“I don’t understand the need for this.”
That’s the response Rachel Bartholomew, CEO and founder of Hyivy Health, would often receive when pitching investors on a new vaginal dilator.
Used to improve the flexibility and strength of the pelvic floor, this type of medical device relieves pain that can arise due to anatomical differences, pelvic surgery, cancer treatment or menopause.
Hyivy Health’s vaginal dilator, called “Floora,” uses auto-dilation and heat therapy to help patients, making it more technologically advanced than the ones Bartholomew had seen on the market, she says. The medical device is currently in development but, as Bartholomew points out, there are steep hurdles for anyone marketing women’s health innovations.
“You have to pitch to wives, pitch to daughters, pitch to mothers, pitch to all of these adjacent women that are in the lives of the people who hold the power,” says the founder of the Kitchener, Ont.-based company.
A news release issued by the Canadian government in 2022 states women-owned businesses receive about four per cent of venture capital funding in Canada. More recent data from the United States and Europe shows that only two per cent of venture capital funding went to women-founded startups in 2023, and many of those pitching women’s health innovations are women themselves.
In frustration, Bartholomew started reaching out to other founders of women’s health startups, eventually partnering with Innovation Factory, a business accelerator based in Ontario, to help her peers with community-building, professional development and fundraising support.
In January, she launched Femtech Canada, a network of more than 120 companies, industry partners, investors and accelerators, all specializing in femtech, a subsector of health-care technology focused on women’s health. The initiative caters to the health needs of women, girls, non-binary and transgender folks, as well as those assigned female at birth.
Bartholomew points out that 85 per cent of the companies in Femtech Canada’s network are women-founded.
Bartholomew says part of the problem is that funders are less attuned to non-fatal women’s health issues such as endometriosis, polycystic ovarian syndrome and uterine fibroids, and how they can impact quality of life. Additionally, they often miss the economic impact – and market potential – of treatments.
A January 2024 analysis from the McKinsey Health Institute, based in the United States, notes that nearly half of women’s “health burden” happens during their working years, and the global market potential for endometriosis treatments alone is predicted to be between US$180 billion and US$250 billion. The analysis also discovered that funding for companies treating erectile dysfunction was six times higher than for those concentrating on endometriosis.
There is often a bias within the health system, too, Bartholomew says, with women’s health concerns frequently missed, misunderstood or minimized. One analysis published in the journal Fertility and Sterility in 2011 looked at the effects of endometriosis on women in 10 countries around the world. Researchers found it takes an average of seven years for women to get an endometriosis diagnosis from when they first notice symptoms, mainly due to delays in referral from primary care physicians.
And Bartholomew points out that women’s health problems can snowball if not diagnosed and treated as soon as possible. For example, “endometriosis can cause chronic pelvic pain and infertility,” she says.
“We still have a long way to go to reach gender equity in health care. Research wasn’t even required to include women until the 1990s,” says CMA President Dr. Joss Reimer.
It wasn’t until 1993 that the U.S. Congress passed a law mandating the inclusion of women in government-funded clinical trials. In Canada, there are guidelines – most recently updated for release in 2013 – but no legal requirements to ensure women are part of research design and trials.
In both countries, although inclusion has improved, significant gaps remain. For example, a 2023 review published by the Canadian Women’s Heart Health Alliance states that about one-third of subjects for clinical trials related to cardiovascular disease are women.
“The medical community has just assumed women would have the same outcomes as small men,” Reimer says. “We know this isn’t true, and the lack of inclusion in research means that I see patients in my practice having fewer treatment options, having the treatments be less effective and having more side-effects – because women are not small men,” says Reimer.
Dr. Jennifer Johnston is a family physician and founder of Elle, MD, a biotechnology company based in Nova Scotia. As a member of the Femtech network, she points out the lack of innovation in many reproductive and hormonal health issues, from birth control to menopause.
Widely used hormonal contraceptives, she says, are highly effective and can have positive impacts like reducing acne and decreasing the risk of some cancers. But through the years, studies have suggested they can also affect a person’s mood and in some cases, increase the risk of blood clots and cervical and breast cancers. According to a 2020 research article published in the Nature journal, about a third of women around the world discontinue hormonal birth control in the first year because of either side-effects or health concerns.
This level of dissatisfaction was part of what prompted Johnston to create an alternative, with Elle, MD’s non-hormonal vaginal ring currently in preclinical trials.
Johnston thinks the lack of highly effective non-hormonal birth control options is, in part, due to the fact that few women have been driving business and funding decisions.
“Most of the investors out there are men and that’s a bit of a problem, since they’re just not the target market for innovations in women’s health,” she says.
The gender discrepancies in health-care funding apply to cancers, too. While funding for breast cancer research has skyrocketed in recent decades, due to advocacy driven in large part by survivors, funding for the treatment of other cancers that affect women is lacking, says Dr. Lucy Gilbert.
A professor in the department of obstetrics and gynecology and the department of oncology at McGill University in Montreal, Gilbert says the death rate of endometrial cancer has actually increased in recent years in Canada and the U.S., and according to Ovarian Cancer Canada, survival rates for ovarian cancer haven’t improved in decades. Both types of cancer receive funding from the National Institutes of Health (NIH), which pays for research in Canada and the U.S. But neither endometrial nor ovarian cancer receive as much funding from the NIH as prostate cancer, despite their lower survival rates.
For more than 15 years, Gilbert has been focused on improving the diagnosis of ovarian and endometrial cancers so they’re found at a curable stage.
In 2008, she led a study involving nearly 1,500 Canadian women aged 50 and older with symptoms of ovarian cancer. The study, published in the Lancet Oncology journal, showed that even skipping the referral requirement to fast-track ultrasounds and blood tests for women worried about ovarian cancer didn’t help find more cancers at an earlier stage. “Even if people call us as soon as they notice something,” she explains, cancers are still usually detected in an advanced stage.
That bleak realization inspired Gilbert to pursue better screening. Her DOvEEgene test, which analyzes cell samples from inside the uterus for genetic mutations associated with endometrial and ovarian cancers, is currently undergoing a trial to evaluate its ability to detect these cancers early.
Gilbert’s research could radically change the dismal outcomes for ovarian cancer and aggressive endometrial cancer.
Her trial has enrolled 4,700 women – more than planned due to the overwhelming interest in a screening test. “We’ve had people coming from across the country,” says Gilbert, who received a $6.2-million grant for the project from Genome Canada, a non-profit organization.
While she can’t release data, she said the investigative test detected early-stage ovarian cancer in some patients. “The results are even beyond my dreams.”
But getting here wasn’t easy, she says. In the early days, Gilbert relied on her male colleagues to pitch funders. “I had to use men because as women, our voices do not count,” she said. “The fact I’m Black is an added disadvantage.”
While Dr. Gilbert wasn’t aware of Femtech Canada until recently, she sees the great need for an organization that connects people working in women’s health and elevates their voices. “Femtech provides a structure and network for people who are not being taken seriously,” she says.
This piece is part of a partnership between the Canadian Medical Association (CMA) and CTV News. For more information on the CMA, visit www.cma.ca.
