The Rising Self-Advocacy of Female Healthcare Consumers at Midlife
Michelle Silva, M.A., Strategic Advisor of Consumer Experience, NRC Health
Print Full ReportShe's one of health systems' most valuable and vocal consumers—and she's getting louder.
Women are the world’s most powerful consumers, projected to control 75% of all discretionary spending by 2028.1 Those over 50—whom Forbes has dubbed “super consumers”—account for a whopping $15 trillion in purchasing power and control 95% of U.S. household purchasing decisions.2,3 When it comes to healthcare spending in particular, current research suggests that U.S. women around age 50 spend far more than men of the same age.4
Despite their enormous spending power, these middle-aged super-consumers have been feeling ignored by the traditional healthcare industry.
While many health systems have supported the unique biological needs of female patients through prenatal, maternity, and senior wellness programs over many decades, a significant gap has persisted in care: support for the substantial symptoms of perimenopause that are common at midlife. But middle-aged women aren’t waiting for the system to catch up on this needed care—they’re redefining it from the ground up.
For the first time, the perimenopausal life stage is entering mainstream public health, wellness culture, and even workforce policy, thanks to Gen X and Millennial women who, now at midlife, are openly discussing their often misunderstood and complex symptoms, misdiagnoses, and care gaps on social media, podcasts, blogs, and mainstream media.5 They are driving cultural reframing around perimenopause as a transitional life stage worth understanding and supporting, both socially and medically. And more and more, they’re putting their healthcare dollars outside the traditional care system as they struggle to find adequate support there.
Investors have taken notice. Women’s health investments have skyrocketed over the last few years, with 2024 considered the biggest year for funding yet, at a new high of $2.6B.6 As a result, a new category of direct-to-consumer healthcare and “femtech” is thriving, filling the wide gap in traditional, health system–based care between the childbearing and senior years. Among other options, startups are offering virtual perimenopause care by specially trained providers and hormone therapy delivered right to patients’ doorstep. The movement has so much momentum that A-list celebrities and renowned female business leaders are investing in companies like Midi Health, with some even hawking their own perimenopause wellness products.
A matter of (dis)trust
The catalyst for the rise of self-advocacy by women for perimenopause care is, quite simply, a fundamental lack of trust that the healthcare system will address their specific needs at midlife.
Trust is the invisible force that drives every consumer and patient experience. A 2024 NRC Health Market Insights survey shows that reliability, competence, and respect are the top three factors that consumers say contribute to their trust in a hospital or health system.
NRC Health data also shows that women value these drivers more than men do across all ages, with all becoming more important with age. This data becomes more salient when we consider the current public narrative that indicates that a growing number of middle-aged female consumers do not trust providers to reliably and competently provide the guidance and treatments they need for the midlife transition. Many report leaving encounters feeling misunderstood, dismissed, and disrespected.7,8
The lack of perimenopause support is systemic: An astonishingly low number (31.3%) of U.S. OB-GYN residency programs include a dedicated perimenopause and menopause curriculum.9 This likely means that an even lower number of internal and primary-care physicians have been appropriately trained in this area.
Providers of all specialties are now caught between meeting the demands of an increasingly vocal and informed patient base and having few meaningful resources to support it. Despite this, most institutions have been slow to respond with provider training programs, specialty clinics, and funding.
They are losing super-consumer trust, confidence, and loyalty, often to well-funded startups—including even celebrity entrepreneurs and TikTok influencers—who are showing that they are listening and are reliable and competent when it comes to understanding and providing solutions for their frustrating perimenopausal symptoms.
Mind the gap
Health systems have a significant opportunity to meet this moment by acknowledging and addressing the care that one of their most powerful consumer groups needs in midlife. With NRC Health survey data showing an increase in concern for perimenopausal wellness over the last few years—and U.S. Census data showing more than 30M women aged 40 to 55 in 2025 (with similar numbers projected year over year over the next 10 years)—health systems should mind the care gap between prenatal/maternity care and senior wellness, to include the unique needs of women in perimenopause.
Below are steps you can take to build and sustain trust with one of your most valuable consumer groups:
Make perimenopause care standard preventive care.
Treat perimenopause screening and management like prenatal and annual exams—routine, expected, and necessary.
Train all providers in perimenopause care.
Mandate education and training not only for OB-GYNs, primary-care physicians, and nurse practitioners, but for all other providers as well, to support holistic care.
Anticipate perimenopause care needs.
Use your age- and gender-based demographic data to design targeted outreach to biologically female consumers and patients during perimenopausal years (typically ages 45–55), offering education, specialized clinical care, and wraparound support such as mental health services. Create educational outreach to female consumers aged 40–44 to help them prepare for perimenopause and identify symptoms. Make them aware of the special care your organization can provide during this life stage.
Provide easy access.
Hire and create dedicated access to trained providers who understand the latest research in hormonal health, symptom patterns, and appropriate treatment options like hormone replacement therapy (HRT), non-hormonal interventions, and lifestyle strategies. Consider partnering with virtual care platforms (like Midi or Evernow) to increase access.
Join the movement.
Normalizing perimenopause as part of the whole care journey helps build a medical and care community that supports and advocates for women at a crucial life stage that has historically been ignored. Enhance and elevate your brand by sharing evidence-based information to educate and destigmatize perimenopause in social platforms, on mainstream media, and at community events. Co-design care programs with input from your super-consumers. Create forums, focus groups, and patient advisory panels to keep care grounded in real experiences—and to keep patients connected to your organization.
Seek targeted insights from consumers in your market.
Understanding what your consumers want, struggle with, or value is vital to enhancing their experience and designing services that meet their needs. When they feel heard, they’re more likely to trust and remain loyal to your brand. NRC Health has many ways to help health systems understand the specific needs of female consumers. Community Insights enables clients to create topic-specific studies that can be commissioned anytime to explore what personalization means to women in individual markets. And Market Insights offers a syndicated survey platform with standard service-line modules and the added ability to field questions customized to meet individual market needs.
Explore additional nSight reports to get insider data and perspectives you need to drive strategic change. Discover More.
Explore additional nSight reports to get insider data and perspectives you need to drive strategic change. Discover More.
© NRC Health 2024
Suggested citation for this report:
NRC Health. 2025. The Rising Self-Advocacy of Female Healthcare Consumers at Midlife. https://go.nrchealth.com/nSight/june-2025 (Accessed mm/dd/yyyy).
© NRC Health 2025
1 Graham, Kymberly. “Shaping Success: A Deep Dive into Women’s Impact on the CPG Landscape.” Industry Trends. NielsenIQ (NIQ), 2024. Accessed at: https://nielseniq.com/global/en/insights/analysis/2024/shaping-success-a-deep-dive-into-womens-impact-on-the-cpg-landscape/.
2 Falk, N. J. “How To Harness the Untapped Spending Power of the 50-Ish Super Consumer.” Forbes. Accessed at: https://www.forbes.com/sites/njgoldston/2018/08/21/how-to-harness-the-untapped-spending-power-of-the-50-ish-super-consumer/.
3 Graham, “Shaping Success.”
4 McGough, Matthew, Gary Glaxton, Krutika Amin, and Cynthia Cox. “How Do Health Expenditures Vary across the Population?” Peterson-KFF Health System Tracker (blog), January 4, 2024. Accessed at: https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population/#Average%20total%20health%20spending,%20by%20age%20and%20sex,%202021%C2%A0.
5 Reed, Tina. “Rising Menopause Market Captures Generational Turn.” Axios Health (blog), January 23, 2025. Accessed at: https://www.axios.com/2025/01/23/menopause-influencers-symptoms-supplements.
6 Spencer, Jackie, Julie Ebert, and Nina Kandilian. “Innovation in Women’s Health 2025.” Silicon Valley Bank, 2025. Accessed at: https://www.svb.com/trends-insights/reports/womens-health-report/?utm_source=chatgpt.com.
7 Taylor-Swanson, Lisa, Kari Stoddard, Julie Fritz, and Belinda Beau Anderson. “Midlife Women’s Menopausal Transition Symptom Experience and Access to Medical and Integrative Health Care: Informing the Development of MENOGAP.” Global Advances in Integrative Medicine and Health 13, no. 2 (July 2024). Accessed at: https://doi.org/10.1177/27536130241268355.
8 Cunningham, Adam C., Yella Hewings-Martin, Aidan P. Wickham, Carley Prentice, Jennifer L. Payne, and Liudmila Zhaunova. “Perimenopause Symptoms, Severity, and Healthcare Seeking in Women in the US.” Npj Women’s Health 3, no. 1 (February 25, 2025): 1–8. Accessed at: https://doi.org/10.1038/s44294-025-00061-3.
9 Allen JT, Laks S, Zahler-Miller C, Rungruang BJ, Braun K, Goldstein SR, Schnatz PF. “Needs Assessment of Menopause Education in United States Obstetrics and Gynecology Residency Training Programs.” Menopause. 2023 Oct 1;30(10):1002-1005. doi: 10.1097/GME.0000000000002234.