Our focus is women’s health and the healthcare AI and technology infrastructure enabling its development and delivery.

Calabar is currently in formation and we are building it with the same disciplines I used when underwriting another institutional platform: a defined investment process, independent challenge, appropriate governance and an operating structure designed for long-term stewardship.

For me, Calabar is a natural continuation of the work I have done throughout my career: translating complex investment opportunities into structures that sophisticated investors can actually access.

This new chapter will also shape what I write. Here at The Billion Dollar Blindspot, I will continue to write about what is changing in women’s health and why it matters. In my sister publication, Diary of an Allocator, I will write from the other side of the table. It will contain observations from my work of allocating capital over 20 years: what allocators look for when assessing managers, prepare for due diligence and consider an allocation.

Diary of an Allocator

Allocating capital at the intersection of women’s health, emerging managers and venture capital.

By Maryann Selfe

Diary of an Allocator will make more of that thinking visible alongside some field notes from my current work at Calabar Capital.

The personal question that began this journey “what options are available to women like me?” eventually became an investment question: “how should capital be allocated to the companies and managers capable of creating better options?

That is the question I am now working to answer through Calabar Capital.

If you want to follow the companies, technologies and market shifts changing women’s health, subscribe to The Billion Dollar Blindspot.

If you want to follow the allocator’s work behind the capital (manager selection, due diligence, portfolio construction, access and the decisions made when the evidence is still incomplete) follow Diary of an Allocator.

If you are an institutional investor or family office considering the role that women’s health and healthcare technology could play in your private-markets portfolio, I’d love to have a conversation.

And if you are a venture manager investing in these areas, I would also love to understand what you are building. Just hit reply.

My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.

Order Your Copy

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.

Connect on LinkedIn · Discover the Book · Learn more about Calabar Capital

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

But there is another challenge that is much harder to solve: healthcare is a system of incentives, and even great ideas have to operate within it.

In a recent episode of Blindspot Capital, I sat down with Halle Tecco, one of the pioneers of digital health investing, co-founder of Rock Health, founder of Natalist, co-founder and Chair of Cofertility, and author of Massively Better Healthcare.

Halle has seen healthcare innovation from almost every angle: as an investor, founder, operator, board member and educator. And what makes her perspective particularly interesting is how much her experience building companies changed the way she thinks about investing in them.

Our conversation explored a deceptively simple question: what actually separates healthcare companies that scale from those that don’t? The answer is not simply better technology or more capital.

It starts with understanding the problem deeply enough to build for the healthcare system that actually exists (its incentives, reimbursement structures, workflows, stakeholders and constraints) rather than the system we wish existed.

And for investors, that has important implications for how we evaluate healthcare businesses.

We talk about:

• Problem before product: why the strongest healthcare companies start by becoming deeply embedded in the problem rather than searching for healthcare applications for new technology

• What venture capital changes: why taking VC funding fundamentally changes the growth expectations, time horizon and eventual destination of a company

• Aligning margin with mission: how business models can reward better outcomes rather than simply more activity and why incentive design matters in healthcare

• Why good companies still fail: the role of founder adaptability, market timing, capital, changing conditions and luck and why failure does not necessarily mean the underlying idea was poor

• What operating teaches investors: why Halle says building and running a company gave her a very different appreciation for the difficulty founders face

• Where healthcare opportunity is moving: why Halle is watching full-stack healthcare services businesses using AI and other technologies to deliver better services and outcomes, rather than simply selling another software tool

Perhaps the most important idea from the conversation is that healthcare does not change simply because a better technology arrives. Systems produce the outcomes their incentives encourage.

For founders and investors, understanding those incentives may be just as important as understanding the innovation itself.

🎧 Watch the full episode on YouTube

1. New estrogen data reopen an important question about menopause and brain health

A new study published in Neurology examined data from 21,462 women and found that estrogen-only hormone therapy use was associated with lower rates of dementia and less Alzheimer’s-related pathology.

Among women whose brains were examined after death, hormone-therapy use was associated with 35% lower odds of Alzheimer’s pathology after adjustment for factors including age, education, genetics, race and hypertension. It was also associated with 39% lower odds of a clinical dementia diagnosis.

But the findings need substantial qualification.

This was an observational study, so it cannot establish that estrogen prevented dementia. More importantly, women in the study who had used estrogen began treatment at an average age above 70, which is very different from modern menopause practice, where hormone therapy is generally initiated much earlier.

The researchers themselves caution that the findings may therefore not translate directly to women using hormone therapy today. Read More

What I find Interesting

What I find interesting here is how much we still don’t understand about estrogen and the ageing female brain.

Women account for a disproportionate share of Alzheimer’s disease, and menopause represents one of the most significant biological transitions in a woman’s life. Yet the relationship between declining estrogen, hormone therapy and long-term cognitive health remains remarkably difficult to pin down.

This study adds another piece to that puzzle, but it doesn’t resolve it. In fact, the age of the women taking estrogen makes the finding particularly interesting. If estrogen use beginning much later in life is associated with lower Alzheimer’s pathology, what exactly are we observing? Is there a biological effect from estrogen itself? Are there characteristics of women who received estrogen that aren’t fully captured by the analysis? And would we see the same relationship in women starting hormone therapy around menopause today?

Those questions matter because there is a danger of moving too quickly from an association like this to a much more attractive conclusion: that estrogen might protect women against dementia. We simply don’t know that yet.

But I don’t think the appropriate response to uncertainty is to dismiss the finding either. It is to recognise how important the unanswered question is.

We have become much better at thinking about menopause in relation to symptoms, bone health and cardiovascular health. Brain health may ultimately prove to be another important part of that picture, but the science still has some catching up to do.

For me, that is the signal here - a major area of women’s health where the biology is important, the patient population is enormous, and still, some very fundamental questions remain unanswered.

Maryann Selfe is an institutional investor, Founder and CIO of Calabar Capital, and author of The Billion Dollar Blindspot.

Research · The book · About Maryann

For informational and educational purposes only. This is not financial advice or an investment recommendation.

1. Early menopause plus social disadvantage appears to compound long-term health risk

New research published online today in Menopause, the journal of The Menopause Society, suggests that social disadvantage is associated with significantly worse long-term health outcomes among women experiencing early natural menopause.

Researchers analysed 19,912 women with early natural menopause in UK Biobank, with mortality findings externally validated using US NHANES data.

Women in the most disadvantaged group had higher observed risks of all-cause mortality, cardiovascular disease and dementia than those in the most advantaged group. Among the individual social factors examined, unemployment showed the strongest association with mortality and dementia.

Importantly, this is observational research. It identifies associations; it does not establish that social disadvantage (or any individual factor such as unemployment) causes these outcomes.

Read More — The Menopause Society

What I find Interesting

What I find interesting about this research is the interaction between biology and environment. Early menopause is already associated with higher long-term health risks. This study suggests that those risks don’t exist in isolation: the social and economic circumstances surrounding a woman may meaningfully influence the trajectory that follows.

For me, that raises a much broader question about how we think about women’s health. We tend to separate biological risk, clinical care and social determinants into different buckets. But the patient experiences all three at the same time. The opportunity may therefore be in understanding how those factors interact well enough to identify which women need earlier or different intervention.

There is still a lot we don’t know. This is observational research, and social disadvantage is associated with poorer health outcomes more broadly. But if combining reproductive history with other risk factors improves our ability to identify women at elevated cardiovascular or cognitive risk, that could eventually have implications for screening, prevention and care pathways.

2. AbCellera’s menopause data show the category becoming a real pharmaceutical market

AbCellera has reported positive Phase 2 results for ABCL635, its experimental non-hormonal treatment for moderate-to-severe vasomotor symptoms associated with menopause.

In the 92-patient trial, women receiving ABCL635 experienced an 83% reduction in moderate-to-severe hot-flush frequency after four weeks, compared with 33% for placebo. The placebo-adjusted reduction was 5.3 hot flushes per day. AbCellera shares rose sharply following the announcement.

ABCL635 targets the neurokinin 3 receptor (NK3R), part of the same biological pathway that has already produced approved non-hormonal menopause therapies from Astellas and Bayer.

But there is an important difference in how AbCellera is approaching the market. While existing therapies are oral medicines taken daily, ABCL635 is a long-acting antibody being developed as a once-monthly injection. Read More

What I find Interesting

What I find interesting here is that we are beginning to see something that women’s health has historically had too little of: genuine pharmaceutical competition.

For decades, the menopause treatment conversation was largely framed around hormone therapy: whether women should take it, who should take it and what the risks were.

We are now beginning to see a much broader therapeutic market emerge, with multiple companies targeting the neurokinin pathway and competing not simply on whether they can treat hot flushes, but potentially on efficacy, tolerability, convenience and how the treatment is delivered.

That changes the investment question. Once several drugs can address the same problem, scientific novelty alone becomes less important. What matters is whether a new entrant can create a sufficiently differentiated product profile to change physician prescribing or patient preference.

ABCL635’s once-monthly injection is particularly interesting in that context. Some women may prefer the convenience of monthly dosing; others may strongly prefer a tablet. We don’t know yet how that trade-off will play out commercially, and cross-trial efficacy comparisons need to be treated carefully. But the bigger signal for me is the evolution of the category itself.

Menopause therapeutics are beginning to look less like an underserved niche and more like a competitive pharmaceutical market. And when that happens, the question moves from “Is there a market?” to the much more interesting question: “Who is going to win it, and why?”

3. Private biotech M&A is accelerating and it isn't just a few mega-deals

Jazz Pharmaceuticals has agreed to acquire privately held Actio Biosciences for up to USD 1.32 billion, comprising USD 820 million upfront and up to USD 500 million in potential milestone payments.

Actio is developing treatments for genetically defined neurological diseases. Its lead clinical programme, ABS-1230, targets KCNT1-related epilepsy, a rare and severe genetic epilepsy for which there is currently no approved disease-specific therapy.

The Jazz transaction is interesting on its own. But the broader private-biotech M&A data make it considerably more interesting. According to HSBC Innovation Banking data reported by BioPharma Dive, there were 19 acquisitions of private venture-backed biotechs in the first half of 2026 - already more than the number recorded in the entirety of each of the previous five years.

And it isn’t just deal volume. The median value of those acquisitions reached approximately USD 950 million, around three times the levels seen in the early 2020s.

What I find Interesting

What I find interesting is that here is what this is beginning to tell us about the exit environment. There are several possible reasons. Big Pharma has significant revenue approaching patent expiry and needs to replenish pipelines. Some therapeutic areas have a relatively limited number of differentiated clinical assets. And acquiring companies privately may allow strategic buyers to secure those assets before they reach later stages of development.

I don’t think we can say yet which of those forces is doing most of the work. But from a venture perspective, the direction is important.

If private companies can increasingly find strategic buyers before requiring an IPO, and if both the frequency and value of those exits are improving, that potentially changes the economics of the entire venture pathway.

1. Women’s health investment hit a record but Series A remains the bottleneck

Women’s health companies attracted a record USD 1.55 billion of disclosed equity investment in 2025, up 41% from USD 1.1 billion in 2024, according to W Group’s first Global Women’s Health Investment Report. The capital was spread across 85 companies and more than 30 countries.

But there is a more interesting number underneath the headline.

Around 35–40 women’s health companies raise pre-seed or seed rounds each year, while only 20–25 progress to Series A. So while more capital is entering the sector, there remains a visible financing bottleneck between early validation and institutional scale. Read More

What I find Interesting

The USD 1.55 billion headline is encouraging. Regarding the drop from seed to Series A, I’d love to offer a nuanced view and somewhat controversial opinion. Not every seed company should raise a Series A. Venture capital is supposed to be selective.

The question I am keen to understand is simple:

Are good women’s health companies that have achieved the milestones we would normally expect at Series A struggling to raise capital at a higher rate than comparable healthcare companies? If the answer is yes, we have a financing gap.

If the answer is no, what we may actually be seeing is something else: company formation in women’s health growing faster than the number of companies ready for institutional capital.

Those are two very different diagnoses and they require very different solutions.

2. Another USD 100 million flows into AI-enabled drug discovery

Aureka Biotechnologies announced a USD 100 million Series B yesterday, bringing the company’s total funding to nearly USD 200 million.

Aureka combines AI with high-throughput biological experimentation to discover protein therapeutics and describes its ambition as building a “biological world model” for drug discovery.

The distinction here is important: this is not simply a software company applying AI to existing biological data. Aureka combines computational models with its own experimental infrastructure and data generation.

What I find Interesting

There is so much capital going into AI drug discovery that I increasingly think the question “How good is the AI?” is the wrong first question.

Nowadays, even asking whether the company has proprietary data may not be enough. I think the real question is whether that proprietary system produces better drugs, faster or with a higher probability of success.

A closed-loop wet lab, proprietary biological data and an AI model may be difficult to replicate. But complexity isn’t the same thing as competitive advantage.

Eventually the platform has to demonstrate that it changes the economics of drug discovery.

Does it improve hit rates? Reduce optimisation cycles? Identify targets others miss? Increase the probability that a molecule survives the clinic?

And then there is another question I find particularly interesting: if the system discovers a successful drug, where does the value actually sit? in the platform or in the molecule? That distinction matters enormously when deciding whether an AI drug-discovery company deserves a platform valuation.

3. The FDA rejected a promising radiopharmaceutical because of manufacturing

The FDA has issued ITM Isotope Technologies Munich a Complete Response Letter for ¹⁷⁷Lu-edotreotide (ITM-11), its investigational radiopharmaceutical treatment for gastroenteropancreatic neuroendocrine tumours.

What makes the rejection particularly interesting is what the FDA didn’t object to.

The agency identified no concerns with the clinical or nonclinical data package or the therapy’s safety profile. Instead, it cited Chemistry, Manufacturing and Controls (CMC) issues and matters relating to a third-party commercial manufacturing facility that must be addressed before approval.

That is notable because the Phase 3 COMPETE trial had reported median progression-free survival of 23.9 months with ¹⁷⁷Lu-edotreotide versus 14.1 months with everolimus. Read More.

What I find Interesting

We tend to think about biotech risk in terms of the science: Does the drug work? Is it safe? Will the trial succeed? Well…here, apparently, the clinical package wasn’t the problem. It was manufacturing.

That is a risk. But I think there is another way to look at it.

The thing that makes a modality difficult to manufacture can also be the thing that makes a successful company difficult to compete with.

Radiopharmaceuticals require isotope supply, specialised facilities, quality systems and time-sensitive logistics. Those look like operational complications when they go wrong. When they work, they can become infrastructure competitors cannot easily reproduce.

So “Can this drug be manufactured reliably at scale?” isn’t simply a diligence question. It may be part of the moat.

The investment question therefore becomes not only whether management has solved the manufacturing problem, but whether solving it creates an advantage that compounds across the rest of the pipeline.

4. Menopause is moving into neurology but the evidence is still remarkably thin

A new roadmap published yesterday in Nature Reviews Neurology argues that menopause remains significantly under-recognised as a contributor to brain health and that our understanding of how the menopausal transition interacts with neurological disease remains limited.

Earlier menopause has been associated with a greater risk of cognitive decline, but researchers say it remains unclear how the menopausal transition affects the subsequent risk or progression of specific neurological conditions.

The authors identify major gaps in research and call for greater investigation into the relationship between menopause, the brain and neurological disease. Read More

What I find Interesting

The more we learn about menopause, the clearer it becomes that its effects extend well beyond hot flushes and reproductive symptoms. But I think investors need to be careful with the next leap.

A biological relationship does not automatically create an investment category. If menopause is associated with changes in neurological risk, I want to know what that knowledge allows us to do differently.

Can we identify a subgroup of women earlier?

Does it change how a disease is diagnosed?

Does it reveal a therapeutic target?

Does treatment during the menopausal transition alter the subsequent neurological outcome?

Until we can answer questions like those, we may have important science without an investable intervention. And I think that distinction is particularly important in women’s health right now.

5. Healthcare outperformed again but I wouldn't make the Fed the investment thesis

Healthcare had another strong session yesterday.

The Health Care Select Sector SPDR Fund (XLV) closed 1.67% higher, while the iShares Biotechnology ETF (IBB) also advanced.

What I find Interesting

That continues the healthcare rotation we have been watching over recent weeks, alongside stronger biotech financing, increased M&A activity and improving investor appetite for the sector.

The next major macro test comes tomorrow with US inflation data, which will influence expectations for the Federal Reserve and, by extension, the discount-rate environment facing long-duration assets such as biotechnology.

Three developments I’m watching today: new ovarian-cancer biology, almost USD 500 million raised through two biotech IPOs, and Big Pharma’s increasingly urgent search for pipeline assets.

1. New ovarian-cancer research points to what happens after chemotherapy

A new study in Nature Aging has identified a potentially important mechanism in the way ovarian cancer spreads following chemotherapy.

Researchers found that chemotherapy-induced senescent ovarian-cancer cells can release metabolic signals (including fructose) that appear to reduce cell adhesion and make neighbouring cancer cells more capable of detaching and spreading.

In preclinical models, a high-fructose diet was also associated with greater tumour dissemination. However, this is early research so it’s too early to conclude that dietary fructose causes ovarian-cancer progression in women.

What I find Interesting

A lot of focus when it comes to cancer therapeutics is whether a cancer treatment kills the tumour. But this research raises another question that I find fascinating: “What biological environment does treatment leave behind?”

If chemotherapy kills cancer cells but also changes the surrounding environment in ways that help surviving cells disseminate, then the effect of treatment doesn’t necessarily end when the chemotherapy does.

Now, this is preclinical research so we are a long way from knowing whether this mechanism matters sufficiently in humans to become a therapeutic target. But conceptually, it changes the question from simply: “Did the treatment kill the cancer?” to: “What did the treatment do to the biology of what survived?” That is a much more interesting question.

2. Two biotech IPOs just raised about $500 million

Latigo Biotherapeutics and BlossomHill Therapeutics completed US IPOs on Friday, raising approximately USD 496 million between them. Latigo raised USD 345.6 million after selling 19.2 million shares at USD 18. BlossomHill raised another USD 150 million. Both offerings were upsized.

Latigo is developing non-opioid pain medicines targeting sodium channels. BlossomHill is developing oncology therapies and expects to allocate around $70 million of its proceeds to its lead EGFR programme. Read More

What I find Interesting

The fact that biotech stocks are rising is interesting but the fact that companies can actually raise hundreds of millions of dollars in the public market much more interesting. Because this is where market sentiment starts becoming financing infrastructure.

But I would be careful with the conclusion. The IPO window is opening but is not open to everyone. In the first half of 2026, 68 venture-backed biotechs raised more than $9 billion. That sounds great until you see that roughly two-thirds of those rounds went to companies that already had drugs in human trials, and 76% of the capital went into rounds of $100 million or more.

So capital is returning, but it isn’t returning equally and I think that’s the more interesting signal. Investors are still willing to take extraordinary risk in biotech. What they appear less willing to do is finance too many layers of uncertainty simultaneously.

3. Big Pharma's patent cliff is becoming biotech's M&A opportunity

Biopharma acquisition activity is running at one of its strongest rates in years. By midyear, 38 biotech acquisitions had already been announced (the fastest start in at least seven years) and almost two-thirds were worth $1 billion or more.

Behind that activity sits a very large problem for the pharmaceutical industry. Drugs generating an estimated $200–300 billion of revenue are expected to lose patent protection by 2030. Big Pharma needs replacement assets and increasingly, it is buying them.

What I find Interesting

Pharma has always bought innovation so the interesting thing isn’t that Big Pharma is acquiring biotech. It is the urgency with which some of those buyers may need to acquire it.

Patent cliffs are unusual because the problem is both enormous and reasonably predictable. Management teams know which products lose exclusivity and when. They know roughly how much revenue is exposed and they know their internal pipelines.

Which makes me wonder whether the most important consequence for venture investors is strategic scarcity for the right asset: If several pharmaceutical companies need to fill similar pipeline gaps at roughly the same time, a genuinely differentiated clinical asset could become worth considerably more to a strategic buyer than its standalone financial value might suggest… just some food for thought!

1. Women’s health raised more than $120 million across 17 disclosed rounds in July

A newly published funding roundup by Everything Startups identified more than $120 million of disclosed financing across 17 women’s-health startups in July, spanning the US, UK, Germany, Estonia, Canada and India. The largest disclosed round was Rejoni’s $25 million financing for its Juveena Hydrogel System, designed to prevent intrauterine adhesions following gynaecological procedures. Read More

What I find Interesting

What I find quite interesting is the mix. Diagnostics and monitoring were particularly active, while the largest disclosed round (Rejoni’s $25 million financing) was for a medical device designed to prevent intrauterine adhesions following gynaecological procedures.

This is what the institutionalisation of women’s health looks like. For years, the category was disproportionately associated with fertility apps and consumer products but that is changing. We are beginning to see an investable ecosystem across therapeutics, diagnostics, medical devices, clinical infrastructure and enabling technologies.

This matters for investors because it changes the portfolio-construction question. You can increasingly diversify a women’s-health portfolio not just across diseases, but across business models, technologies, development stages and types of risk.

2. Grail is about to test one of the biggest assumptions in cancer diagnostics

The FDA will convene an external advisory committee on 23 September to consider Grail’s premarket approval application for Galleri, its multi-cancer early-detection blood test. Grail shares rose about 5% after the meeting was announced. Galleri uses molecular signals and machine learning to screen a single blood sample for signals associated with more than 50 cancers.

What I find Interesting

Multi-cancer early detection could create an entirely new screening category. The potential opportunity could be enormous because if we see widespread adoption, this could change how asymptomatic populations enter the cancer-care system but… (and this is a big but), the evidence is complicated.

In a major UK trial, Galleri failed its primary endpoint of significantly reducing overall late-stage cancer diagnoses, although some secondary results were encouraging (by the third screening round, stage IV diagnoses for 12 particularly deadly cancers were 26% lower).

But here is an uncomfortable question at the heart of the diagnostics boom (and not necessarily related to Galleri): What if finding more disease doesn’t actually improve health? The investment case begins when earlier detection changes what happens next; for example:

• Can we treat the cancer differently?

• Does the patient live longer?

• Do we avoid more harm than we create through false positives, unnecessary investigations and overdiagnosis?

• And ultimately: will the healthcare system pay for it?

In diagnostics, outcomes create the market, and that distinction is going to separate some very impressive technologies from some very valuable companies.

3. The “picks and shovels” healthcare thesis has a blind spot

Oxford Biomedica fell more than 24% on Friday after cutting its 2026 revenue forecast because of operational delays and customers postponing programmes.

This came despite what looked like improving fundamentals: 2025 revenue had increased 31%, the company achieved its first positive operating EBITDA and contracted backlog had reached £204 million.

What I find Interesting

I like the “picks and shovels” thesis in healthcare, you know, the CDMOs, CROs, diagnostic infrastructure and specialist manufacturers because they diversify individual drug-development risk.

But there is a blind spot in it. We often say infrastructure is attractive because you don’t have to pick the winning drug. True…but risk doesn’t disappear. It moves.

• From clinical risk to utilisation risk.

• From molecule risk to customer concentration.

• From trial failure to programme delays.

Oxford Biomedica can have a £204 million backlog on paper. But if the biotech company behind that order delays its programme because its financing hasn’t closed, the manufacturer’s revenue moves with it. So I increasingly ask a different question when looking at healthcare infrastructure: “What has to go right for that backlog to become revenue?” The answer tells you where the risk really sits.

4. Healthcare AI has an 8,500-trial reality check

A large analysis examined 8,532 AI-related clinical trials across 32 medical specialties.

• Only around 30% used randomised controlled designs.

• Approximately 38% remained retrospective validation studies,

• while another 21% were prospective but did not allow the AI to influence clinical decisions.

Only 184 trials involved semi-autonomous or closed-loop systems.

What I find Interesting

8,532 AI clinical trials sounds impressive until you look under the hood of that number;

• A large proportion are still retrospective (meaning the AI is being tested on data that already existed, rather than being used with real patients as care is happening)

• Many prospective studies don’t allow the AI to influence the clinical decision.

• Only a tiny fraction involve semi-autonomous or closed-loop systems.

And that tells us something important about healthcare AI. The hard part isn’t getting an algorithm to predict something. The hard part is getting a clinician to trust it enough to act differently, and then proving that acting differently makes the patient better. So this is increasingly how I think about healthcare AI:

Algorithm → validation → workflow → decision → outcome → reimbursement.

Every step removes another layer of risk and, in my view, every step should earn another layer of valuation.

There are thousands of healthcare AI companies but far fewer have crossed the distance between prediction and clinical consequence. That distance is where the investment opportunity sits.

5. Biotech is starting to behave as though the capital cycle is turning

Biotechnology outperformed again on Friday. IBB gained roughly 2.45%, XBI approximately 1.83%, versus about 0.59% for the S&P 500.

The move followed surprisingly weak US employment data, which reduced expectations of another Federal Reserve rate increase. The next major test is US inflation data.

What I find Interesting

I wouldn’t say biotech is back (or at least not yet) but something more interesting may be happening. The transmission mechanism that finances biotech is beginning to reconnect.

• Public valuations are recovering.

• The IPO window is opening selectively.

• Pharma has a very real pipeline problem, with patent cliffs forcing strategic buyers back into M&A.

• And weaker employment data may finally be taking some pressure off the cost of capital.

But these are not the same signal. A biotech ETF rally doesn’t mean an early-stage company can raise its next round and a handful of successful IPOs doesn’t mean the IPO market is open to everyone. And (seriously), pharma buying assets because it needs to replace lost revenue tells us more about pharma’s balance sheet than it does about venture fundraising. The question is whether these separate developments begin to feed into one another.

M&A creates exits. Exits create distributions. Distributions improve venture fund DPI. Better DPI gives LPs a reason (and the all-very-important liquidity) to recommit. And eventually, that capital finds its way back to the companies at the beginning of the cycle.

That is the part I’m watching. Because a good week for biotech stocks is interesting but a functioning transmission mechanism from public markets back into venture capital is something much bigger (and more interesting).

But this week, I am making an exception. The minute I read the Novo Nordisk announcement, I knew I was going to be clearing my calendar to unpack it. So here we go! I’ll give you the facts first and then get to my opinion later.

On July 31, Novo Nordisk announced that Ziltivekimab (I know its a mouthful but please bear with me), a drug it paid up to USD 2.8 billion to acquire, had failed a major clinical trial.

The trial was called ZEUS and it included 6,376 people with heart disease, kidney disease and high levels of inflammation. Half of the people received Ziltivekimab. The other half received a placebo. Researchers followed them for up to four years.

But lets talk about Ziltivekimab for a minute.

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Ziltivekimab was designed to block IL-6, a protein that helps to drive inflammation in the body. This matters because inflammation can make the fatty plaques inside the arteries unstable and if one of those plaques breaks open, it can create a blood clot that causes a heart attack or stroke.

IL-6 is one of the proteins that drives this inflammatory process and when IL-6 activates the liver, the liver produces CRP (C-reactive protein). People with high hsCRP (high sensitivity C-reactive protein) levels tend to have a greater risk of heart attack and stroke, even when their cholesterol is normal.

Novo’s theory was straightforward: blocking the IL-6 inflammatory pathway would make dangerous cardiovascular events less likely.

There were good reasons to test the theory. Genetic studies had linked IL-6 signalling to coronary heart disease. An earlier trial of a different anti-inflammatory drug had reduced cardiovascular events, and in a smaller study called RESCUE, Ziltivekimab had lowered hsCRP and several other inflammatory markers by remarkable amounts.

The ZEUS trial was designed to answer the next (and much more important) question: would those biological changes actually prevent heart attacks and strokes?

The drug succeeded at the first part re - biological changes. It reduced hsCRP by as much as 92%. But regarding the second and more important part of the question re - prevent heart attacks and strokes, the results were clear. That dramatic reduction in hsCRP did not lead to fewer heart attacks, strokes or cardiovascular deaths. The results were almost identical in the drug and placebo groups.

Why the failure hit Novo so hard

For Novo Nordisk, the financial consequences were immediate. The company said it would record an impairment charge in the third quarter (basically write down the value of the asset), and its shares fell by close to 10%.

But the market reaction was about more than one failed drug. This was an important opportunity for Novo outside of its obesity and diabetes business. So investors were doing two things:

First, they were repricing their expectations for potential future revenues from Ziltivekimab and Novo’s growth trajectory. And second, they were also treating the results from ZEUS as evidence against the broader biological approach. This explains why companies like BioAge Labs who is pursuing a related inflammatory mechanism, lost 65% of its value in one day.

That broader conclusion (about the biological approach of this class of drugs) may eventually prove correct. But one detail deserves closer attention.

Only 27.5% of the people in ZEUS were women. Heart disease is the leading cause of death among women worldwide. Yet a trial now influencing how investors value a multibillion-dollar area of drug development was conducted in a population that was almost three-quarters male.

That figure is striking, but please allow me to add some context.

ZEUS did not study everyone with heart disease. It studied a narrower population with atherosclerotic cardiovascular disease, chronic kidney disease and elevated inflammation. In a recent real-world study of a similar population, women represented 25.9% of participants.

So the 27.5% figure does not prove, by itself, that ZEUS enrolled too few women relative to the population eligible for the drug but it does fit a much broader pattern in cardiovascular research.

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This is the pattern not the exception

A 2025 review examined 1,079 cardiovascular trials conducted between 2017 and 2023. Together, those trials included almost 1.4 million patients and women represented 41% of participants.

But even that figure hides the scale of the problem. Some types of trials, including those involving obesity and pulmonary hypertension, enrolled more women than men. But trials for some of the deadliest forms of heart disease included far fewer women:

• Women represented only about 30.8% of participants in coronary heart disease trials.

• They represented roughly 22.1% in trials for acute coronary syndrome

• and heart failure trials were not much better with 37.4% female representation.

So, this is the pattern and clearly not a new problem. One study examined 60 trials of cholesterol-lowering drugs conducted between 1990 and 2018. The results are stark: in the early 1990s, women represented 19.5% of participants. By 2018, that percentage had risen to 33.6%.

Even government-funded trials show how headline numbers can hide the problem. One study examined cardiovascular trials funded by the US National Heart, Lung, and Blood Institute between 1965 and 1998. At first sight, women represented 54% of participants in trials. But that figure was pushed up by two enormous studies that enrolled only women: the Women’s Health Study and the Women’s Health Initiative. When researchers removed those two all-female studies, female participation in clinical trials actually fell to 38%.

ZEUS did not break the pattern. But whether women were underrepresented relative to its specific eligible population is a separate question.

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Why ZEUS does (and does not) tell us

ZEUS was designed to test whether Ziltivekimab reduced cardiovascular events across all 6,376 participants. Meaning the trial was large enough to detect a 20% reduction in risk if it showed up. The result was clear: the drug did not reduce cardiovascular events across the overall trial population.

That conclusion includes the women enrolled in ZEUS. It would therefore be wrong to say that the drug was not tested in women. But the topline result does not answer a different question: did women and men respond differently?

Approximately 1,750 women participated. Whether that produces a meaningful result depends on the number of events among women, the hazard ratio, the confidence interval and whether there was a credible interaction between sex and treatment. Novo has not yet published those details.

This means we do not yet know whether the negative result was entirely consistent across women and men. And even if a more favourable result appeared in one subgroup, it would need to be treated cautiously because ZEUS failed its primary endpoint (but that’s another point).

What this means for investors

or investors, three lessons stand out.

First, ZEUS provides strong negative evidence against ziltivekimab in the population studied. It is reasonable to reduce the value assigned to the drug and weaken confidence in the mechanism.

But deciding that the same conclusion applies to every patient group, clinical setting and related drug is a broader investment judgement. That should be informed by the full results and not only the headline.

Second, trial demographics are investment information, but percentages cannot be interpreted in isolation. Investors need to compare trial participants with the population that would actually be eligible for the treatment. They also need to understand whether the trial was designed to examine differences between women and men.

The drug failed overall and that is clear. Perhaps the real investment question is how much further that conclusion should travel.

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References

1. Swerdlow DI, Holmes MV, Kuchenbaecker KB, et al. “The interleukin-6 receptor as a target for prevention of coronary heart disease: a Mendelian randomisation analysis.” The Lancet. 2012;379(9822):1214–1224. Full text | DOI

2. Ridker PM, Everett BM, Thuren T, et al. “Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease.” New England Journal of Medicine. 2017;377:1119–1131. PubMed | DOI

3. Ridker PM, Devalaraja M, Baeres FMM, et al. “IL-6 inhibition with ziltivekimab in patients at high atherosclerotic risk (RESCUE): a double-blind, randomised, placebo-controlled, phase 2 trial.” The Lancet. 2021;397(10289):2060–2069. PubMed | DOI

4. Rivera FB, Magalong JV, Bantayan NRB, et al. “Participation of Women in Cardiovascular Trials From 2017 to 2023: A Systematic Review.” JAMA Network Open. 2025;8(8):e2529104. Full article | Open-access version | DOI

5. Khan SU, Khan MZ, Raghu Subramanian C, et al. “Participation of Women and Older Participants in Randomized Clinical Trials of Lipid-Lowering Therapies: A Systematic Review.” JAMA Network Open. 2020;3(5):e205202.
   Full article | Open-access version | DOI

6. Kim ESH, Carrigan TP, Menon V. “Enrollment of Women in National Heart, Lung, and Blood Institute-Funded Cardiovascular Randomized Controlled Trials Fails to Meet Current Federal Mandates for Inclusion.” Journal of the American College of Cardiology. 2008;52(8):672–673. PubMed | DOI

Disclaimer & Disclosure

This content is for informational and educational purposes only.

“Why do we wait until adulthood to fix what could have been prevented by the first 1,000 days of nutrition?

Yes, it was a question about infant nutrition that sent her down the rabbit hole but it was also a question about maternal health, biotechnology, and an industry that had prematurely settled for “good enough”. Your messages to me in response to that story told me that you loved that story.

Then I asked Bonnie Marcus to talk about ambition, age and what it means to continue navigating the workplace as a woman over 50….and you responded again

And then, two weeks ago, Professor Sandra Kooij shared her work on ADHD in women and how hard it is to get funding and attention to something that affects so many lives, you wanted more of that too.

On the face of it, these three articles don’t have much in common: infant nutrition, workplace ambition after 50, an under-funded slice of women’s health. But look closer and there is a pattern.

Each one takes you behind the headline and introduces you to the person and the work: what they’ve seen, what they’re trying to change, and the challenges and obstacles in their way. None of them treats the subject like a market opportunity first.

That tells me something about what you actually want from this newsletter. Not just to know what’s happening in women’s health, but to hear from the people building it, researching it, funding it, changing it. I’ve heard you.

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There’s over 20,000 of you here - investors, founders, healthcare operators, and people who just want to understand what is changing in the world of women’s health from a capital perspective.

You’ve read, shared, questioned and paid for this newsletter. Somewhere along that journey, this stopped being about one person writing about an overlooked corner of healthcare and became an actual community. And I think that community deserves the best stories and ideas across women’s health that’s out there.

There is an incredible amount of knowledge and stories across the women’s-health ecosystem.

• … from founders who are learning what it really takes to build companies in categories that markets and healthcare systems do not yet fully understand.

• … from investors who are seeing patterns in what gets funded, what struggles to attract funding and how todays’ investment frameworks are being adapted to fit an emerging category.

• …from researchers are uncovering sex-specific evidence gaps and emerging risks that the wider market may not yet know to look for.

• …from operators and industry leaders are navigating the less or (in)visible barriers that determine whether a promising innovation ever reaches patients.

• and from people around the world (who rarely get press coverage) building and developing women’s-health markets under very different clinical, cultural and economic conditions.

These stories need to be heard, not just because they can show us what's actually changing, but also because they can potentially help us understand the women’s-health market better than any glossy report or funding report could.

It takes hours each week to research, write, and produce at this level. Consider becoming a free or paid subscriber to support my work. Thank you.

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I'm opening the newsletter up to other voices

Starting today I an opening up this newsletter to the people building, funding, researching, and pushing forward the women's-health economy directly and not just filtered through my interviews.

• Maybe you're a founder or operator who learned something important that never made it into the pitch deck.

• Maybe you're an investor who's noticed where capital keeps flowing, or where it keeps getting stuck.

• Maybe you're a clinician or researcher who can explain what a piece of new evidence actually means for patients or product development.

• Or maybe you work somewhere that barely registers in international women's-health coverage,

• Or you've watched a regulatory or reimbursement mess up close, or something in your own life exposed a failure (or an opportunity) that the people deciding what gets funded need to understand.

You don't have to be a polished writer. You just need something worth saying.

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What I'm actually looking for

You can write about what you’re building, but the piece has to hold up on its own. The pieces that work are built on something you actually earned, an argument you can back up, or a part of the market that only comes into focus because of where you’re standing.

It shouldnt be a press release dressed up as thought leadership. If in doubt, here’s a test: “would this still teach the reader something if we cut the company name and the ask to buy, invest, or participate?”

Every contributor gets a byline and bio. Plus I’ll work with you to edit and fact-check before anything goes out, and contributed pieces stay clearly marked apart from my own reporting.

How to pitch us

Just reply to this email with your name, role, and organisation; your idea in one sentence; a few sentences on the argument; why you’re the right person to write it; any research or data behind it; and any commercial interest I should know about. That’s genuinely it, no full draft, no formal proposal.

I can’t run every pitch. But if there’s something you know that this community needs to hear, reply and tell me.

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These ideas are at the heart of my new book, The Billion Dollar Blindspot. You can find The Billion Dollar Blindspot on Amazon.

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About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing, Healthcare AI and capital allocation.

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The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

She didn’t hesitate. Researchers already knew the study they wanted to do. The proposal was simple. The study would compare three approaches for women with ADHD entering perimenopause: stimulant medication, hormone replacement therapy (HRT), and the combination of both to answer the questions:

• Which treatment works best?

• Which symptoms improve?

• When should one be preferred over another?

Then she told me something I wasn’t expecting. They had already applied for the funding but the proposal had been rejected. When I asked why, she paused before giving the answer she had been given.

“It was considered not relevant for society.”

I kept coming back to those five words, not because I doubted that research funding is competitive; every year, excellent ideas fail to receive support. What I couldn’t understand was something much simpler. How does a scientific question become important enough to deserve an answer? That was the question I found myself trying to wrap my head around.

Not whether the study was right or whether the study would succeed, but something more fundamental: who decides which research questions matter?

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Over the past few weeks, this series has followed a simple question.

Why are women with ADHD still entering a healthcare system that struggles to meet their needs?

In Part One, we traced that story back to diagnosis itself. ADHD became defined around the behaviour of hyperactive boys, leaving generations of girls to grow up without recognising themselves in the condition.

In Part Two, we followed the story beyond diagnosis. Women were finally being recognised, but they were entering a treatment system that had been developed largely without considering the biological questions unique to women.

That led me to a conversation with Professor Sandra Kooij, one of the world's leading experts on ADHD in women and lead author of a landmark 2025 international review on hormonal transitions and ADHD across the female lifespan. I wanted to understand why these gaps still existed. Instead, I left our conversation thinking about something else entirely: the reason she had been given when the study was rejected:

“Not relevant for society.”

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One possibility for the rejection was that the funding committee was right. Perhaps studying treatment options for women with ADHD simply is not an important scientific question, although the evidence suggests otherwise.

ADHD affects an estimated 2–5% of adults, and increasing numbers of women are receiving ADHD diagnoses in adulthood, many only in their thirties, forties or fifties after years of going unrecognised. Increasingly, clinicians have also begun to notice another pattern: many of these women report that their symptoms fluctuate during periods of hormonal change.

That observation is no longer confined to individual consulting rooms.

Research has shown that women with ADHD are substantially more likely to experience premenstrual dysphoric disorder (PMDD), postpartum depression and more severe menopausal symptoms than women without ADHD. These are not isolated conditions. They represent recurring stages of a woman’s life where changing hormone levels appear to interact with attention, mood and executive functioning.

The scientific community has already recognised this.

Earlier last year, an international collaboration led by Professor Sandra Kooij reviewed the state of knowledge on ADHD in girls and women across the lifespan. The authors concluded that hormonal transitions—including puberty, the menstrual cycle, pregnancy and perimenopause—appear to exacerbate ADHD symptoms and mood disturbances.

At the same time, they found that pharmacological research addressing these hormonal changes remains limited and called for longitudinal, sex-specific studies to develop more individualised care.

That is an important distinction. Researchers are no longer asking whether hormones matter in women with ADHD. They are asking how that knowledge should change diagnosis, treatment and care.

Professor Kooij’s proposed study was not attempting to answer a speculative question. It was attempting to answer a recognised one.

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The assumption most of us make is that once medicine recognises an important question, the search for an answer simply begins. In reality, there is another step in between. Questions do not become evidence on their own.

Before a single patient is recruited, before the first blood sample is taken and before the first result is published, a question must first survive a very different process. Someone has to write the grant application. Experts have to review it. Funding bodies have to decide whether it deserves support and only then can the science begin.

This is easy to overlook because we tend to think of scientific knowledge as something that accumulates naturally over time. In reality, every clinical trial exists because, at some point, a group of people decided that one question was more important than the hundreds of others competing for the same resources.

Evidence, in other words, is not produced by science alone. It is also shaped by the decisions that determine which science gets done.

That was what made Professor Kooij’s story so striking. The scientific question already existed. The study had already been designed. The researchers were ready to begin. What stood between the question and the answer was not another scientific breakthrough. It was a funding decision.

During our conversation, Professor Kooij said something that stayed with me.

“A real taboo is something you don’t even realise is there.”

At first, I thought she was talking about ADHD.

She wasn’t.

She was talking about something much larger: what it means to be a woman living with hormonal fluctuations that influence almost every organ system throughout life, and how little of that reality is still reflected in medical knowledge, diagnosis and treatment.

ADHD is one place where that gap becomes visible. Research tells us that women with ADHD are substantially more likely to experience worsening mood, anxiety and emotional symptoms during the menstrual cycle and in the days leading up to it. Yet many women assume these experiences are simply part of being a woman. They often do not realise that what they are experiencing is part of a pattern increasingly recognised in the scientific literature.

As Professor Kooij explained, many women cope with these symptoms quietly. They continue working. They reorganise their lives around them. They also rarely compare experiences with other women and therefore don’t recognise that millions of others are describing remarkably similar patterns.

The result is that what is, in reality, a widespread clinical phenomenon is often experienced as millions of separate personal and individual struggles. The problem exists at population scale, but it is lived in isolation.

That matters because problems that remain largely invisible can also appear less urgent. When the true burden is dispersed across individual experiences rather than recognised collectively, the need to investigate it can be underestimated.

Professor Kooij believes this is one reason that research into the interaction between ADHD and women’s hormonal transitions has progressed so slowly. Not because the symptoms are uncommon, but because much of the burden has remained hidden in plain sight.

Professor Kooij challenged another assumption. Many people think of ADHD as a psychiatric condition. She doesn’t.

Increasingly, she sees it as a condition that affects—and is affected by—many different biological systems. Hormones, the immune system, connective tissue, cardiovascular health and reproductive health all appear to interact with ADHD throughout a woman’s life.

That has an important consequence. Women do not experience these systems separately. A woman going through perimenopause is not experiencing hormones one day, ADHD the next and cardiovascular changes the day after. They are happening at the same time, in the same person, and influencing one another.

Medicine, however, is organised differently. Psychiatrists specialise in ADHD. Gynaecologists specialise in reproductive health. Cardiologists specialise in the heart. Immunologists specialise in the immune system. Each specialty is essential. But some of the most important questions in women’s health sit at the intersection of several of them.

Take Professor Kooij’s proposed study. On the surface, it was about ADHD medication. But it was equally about hormonal changes during perimenopause and how those hormonal changes influence treatment response. It wasn’t purely a psychiatry question or purely a gynaecology question. It belonged to both.

And that is where the difficulty begins.

Research funding is organised in much the same way as medicine itself. Most grants are reviewed within specialist fields, and questions that fit neatly within a single discipline have a natural place to be evaluated. Questions that span several disciplines often do not.

Perhaps that is one reason important questions in women’s health can remain unanswered for so long—not because they lack scientific merit, but because they do not fit neatly into the way scientific research is organised.

I spend much of my time thinking about capital allocation. Most people assume that capital allocation in healthcare begins when investors decide which companies receive funding.

In reality, it begins much earlier. Long before venture capital backs a new therapy or a pharmaceutical company develops a new treatment:

• Someone has to decide which scientific questions are worth answering.

• Someone has to fund the laboratory, and the (pre-) clinical trial.

• Someone has to generate the evidence

and only then can new knowledge emerge for entrepreneurs to build new products and for investors to finance them.

Seen through that lens, research funding is not simply an administrative exercise. It is the first capital allocation decision in healthcare. Every grant awarded is an investment in one possible future. Every grant declined is a decision that another question will have to wait.

Over the past few weeks, this series has followed the same story from three different perspectives. First, we saw how generations of women with ADHD were overlooked because the condition was defined around the behaviour of boys. Then we saw that, even after women began receiving diagnoses, many entered a treatment system that still lacked evidence for the questions their biology raised.

Now we arrive at a deeper conclusion.

Sometimes the missing evidence is not the result of scientific disagreement. Sometimes researchers know exactly which questions need answering. The harder question is whether we choose to invest in answering them.

Perhaps the greatest blind spots in medicine are not created by what science fails to discover. Perhaps they are created by the questions society never chooses to fund.

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These ideas sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

References

• Faraone SV, et al. The World Federation of ADHD International Consensus Statement. Neuroscience & Biobehavioral Reviews. 2021. DOI: 10.1016/j.neubiorev.2021.01.022.

• Young S, et al. Females with ADHD: An Expert Consensus Statement. BMC Psychiatry. 2020. DOI: 10.1186/s12888-020-02707-9.

• Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research. 2021.

• Kooij JJS, de Jong M, Agnew-Blais J, et al. Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health. 2025. DOI: 10.3389/fgwh.2025.1613628.

• Ter Beek, L. S., Böhmer, M. N., Wittekoek, M. E., & Kooij, J. J. S. (2023). Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Archives of women's mental health, 26(6), 851–855. https://doi.org/10.1007/s00737-023-01356-7

• H3 Network: Head, Heart & Hormones

• Personal interview with Professor J.J. Sandra Kooij, July 2026.

• Valedictory Speech - Professor Sandra Kooij

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing, Healthcare AI and capital allocation.

Explore the research · Discover the book · Learn more about Maryann

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

Over time, you stop reading individual reports in isolation. You begin reading them against each other, looking for contradictions, blind spots and patterns that only become visible when different pieces of information collide.

Two reports landed on my desk over the past few weeks.

The first was Silicon Valley Bank’s latest Innovation in Women’s Health report. The headlines were encouraging. Investment continues to flow into women’s health. New specialist funds are being launched. The ecosystem continues to mature.

The second was PitchBook’s latest Venture Monitor, which showed that three established venture capital firms accounted for almost half (48.1%, to be precise) of all venture capital raised during the first half of 2026... and no, they were not women’s health-focused.

Individually, neither report surprised me.

Together, they made me question whether we’re looking at women’s health investment through the wrong lens.

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The narrative surrounding women’s health has changed considerably over the past five years. For a long time, the conversation centred on neglect, lack of research and lack of funding.

Today, the narrative is more optimistic. Funding remains modest, but it is increasing. New companies are being founded. Dedicated investors are emerging. Large healthcare companies are beginning to size up potential acquisition targets.

While all of that is true, institutional investing teaches you to ask a slightly different question.

As allocators, we are trained to think in proportions rather than absolutes. Growth, by itself, tells us very little. Context tells everything. A market can double in size and still remain materially under-allocated.

Women’s health is no longer an emerging scientific curiosity. It sits at the intersection of some of the largest structural forces reshaping healthcare: demographic ageing, precision medicine, artificial intelligence, diagnostics, fertility, longevity and the growing recognition that sex-specific biology matters across almost every major disease area.

If those trends continue, and I believe they will, then women’s health is not simply another healthcare vertical. It becomes one of the defining investment themes of the coming decades.

Which brings me back to one of the starkest observations from the H1 2026 venture fundraising environment; Just three established venture capital firms accounted for almost half of all venture capital raised during the first six months of the year. In other words, fundraising remained highly concentrated among a small number of established managers.

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At this point, it’s worth explaining what institutional investors mean by an emerging manager.

Broadly speaking, these are independently owned investment firms still in the early stages of building their institutional business. Most are raising Fund I, II or III. Many are led by highly experienced investment professionals who have left established firms to build specialist platforms of their own.

This matters because the vast majority of specialist women’s health investment firms today are still at that stage. By institutional standards, many women’s health funds are emerging managers.

That, in itself, isn’t unusual. Every successful investment firm started as an emerging manager. Sequoia once raised Fund I. Andreessen Horowitz once raised Fund I. Every manager trusted with billions today had a first institutional investor.

Every institution now considered “blue chip” was once asking someone to believe before the track record existed.

But this is where the two reports began to collide in my mind.

Institutional capital overwhelmingly allocates to established managers. That is neither surprising nor wrong. It’s a feature of prudent fiduciary investing. Track record matters. Governance matters. Operational resilience matters. The ability to manage capital through multiple market cycles matters. These are exactly the characteristics institutional investors should evaluate.

But it also means that for a category like women’s health—which remains a relatively young investment category—many of the managers with the deepest domain expertise are still in the early stages of building institutional businesses and are therefore largely invisible to institutional capital.

That, I believe, is the conversation we are still not having.

Women’s health is often discussed as though the primary challenge is getting more venture capital into the sector. I wonder whether that is only half the story. Because venture capital is just one layer of the capital stack.

If women’s health is genuinely becoming one of healthcare’s defining investment themes (and I believe it is) then eventually the sector will need to attract not just venture capital, but long-term institutional capital; the long-term pools of capital capable of supporting the sector as it matures like pension funds, endowments, sovereign wealth funds and family offices.

But that requires us to zoom out.

The opportunity itself has never been clearer. Women account for roughly half of the world's population and make around 80% of healthcare purchasing decisions, yet continue to experience measurable gaps in research, diagnosis and treatment. At the same time, advances in precision medicine, artificial intelligence, diagnostics, genomics and longevity are transforming our understanding of sex-specific biology across almost every major disease area.

From an investment perspective, that combination represents one of the largest structural opportunities in modern healthcare. This is no longer simply a conversation about women’s health. It is a conversation about the future of healthcare.

And if that future is as significant as many of us believe it to be, then perhaps we should be asking a different question. Not simply, “Is capital increasing?” But, “Is capital increasing at a scale that reflects the opportunity?” Because those are two very different questions.

I’ve spent enough years sitting on investment committees to know that they lead to very different conversations. The first is about innovation. The second is about institutionalisation. One asks, “Is there an opportunity?” The other asks, “Can institutions responsibly access that opportunity?”

The distinction may appear subtle but I don’t think it is. In fact, I suspect it may become one of the defining questions for specialist healthcare investing over the next decade.

I don’t yet know the answer. But I increasingly believe we’re asking the wrong question.

So let me leave you with the one I haven’t been able to stop thinking about since those two reports landed on my desk.

If specialist women’s health investing is still largely being led by Fund I, II and III managers, and institutional capital overwhelmingly allocates to established firms, how do we create the conditions for women’s health to become an institutional investment category?

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These ideas sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing, Healthcare AI and capital allocation.

Explore the research · Discover the book · Learn more about Maryann

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.

For years, I thought my aunt died from diabetes. That was the story our family told ourselves. She had developed gestational diabetes during pregnancy, then life moved on. She had her baby. The pregnancy ended. The diagnosis disappeared into her medical history like a chapter that had served its purpose.

No one suggested that pregnancy had revealed something important about the decades still to come. No one spoke about long-term cardiometabolic risk. No one explained that the pregnancy itself might have been the first signal of a biological trajectory that deserved to be watched carefully for the rest of her life.

Years later she would develop diabetes. Then came the complications which eventually took her life. Looking back now, I no longer think the defining medical event in her story was the diagnosis that appeared years later. I think it was the one that came first.

Her body had already told the healthcare system something important. The system simply didn’t yet know what to do with the information.

That, increasingly, is what precision healthcare is supposed to change.

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Precision health is often described through the language of technology. Genomics. Artificial intelligence. Biomarkers. Wearable sensors. Personalised therapies.

Those technologies matter, but they are not the essence of precision medicine. Its deeper promise is much simpler. It is the idea that medicine should become better at recognising meaningful biological differences before those differences become avoidable harm.

If that is true, then precision healthcare faces an important test. Can it recognise biology that changes over time? Because that is exactly what women’s health asks it to do.

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Picture two patients. Both are fifty years old. Both have identical cholesterol, identical blood pressure and identical weight. Run them through a conventional cardiovascular risk calculator and they receive exactly the same score.

What the calculator cannot see is that one woman entered menopause two years ago while the other has not yet begun the transition. From the model’s perspective, they are identical but biologically, they are no longer the same. The model has nowhere to put that.

That single sentence reveals something important.

Much of medicine has become remarkably good at measuring biological differences between people. It is still learning how to measure biological change within the same person.

That distinction may define the next generation of precision healthcare.

To understand why, it helps to look at one of medicine’s greatest success stories. Modern oncology rarely treats cancer as a single disease anymore. HER2-targeted therapies are prescribed only when a tumour expresses a specific protein. BRCA-directed therapies follow a genetic signature rather than a diagnosis code.

This is precision medicine working exactly as intended. A measurable biological variable determines who receives which treatment. Outcomes improve because the match becomes more precise. But there is something important about these variables. They are largely static. Once measured, they remain informative for years.

Female biology is different because it unfolds through biological time. Across a lifetime, the same woman moves through adolescence, reproductive years, pregnancy, postpartum recovery, perimenopause, menopause and older age. These are not separate medical stories. They are chapters in the same biological narrative. Each chapter alters physiology, changes risk and provides new biological information.

Precision medicine’s first generation became exceptionally good at recognising fixed biology. Its second generation must learn to recognise biology that changes over time. That is a much harder problem.

This is not simply an observation from outside the medical profession. Cardiology itself has acknowledged it.

The American Heart Association’s dedicated guidelines for cardiovascular disease prevention in women, published in 2011, did not incorporate menopause as an independent cardiovascular risk factor. Menopause appeared largely as a period of possible vulnerability rather than as a transition requiring changes in risk assessment or management.

Yet the evidence already showed that the menopause transition is associated with measurable changes in lipid metabolism, vascular function and cardiometabolic risk that cannot be explained by chronological ageing alone.

Age has always been part of cardiovascular risk models. Biological transition was not. That difference matters because age moves in one predictable direction whereas biology does not.

It took until 2023 for major cardiology guidance to begin explicitly addressing pregnancy, lactation and menopause as transitions requiring specific clinical consideration. This is genuine progress. But it also reveals something larger.

One of medicine’s most data-rich and scientifically sophisticated specialties needed more than a decade to begin integrating one of the most common biological transitions experienced by half the population.

This was not because women were invisible. Cardiovascular disease in women has been studied for decades. The blind spot was more subtle. Medicine had evidence What it lacked was a way of modelling biological time. It knew biology changed. It simply didn’t yet know how to organise care around that change.

That distinction matters far beyond cardiology. Women’s health is often treated as though it were another clinical specialty alongside cardiology, oncology or endocrinology. It is not. Women’s health is one of the clearest demonstrations that biology unfolds across a life course.

Pregnancy is not merely an obstetric event. It can become an early warning for future cardiovascular disease. Menopause is not simply the end of reproductive life. It reshapes metabolic health, bone health, brain health and vascular risk.

The point is not that women experience different diseases. It is that biology itself changes in ways medicine increasingly needs to recognise, measure and respond to. That is why women’s health should not be understood as a niche within precision healthcare. It is one of the clearest tests of whether precision healthcare is becoming genuinely precise.

The implications extend beyond medicine. Every time science learns to measure something it previously overlooked, new opportunities emerge to build diagnostics, biomarkers, therapeutics, care pathways and entirely new companies around that knowledge.

Markets follow measurement and capital follows markets. Wherever biology becomes more visible, innovation follows. Women’s health therefore represents more than an overdue correction to historical blind spots. It offers one of the clearest windows into where precision healthcare is heading next.

The question is no longer whether medicine will become more biologically precise. It already is. The more interesting question is who recognises the implications early enough to build around them. That is where this series goes next.

These ideas sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

The Women’s Health Capital Thesis Map

1. Part I: The Women’s Health Capital Thesis

2. Part II: Why Women’s Health Is the First Test of Precision Health — You are here

References

1. American Heart Association — 2011 guidelines never incorporated menopause as a CVD risk factor

   Mosca L, Benjamin EJ, Berra K, et al. “Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update.” Circulation. 2011;123:1243–1262.
   https://www.ahajournals.org/doi/10.1161/CIR.0b013e31820faaf8

2. The 2020 AHA scientific statement confirming the gap and discussing menopause transition’s cardiometabolic effects

   El Khoudary SR, Aggarwal B, Beckie TM, et al. “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association.” Circulation. 2020;142:e506–e532.
   https://www.ahajournals.org/doi/10.1161/CIR.0000000000000912

3. Independent confirmation in 2020 that no AHA/ACC women’s CVD prevention guideline has been issued since 2011

   JACC State-of-the-Art Review, “Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women.”
   https://www.jacc.org/doi/10.1016/j.jacc.2020.03.060

4. The 2023 Chronic Coronary Disease guideline finally addressing menopause, pregnancy, and lactation as risk-relevant transitions

   Blazoski C, Kim YJ, Spitz J, Blumenthal RS, Sharma G. “Sex and Gendered Approach in Chronic Coronary Disease Guidelines: One Size Does Not Fit All.” JACC: Advances. 2024;3(6):100859.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC11286996/

5. HER2-targeted therapy as the static-biomarker precision medicine example

   “Deep Learning-Based Prediction of Molecular Tumor Biomarkers from H&E: A Practical Review.”
   https://arxiv.org/pdf/2211.14847

   ---

About Maryann Selfe

Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing, Healthcare AI and capital allocation.

Explore the research · Discover the book · Learn more about Maryann

The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.