Women seeking answers about menopause are entering a digital health landscape where intimate data, algorithmic predictions and aggressive marketing increasingly influence medical decisions, raising serious questions about privacy, autonomy and care.

Menopause and perimenopause, long under-researched and dismissed, have become a growth industry for online advertisers and wellness companies. Mining intimate data, this lucrative digital ecosystem exploits medical uncertainty to sell women hormones and supplements they don’t need, or that can even harm them.

Apple’s health app has a new feature that can allegedly detect whether a woman is in perimenopause. The app notifies a user of her new health status, and a chatbot is available to provide more information. The bot asks: “Are you feeling tired and uninterested in sex?” “Having night sweats?” “Are you always itchy?” After answering “yes” to all three, the bot confirms that she may be experiencing early signs of perimenopause and potentially low testosterone or oestrogen.

Here is what happens next: in her browser, the woman sees advertisements for supplements, creams and other “solutions” to hormonal problems. Posts in her Instagram feed suddenly say, “Looking to start [hormone replacement therapy]? If you’ve been told your symptoms are just ageing or bounced from doctor to doctor – we get it. Real relief is possible … Talk to one of our expert clinicians.” Influencers, who appear to be in their mid-30s, crowd her feed to recommend wellness supplements.

The ads and posts claim that the woman’s symptoms indicate a medical problem, despite the absence of evidence that they do: she has not had sex with her partner for several years, she is hot because it’s a heatwave, and her skin gets itchy every summer. None of that matters. She orders the supplements and contacts an online provider whose remote doctors instantly prescribe hormones like testosterone, oestrogen and progesterone (in patches or pills) without physically seeing her.

Here is what doesn’t happen: the woman does not talk to her long-time physician, who knows her medical history (blood clots, migraines and a family history of strokes), prescriptions (antidepressants), workout regimen (none) and personal situation (disintegrating marriage).

Meaningfully addressing the real phenomena of perimenopause and menopause requires a comprehensive clinical review of a patient’s medical and personal history, and doctors want to provide that kind of care. But patients are not getting it, because a sprawling digital ecosystem of health startups, influencers and advertisers increasingly gets in the way.

This ecosystem is driving a menopause gold rush, turning women’s health into a lucrative business. Instead of clinical diagnoses, health apps flood them with marketing pitches from wellness companies that raise hundreds of millions of dollars in venture capital and, in some cases, may have billion-dollar valuations.

The digital wellness industry does not care about women’s well-being. Its business model is built on wonky inferences drawn from noisy data, algorithmic predictions and violations of intimate privacy. Advertisers and marketers buy dossiers from data brokers that categorise women as “affluent mature women health and wellness”, “midlife transition focused” and “Gen X supplement buyers”.

By mining data-broker dossiers and women’s search history, emails, web browsing, social media posts and geolocation data, advertisers and marketers can predict that targeting women at certain times on certain days is more likely to yield purchases. For example, advertisers know that women feel less than fabulous about themselves early on Monday mornings. As OB-GYN Nanette Santoro explains, the marketing of menopause-related supplements to women “has gotten very, very aggressive”, even though many of the claims made by supplement providers are not backed by science.

Above all, perimenopause and menopause are a growth market. In February, a popular menopause-focused telehealth company was valued at $1 billion. Predictions generated by self-tracking apps have thus become a purchase funnel for a market projected to reach $28.8 billion by 2033.

Meanwhile, patients’ prediction-influenced decisions create difficulties for doctors, who must deal with the fallout. They now treat grave medical problems resulting from ill-advised supplements and hormonal treatments, including complications requiring surgery, and try to educate patients about clinically proven and medically appropriate approaches to perimenopause and menopause.

Doctors want patients to feel heard and understood. They want to provide gold-standard care and earn their patients’ trust and confidence. Yet now doctors must also explain to their patients that they have been played and manipulated into paying for expensive medicines and supplements that are not right for them given their health, family history and prescriptions. They have to help patients understand that those pricey supplements may not be supported by science and are fuelling someone’s bottom line but not serving their own.

The impact of digital manipulation on women’s autonomy, privacy and health is far-reaching. The prediction- and ad-driven digital-health ecosystem has hijacked women’s and doctors’ attention and time. It has also changed the way women see themselves: as people whose hormones and bodies are broken and need to be fixed with supplements that are useless or, worse, harmful.

By restructuring clinical encounters, app-based predictions and online ads have undermined women’s agency and self-esteem and corroded intimate privacy, with severe effects on health outcomes. Expert discretion has shifted from clinical judgment to adjudicating machine-derived predictions based on noisy data.

There is no easy solution to this problem, but lawmakers and regulators can take meaningful actions. In the United States, Congress should ban the use and sale of intimate information and sharply curtail data brokers. The Federal Trade Commission and Food and Drug Administration could crack down on unfair and deceptive advertising by online advertisers and supplement companies. The United Kingdom has already moved in the right direction by banning several misleading ads.

In the meantime, users should exercise caution when interpreting the health notifications they receive on their phones. They should always, as advertisements and app prompts suggest, “talk to a doctor”.

Women’s midlife health has been under-researched and dismissed for decades. Tracking tools can give women the data and language that they have long been denied without funnelling them into manipulative advertising schemes. Being seen and heard should not mean being segmented and monetised.

Copyright Project Syndicate 2026

The views expressed in this article may or may not reflect those of Pearls and Irritations.