The Health Gap Hawai‘i’s Women Are Talking About

When Unyong Nakata, a high-powered business executive, asked her doctor if she was in perimenopause, he asked her two questions.

“Are you getting hot flashes?”

“No.”

“Do you have night sweats?”

Again, no.

“Then you aren’t in menopause,” he told her.

“It was dismissive,” Nakata says.

That exchange points to a larger problem and a multibillion-dollar opportunity. If medicine still lacks satisfactory answers for a biological transition that half the population will experience, why has so little money gone toward finding them?

According to a January 2026 World Economic Forum report produced in collaboration with Boston Consulting Group, women’s health captures just 6% of the $2.9 trillion in total private health care investment. And the capital that does flow into women’s health is heavily concentrated in women’s cancers, reproductive health and maternal care.

For conditions such as menopause, endometriosis and polycystic ovary syndrome, the investment gap is even wider. Together, they receive less than 2% of private health care funding, according to the report, despite affecting hundreds of millions of women globally.

Now, money is beginning to move. But investment may be advancing faster than the health care and workplace systems women depend on, creating both a business opportunity and a new question: Who, exactly, is going to take care of women in midlife?

In 2025, the Gates Foundation committed $2.5 billion through 2030 to research focused exclusively on women’s health. Separately, Melinda French Gates has directed more than $600 million toward women’s health over the past two years through Pivotal, her philanthropic organization, including a $215 million pledge in June 2026 targeting contraceptive access, maternal care and research on conditions affecting middle-aged women, including menopause.

Private investors are moving, too. Women’s health startups raised a record $1.55 billion in equity in 2025, up 41% from the year before, significant capital from private donors and investors even as federal budgets and research funding face widespread cuts and freezes.

Unyong Nakata experienced firsthand the medical dismissiveness surrounding perimenopause. Photo: Aaron Yoshino

Philanthropy is stepping up as well. When superstar singer Olivia Rodrigo’s inaugural Daisy Chain Fields Music Festival raised $10 million on August 29, Melinda French Gates matched it dollar for dollar, bringing the total to $20 million for nonprofits supporting women and girls. The funds will be split equally among 10 organizations, including Baby2Baby, Johns Hopkins Center for Indigenous Health, National Domestic Workers Alliance, National Institute for Reproductive Health, National Women’s Law Center and Planned Parenthood.

The potential payoff extends well beyond health care.

Research from the McKinsey Health Institute has found that women spend an average of nine years of their lives in poor health, affecting their ability to participate fully at home, at work and in their communities. Women also spend 25% more time in poor health than men. Closing that health gap, McKinsey estimates, could add at least $1 trillion annually to the global economy by 2040.

In Hawaiʻi, the gap is harder to measure but easy to hear.

In a dozen interviews with women in their 30s, 40s and 50s in Hawaiʻi, many described frustrations and a persistent sense of being misunderstood, by doctors, employers or both. The disconnect suggests that investment may be outpacing the systems women rely on for care and workplace support.

Part of the problem, says Kelly Yamamoto, a nurse whose career started in emergency medicine at The Queen’s Medical Center and moved into systems improvement, is cultural.

“We’re used to sucking it up and dealing with these issues, no further discussion. We often put ourselves last,” Yamamoto says. “Women are the managers of our lives, from family to our household and careers along with our health issues.”

She believes that expectation has helped keep women’s midlife health out of sight and underfunded.

“Normal biological transitions deserve to be understood, supported and funded,” she says.

Where traditional health care has left gaps, entrepreneurs and investors increasingly see a market.

Ally Tam Tumasova co-founded Respin Health, a digital platform for women in menopause and midlife, with Oscar-winning actress and health advocate Halle Berry. Tumasova, who served as founding CEO before stepping back from day-to-day operations in early 2026, remains a co-founder and shareholder.

“This isn’t just a medical problem, it’s a data problem,” she says.

Menopause itself hasn’t changed, she argues. What is changing is medicine’s understanding of a transition women have experienced for generations, after years of underinvestment left clinicians and patients making decisions with incomplete evidence.

Her approach grew out of a deliberate decision to give women options rather than prescribe a single path. Respin paired clinical research on hormone therapy, nutrition and fitness with something more basic: asking women what they actually wanted.

“The idea was not just, ‘Here’s the science, go do it,’” Tumasova says. “Giving women the agency to choose was so important.”

She describes the concept as “a GPS for women’s health,” a system designed to continually recalibrate care as a woman’s health data changes rather than forcing her to start over at every appointment.

Listening to women also challenged some of the assumptions Tumasova’s team brought to the work.

Respin Health co-founder Ally Tam Tumasova believes midlife women’s health is a data problem requiring personalized care options. Photo: Courtesy of Ally Tam Tumasova

They expected hot flashes to rank among women’s biggest concerns. Instead, she says, body-composition changes, including weight gain and loss of muscle mass, rose to the top.

“That actually goes in contrast to how people think about menopause,” Tumasova says. “When people think menopause, they think hot flashes and night sweats.”

That concern has also drawn attention to the use of GLP-1 drugs to suppress appetite among women in midlife and to an emerging area of research: whether GLP-1 medications and hormone therapy might work differently, or potentially more effectively, in combination.

“The hormone therapy and GLP-1 combination has been a really promising mechanism,” Tumasova says, while emphasizing that it has not been tested in a randomized controlled trial.

Some research has also found that women lose more weight than men while taking GLP-1 medications, even after researchers account for factors including age and ethnicity.

“The hypothesis is because of the relationship between estrogen and the GLP-1 receptor,” Tumasova says.

But she stresses the important word: hypothesis.

The research remains early, with small retrospective studies drawn from individual health systems. Researchers themselves have called for randomized trials before such findings are used to guide clinical practice.

At the same time, Tumasova sees another paradox emerging. Wearables, at-home lab tests and continuous glucose monitors have given consumers unprecedented amounts of personal health data. The ability to interpret all of it hasn’t necessarily kept pace.

“Three years ago, for menopause, we had no information and no next steps,” she says. “Now we have a ton of information, and still no next steps.”

Without trusted guidance, she says, women can end up at one of two extremes: ignoring the information altogether or panicking over signals that may not be meaningful.

What has been shown to help can sound almost mundane by comparison.

“The building blocks of the proven interventions for menopause are unsexy,” Tumasova says. “Change the way you eat. Change the way you move your body. Consider hormone therapy. … There’s no special cocktail or elixir.”

WHAT EMPLOYERS ARE DOING

The workplace is confronting its own version of that gap: Awareness is outpacing infrastructure.

That shift is beginning to show up in public policy. Rhode Island became the first state to mandate workplace accommodations for menopause, amending its Fair Employment Practices Act in June 2025 to cover symptoms such as hot flashes and night sweats. Philadelphia followed with a municipal ordinance set to take effect in 2027.

In June 2026, Washington Gov. Bob Ferguson signed an executive order directing the state’s Women’s Commission to review workplace policies, citing research suggesting that two in five women have left or considered leaving a job because of menopause symptoms and one in four have passed on a leadership opportunity because of them. Other states, including California, Illinois, Louisiana and Oregon, have introduced or enacted measures involving insurance coverage, provider training or education.

Hawaiʻi employers, meanwhile, are moving at different speeds.

At American Savings Bank, where 65% of the workforce is female, benefits have been designed with that demographic in mind, though the bank does not have a menopause-specific program.

“American Savings Bank’s benefits are designed to meet the needs of all our teammates through different stages of life,” says Chrystal Leung, senior vice president and director of human resources. “Prevention is the best medicine, and we reward teammates who proactively take care of their health.”

Each year, employees receive eight hours of paid wellness time for completing a preventive screening, including a physical, well-woman exam, eye exam, mammogram or dental cleaning.

At The Queen’s Health Systems, Hawaiʻi’s largest employer, a more targeted conversation around midlife women’s health is just beginning.

“Queen’s is super early in our strategy in how we’re going to tackle this important phase of life for our employees,” Alexandra Wroe, senior vice president and chief operating officer, says.

So far, the health system has focused on education, bringing outside experts through its Kaleiopapa: Unity & Wellness department to speak with its Parenting and Caregiver Resource Group. The response revealed the demand. A recent session drew roughly 175 employees across three campuses, making it the group’s most highly attended event yet, according to Yamamoto, who co-led the session. But the attendance wasn’t what stayed with her.

“What struck us most … was not simply the turnout, it was the depth of the conversation afterward,” Yamamoto says. “Women remained engaged, asked thoughtful and personal questions and shared experiences that many had never previously discussed in a workplace setting.”

There is a financial argument for paying attention.

Menopause-related symptoms, including hot flashes, night sweats, mood changes, sleep disturbances, joint aches and cognitive difficulties, can affect quality of life as well as performance at work.

A 2023 Mayo Clinic study estimated that menopause symptoms account for $1.8 billion in lost work time annually in the United States, rising to $26.6 billion when medical expenses are included.

The costs may extend beyond absenteeism and medical bills. Perimenopause and menopause often arrive during the height of women’s careers, when they may be leading teams while simultaneously caring for aging parents and raising children. Symptoms affecting sleep, concentration, mood and confidence can collide with professional responsibilities at a point when women have accumulated years of institutional knowledge and experience.

For employers, that turns what has traditionally been treated as a private health matter into a question of productivity and retention.

Yamamoto, who also co-founded Magnolia Collective Wellness Hawaii, a women’s health organization focused on midlife care that is seeking funding, argues that menopause shouldn’t be viewed solely through the lens of individual wellness.

“This is frequently described as a women’s health issue, but it is also a workforce issue,” she says.

“If we want to retain experienced leaders, clinicians and professionals, we have to recognize that women’s health is workplace health.”

Yamamoto says she helped start Magnolia after seeing a persistent gap between what women were experiencing and the coordinated care available to them.

“Too many women were searching for answers on their own,” she says.

Her advice to employers is not to begin with an expensive new benefit or elaborate initiative.

“The first step is not building a complicated program,” she says. “The first step is acknowledging the conversation.”

Some of the interventions employers can make are relatively modest: manager training that normalizes conversations about menopause, flexible scheduling and basic environmental accommodations.

For Nakata, now 48, those workplace consequences aren’t theoretical. As founder and principal of Nakata Advisory LLC, where she advises organizations on business development and operational alignment, she has experienced firsthand the collision between professional demands and perimenopause.

“This past week, I had a really wonderful week for my business, an out-of-state client, an important strategic planning meeting for a nonprofit, but you know what was happening at the same time? My perimenopause insomnia symptoms were on max,” she says. “I’ve learned that sleep is my superpower.”

Her wish list for employers starts with relatively simple accommodations: flexible hours or remote-work options after nights derailed by insomnia or fatigue, along with desk fans, adjustable thermostats or designated cooling spaces.

More consequential changes could come through benefits, says Yamamoto: pelvic-floor physical therapy incorporated into standard wellness coverage, mental health resources within employee assistance programs, and fitness guidance that accounts for the bone and cardiovascular changes associated with menopause.

None of it requires reinventing the workplace, in Yamamoto’s and Nakata’s view. It requires recognizing that a phase of life most women will experience can also shape how they work.

Women are battling midlife health challenges right as they step into their peak executive years. Illustration: Esther Mohrmann

CAREER PRIME, INTERRUPTED

The stakes extend beyond an employee’s day-to-day comfort.

Yamamoto has also examined where menopause may intersect with another persistent workplace problem: the shortage of women in the C-suite.

She is careful not to draw a straight line between the two.

“I wouldn’t necessarily say that menopause … is the reason women are underrepresented in the C-suite,” she says. “Leadership representation is influenced by many factors.”

But the timing is difficult to ignore.

Perimenopause and menopause commonly occur between ages 40 and 55, Yamamoto notes, “when women are increasingly moving into senior leadership, executive positions and board roles.”

Research suggests that symptoms can affect women’s performance, attendance, retention and career decisions. In one study of health care workers published in a National Library of Medicine database, 65% of women surveyed said menopause symptoms negatively affected their work performance, while 18% reported taking sick leave because of symptoms.

Fatigue was the most commonly reported workplace effect, cited by 54% of respondents, followed by sleep difficulties at 47%, difficulty concentrating at 44% and memory concerns at 40%. Women experiencing more severe symptoms were also more likely to report effects on productivity and career development, including considering reduced responsibilities, declining opportunities or retiring early.

The consequences can extend to women’s decisions about whether to remain with their employers. A separate national menopause workforce survey found that two in five women had considered finding, or had already found, a new job because of their menopause experience or symptoms.

For Yamamoto, the more useful question isn’t whether menopause causes the leadership gap.

“To me, the more important question is not whether menopause explains the leadership gap, but whether employers have an opportunity to better support and retain experienced women during some of their most productive and influential years,” she says. “These are often women with decades of expertise, deep institutional knowledge and significant leadership potential.”

That changes the proposition from accommodating a problem to protecting an investment.

“When women understand what is happening in their bodies and have access to appropriate resources, the conversation shifts from simply managing symptoms to optimizing health, performance, confidence, and longevity,” Yamamoto says. “We view this as an opportunity.”

For employers, she argues, investing in midlife women’s health can also become an investment in retention, institutional knowledge and leadership pipelines.

The growing attention to midlife women is also giving rise to new models of care.

Elizabeth Ignacio, an orthopedic surgeon specializing in advanced arthroscopic and reconstructive surgery and sports medicine, is preparing to launch Femme Vitale, a coaching program for women centered on well-being and lifestyle medicine. The program is designed to complement, rather than replace, a woman’s primary care physician.

“This is plastic surgery to one’s life and to enhance, augment and uplift one’s well-being,” Ignacio says.

Her approach treats midlife not as a collection of symptoms to manage but as a period when women can deliberately reassess how they care for their minds and bodies.

Ignacio has seen what can happen when that integration is missing. Some patients, she says, can be in “extraordinary physical condition, even marathon-ready, and still be miserable. Physical performance alone may not address the broader changes women are experiencing.”

Her model instead emphasizes evidence-based, whole-person care, with the idea that midlife can be approached not simply as a period of decline, but as an opportunity to rethink health for the decades ahead.

Investors are betting on that opportunity, too.

Midi Health, which started with virtual care for women in perimenopause and menopause, has emerged as one of the most heavily funded startups in women’s health. The company has raised about $250 million to date, including a $100 million Series D round in February 2026 that pushed its valuation above $1 billion.

For a category of care long overlooked by the broader health care system, Midi’s rise sends a powerful signal: Midlife women are increasingly being recognized not only as patients whose needs have gone unmet, but as a health care market significant enough to attract major capital.

For women like Nakata, though, the larger point is more personal.

Over time, employers and the health care system have expanded the support surrounding pregnancy, childbirth and the postpartum period, recognizing them as consequential stages in women’s lives and careers. Midlife may be the next frontier.

The question now is whether medicine, employers, entrepreneurs and investors will bring that same attention to perimenopause and menopause, and build the systems women need for the decades that follow.