Women need better treatments for endometriosis. However, endometriosis alone may not be a large enough venture business so companies will need to work into a platform. Equally, companies which start with another fem-tech indication and work into endometriosis would be compelling. (E.g. a fertility or contraception company that works into endometriosis).
Women’s health market share. Endometriosis drugs are just a portion of gynecology drugs (1-2 bn TAM) so need other indications.
Endometriosis is a disease where uteral tissue grows outside of the uterus, most commonly on ovaries, fallopian tubes, and tissues lining the pelvis. It effects 10% of women of reproductive age Symptoms manifest with pelvic pain and severe and frequent cramps (Dysmenorrhea) and trouble conceiving. There is no easy diagnosis with a combination of pelvic exam (checking for cysts caused by endometriosis), ultrasound (checking for cysts caused by endometriosis), magnetic resonance imaging (MRI), and laparoscopy/biopsy needed (insert laparoscope in body through incision for viewing effected area). Punch biopsies of the area are typically taken at this time and tested for endometriosis. Non-invasive and accurate diagnosis is a major area of innovation with Dotlab identifying 6 microRNAs which are biomarkers for disease.
Other innovation is occurring at the level of endometriosis treatment. There are various treatments depending on the specific treatment issues (pain and infertility). The first line treatments of pain with surgery include excision and ablation of the extra-uteral tissue. The first-line pharmacological treatments for pain include combined oral contraceptive (COC), non-steroidal anti-inflammatory drug (NSAID) and progestins (after ovulation secretion) dienogest (DNG) and medroxyprogesterone acetate (MPA). Gonadotropin releasing hormone agonists (GnRH) significantly reduce pain caused by endometriosis but have serious side effects (e.g. accerated bone loss) which mean it cannot be used for more than a year and/or with progestins (which reduce the side effects). If endometriosis is complicating conception, surgery (ablation and excision) is the most common treatment with some support for GnRH agonists to improve chance of pregnancy. A wave of GnRH antagonists are in the process of coming to market (Orilissa, Relugolix, and linzagolix), which would supress estrogen without a hormonal flare, leading to the negative side-effects (bone loss) by agonists. New targets include those found by Dotlab and Endogene + HSD17B1 by Forendo.
Market TAM is currently between 1-2 bn and is expected to be 2.5 - 3 bn in 2028-2030. It’s unclear how increased testing might influence the market growth but I suspect it could expand it significantly. Not only the number number of patients, but the time/duration of treatment. However, endometriosis alone may not allow venture scale returns, but encompassing further women’s health products would allow companies to tab into the potential of the 39 bn market. Multiple indications or for companies to have a joint angle of fertility services + a specific indication might allow venture scale returns. (Fertility market was 20bn in 2018).
Major barriers for endometriosis upstarts from GlobalData: