Why Women's Health Is the First Test of Precision Health
How biological time is reshaping medicine, innovation and healthcare investing.
Every healthcare system is built on assumptions. The most consequential ones are often the hardest to see.
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.
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.
Weekly capital intelligence on women’s health. Summer Special 20%
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.
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The first 250 annual members can join for $120 per year instead of the standard $240. As a founding member, that 50% rate is locked in for life for as long as your membership remains active. There are now only a handful of founding memberships remaining. As a Founding Member you’ll receive:
An exclusive bonus chapter from The Billion Dollar Blindspot, following three remarkable founders building companies in women’s health and what their journeys reveal about the future of healthcare.
A monthly Healthcare Capital Briefing, analysing where LPs and investors are allocating capital, the themes gaining momentum, and what they may signal about the market ahead.
Allocator Intelligence, drawn from my conversations with family offices, institutional investors, specialist fund managers and healthcare leaders, explaining how sophisticated capital is thinking about emerging healthcare opportunities.
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If you’re interested not only in where healthcare is going, but in how new healthcare markets emerge and how capital learns to recognise them before they become obvious, I’d love to have you here.
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.
The Women’s Health Capital Thesis Map
Part II: Why Women’s Health Is the First Test of Precision Health — You are here
Part III: The Emerging Healthcare LP: Why Private Capital Is Looking at Women’s Health Differently — Coming next
Part IV: The Great Wealth Transfer Is an Accelerator, Not the Thesis — Coming soon
Part V: Investable Before Institutionalised — Coming soon
Part VI: Why Specialist Expertise Is the Missing Infrastructure — Coming soon
Part VII: Who Funds the Future of Healthcare? — Coming soon
References
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.0b013e31820faaf8The 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.0000000000000912Independent 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.2020.03.060The 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/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
Key takeaways
Precision healthcare is not defined by technology but by its ability to recognise meaningful biological differences before they become avoidable harm.
Women’s health is one of the clearest tests of precision medicine because female biology changes dynamically across the life course, requiring models that account for biological time rather than static averages.
Traditional medical models have historically incorporated fixed variables such as age but have struggled to integrate biological transitions like pregnancy and menopause into risk assessment and clinical decision-making.
The central challenge is not a lack of evidence about women’s health, but the absence of models capable of recognising and acting on dynamic biological change.
As science makes previously overlooked biology measurable, new diagnostics, therapeutics, care models and investment opportunities emerge demonstrating that markets follow measurement and capital follows markets.
Disclaimer & Disclosure
This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.