Beyond Fertility: The Mental Health Crisis in Women's Healthcare

‍Mental health in women affects every stage of life; yet it remains undertreated, misdiagnosed, and underfunded. Here's why that's changing. Women's healthcare has long been defined by fertility windows and reproductive milestones. But there's a crisis hiding in plain sight—one that touches every life stage, every condition, and every care experience: mental health in women.

One in three women will experience major depression in her lifetime. Women are twice as likely as men to be diagnosed with anxiety disorders. Yet mental health remains siloed from the rest of women's healthcare—treated as a separate specialty rather than a foundational layer of comprehensive care. The result? Millions of women navigate fragmented systems, delayed diagnoses, and treatment plans that miss the full picture.

This isn't just a clinical gap. It's a market failure—and an investment opportunity. As the women's health sector matures beyond fertility-focused solutions, mental health is emerging as one of the most critical and underserved areas for innovation, integration, and scale.

Mental Health in Women Is Hiding in Plain Sight

Mental health in women affects every dimension of women's comprehensive health—yet it's still treated as a secondary concern. The data tells a different story.

According to the World Health Organization, over one billion people globally live with mental health conditions, with women disproportionately impacted. Anxiety and depressive disorders are the most common mental health conditions among both sexes, but women carry a heavier burden: they're nearly twice as likely as men to suffer from major depression and experience higher rates of anxiety, PTSD, and eating disorders.

In the United States, approximately 26% of women reported experiencing some form of mental illness in the past year, compared to 20% of men. Nearly 58 million American adults had a mental illness in 2024, but only 43% received any form of treatment. For women, the treatment gap is compounded by systemic issues: shorter appointments, dismissive providers, and care models that weren't designed with their needs in mind.

The cost of inaction is staggering. Mental health conditions cost the U.S. economy more than $280 billion annually—a significant portion of which falls disproportionately on women. Addressing this gap isn't just a moral imperative; it's an economic one.

Are Mental Health Issues More Common in Women? What the Data and Care Experience Show

The short answer is yes—but the reasons extend far beyond biology. Are mental health issues more common in women? The data consistently shows higher prevalence rates, but understanding why requires looking at the full picture.

• Hormonal fluctuations across life stages: Mental health professionals have identified three critical windows of vulnerability for women: puberty, the perinatal period, and perimenopause. Dramatic hormone fluctuations during these phases can make women more susceptible to depression and anxiety. Women with no prior history of depression are two to four times more likely to experience a depressive episode during the menopausal transition. A 2023 study found that 15% to 50% of perimenopausal and postmenopausal women experience symptoms like anxiety, depression, and insomnia.
• Caregiving burden: Women make up the majority of unpaid caregivers in the United States, a role that takes a measurable toll on mental and physical health. The chronic stress of caregiving—often combined with work responsibilities—creates conditions ripe for burnout, anxiety, and depression.
• Trauma prevalence: Women experience higher rates of intimate partner violence, sexual assault, and childhood abuse—all of which are strongly linked to PTSD, anxiety, and depression. These experiences compound biological vulnerabilities and create lasting mental health impacts.
• Social and systemic pressures: From workplace discrimination to the "mental load" of managing households, women face unique stressors that contribute to mental health burden. Studies show that women are also more likely to delay or skip medical care due to cost, time constraints, or negative past experiences with providers.

But prevalence data doesn't tell the whole story. Higher reported rates may reflect that women are more likely to seek help and report symptoms—while also facing higher rates of misdiagnosis in women's mental health. The gap between what women experience and what gets correctly diagnosed remains significant.

Mental Health and Depression Issues in Women Are Often Missed, Minimized, or Misdiagnosed

Mental health and depression issues in women don't just go unnoticed—they're actively routed into the wrong diagnostic categories. Women aren't only under-supported; they're often placed in treatment pathways that miss the root cause entirely.

Misdiagnosis in Women's Mental Health: Why It Happens

The diagnostic criteria for many mental health conditions were developed primarily based on male presentations. This creates systematic blind spots when women present with different symptom patterns.

• Symptom overlap: Anxiety, ADHD, burnout, thyroid dysfunction, perimenopause, and postpartum changes can all present with overlapping symptoms: difficulty concentrating, fatigue, mood swings, sleep disruption. Without comprehensive evaluation, providers may treat what's most visible rather than what's most accurate.
• ADHD misdiagnosis: Women with ADHD are diagnosed on average five years later than men. Research shows that 50% to 75% of girls with ADHD are missed entirely. Women are twice as likely to have depression or anxiety diagnosed before their ADHD is identified—and many discontinue antidepressants after finally receiving an accurate ADHD diagnosis, suggesting their earlier treatment was addressing the wrong condition.
• The "stress" label: Women's symptoms are frequently attributed to stress, hormones, or life circumstances—ending the diagnostic investigation prematurely. Half of participants in one study reported their ADHD symptoms being misattributed to anxiety, depression, or hormones by healthcare professionals.
• Hormonal dismissal: Symptoms arising during perimenopause, postpartum, or menstruation are often dismissed as "normal" hormonal fluctuations rather than treated as legitimate mental health concerns requiring intervention.

Misdiagnosis in Women's Mental Health: What It Looks Like in Real Life

The practical consequences of misdiagnosis in women's mental health are severe and compounding.

• Short appointments with no context: A 15-minute visit doesn't allow time to understand how symptoms interact with hormonal cycles, life circumstances, or physical health. Providers make quick assessments based on incomplete information.
• Dismissal of physical symptoms: When women present with fatigue, pain, or cognitive changes, these are often labeled as psychosomatic rather than investigated as potential indicators of underlying conditions.
• Generic treatment pathways: Women receive standardized protocols that don't account for hormonal influences, life stage, or the specific presentation of their condition. The result is treatment that may help symptoms temporarily but doesn't address root causes.
• The consequences: Delayed diagnosis leads to worsening symptoms. Women with undiagnosed ADHD report significantly lower self-esteem, problematic relationships, and higher rates of substance use as self-medication. Years of ineffective treatment erode trust in the healthcare system—making women less likely to seek help when they need it most.

Where Mental Health in Women Breaks Down Across Women's Healthcare

Women's healthcare is fragmented by design. Mental health is treated by psychiatrists and therapists. Hormones by endocrinologists or OB-GYNs. Sleep by specialists. Pain by rheumatologists or neurologists. No single provider holds the full picture—and women are left to coordinate their own care across silos that don't communicate.

Perinatal Mental Health: Pregnancy, Postpartum Depression Support, and Care Gaps

Postpartum depression support is one of the most talked-about areas of women's mental health—yet the gap between screening and actual treatment remains vast.

The numbers are stark: One in eight women experiences postpartum depression, with rates as high as one in five in some states. Up to 20% of new mothers experience perinatal mood or anxiety disorders. But nearly 50% of mothers with postpartum depression are never diagnosed by a healthcare professional. Among those with early postpartum depressive symptoms, only 25% report receiving a diagnosis, and just 53% receive any form of mental health care.

Screening exists, but follow-through fails. One in five women report that their provider never asked about depression during prenatal visits. One in eight weren't screened during postpartum visits. When screening does happen, there's often no clear pathway to treatment—no immediate therapy referral, no crisis support, no ongoing check-ins. Women with Medicaid coverage face even greater gaps: they're diagnosed earlier but receive treatment at lower rates and with longer delays than privately insured women.

The stakes are high. Suicide is a leading cause of maternal mortality in the first year postpartum. Many mothers who die by suicide had not seen a mental health professional in the month prior—underscoring the urgent need for better screening and accessible care.

Menopause and Mental Health: Anxiety, Mood Changes, Sleep Disruption

Menopause and mental health are deeply intertwined—but symptoms are typically split across specialists who treat each issue in isolation.

Research shows that perimenopause represents a significant window of vulnerability for mental health. The Penn Ovarian Aging Study found a four-fold increase in depression among women with no prior history during their menopausal transition. Being perimenopausal more than doubles the risk of depression during follow-up. Up to 70% of women experience mood swings during menopause, while 45-60% suffer from depression and nearly 60% report cognitive issues like brain fog.

Yet while 90% of women discuss their symptoms with doctors, only 25% have menopause identified as the likely cause. Instead, symptoms get fragmented: sleep problems go to one specialist, mood changes to another, hormone questions to a third. No one coordinates the plan. No one connects the dots between hot flashes disrupting sleep, sleep disruption worsening mood, and mood changes affecting cognitive function.

Women who have had sensitivity to hormone fluctuations during prior life stages—PMS, PMDD, postpartum mood disorders—face even higher risk during perimenopause. But without continuity of care, this history often goes unshared and unaddressed.

Read Also: The Menopause Innovation Gap - Why Smart Investors Are Funding Solutions for 65 Million Women

Chronic Conditions and Mental Load: PCOS, Endometriosis, Pain, and Burnout

Living with unresolved chronic conditions creates a mental health burden that compounds over time. Two conditions illustrate this pattern clearly: polycystic ovary syndrome (PCOS) and endometriosis.

PCOS and mental health: Women with PCOS are nearly three times more likely to be diagnosed with depression and anxiety compared to women without the condition. They have five times higher odds of experiencing anxiety symptoms and almost six times higher odds of moderate to severe anxiety. The connection is both biological—hormonal imbalances and inflammation affect brain chemistry—and experiential. Managing symptoms like irregular periods, infertility, weight gain, and hirsutism takes a psychological toll. Yet mental health screening is rarely part of standard PCOS care.

Endometriosis and mental health: Approximately 60% of women with a diagnosis of PCOS or endometriosis experience moderate to severe psychological distress, indicating probable depression and/or anxiety. The average diagnostic delay for endometriosis is 4-12 years—during which women often see five or more doctors, have their symptoms dismissed, and develop secondary mental health conditions from the stress of unresolved pain and uncertainty. By the time diagnosis arrives, depression and anxiety may be deeply entrenched.

The pattern repeats across chronic conditions: delayed diagnosis, fragmented care, unaddressed mental health burden, and reduced quality of life. Women aren't failing to cope—the system is failing to provide integrated support.

The Funding Gap: Prevalence Is High, but Mental Health Solutions for Women Are Underbuilt

Mental health support for women is widespread in need but sparse in solutions. The funding landscape reflects historical blind spots that are only beginning to shift.

Women's health still represents only a fraction of global healthcare investment: 15% of venture capital and just 5% of R&D funding as of 2023. Only 4% of all biopharma R&D spending goes toward female-specific conditions. The FemTech market is projected to reach $360 billion, yet funding remains at just 8.5% of digital health investment.

There are signs of change. VC dollars going to women's health tripled between 2019 and 2024, with $2.6 billion invested last year. Despite a 27% decline in overall venture funding from 2022 to 2023, investments in women's health technologies grew by 5%. The emergence of unicorn-status women's health companies like Maven, Carrot, and Kindbody signals growing recognition of the market opportunity.

But mental health within women's health remains particularly underserved. Most investment has concentrated on fertility and reproductive health—important areas, but representing only a fraction of women's total health needs. The opportunity now is to build women-centered models that reduce missed diagnoses, integrate mental health into comprehensive care, and improve outcomes across the full life span.

Read Also: Why Women’s Health Gets Just Two Percent of VC Funding

Emerging Trends: Holistic Women's Health Models That Treat Mental Health as Core Care

A new generation of women's health companies is rejecting the fragmented model. Instead of treating mental health as a specialty add-on, they're building it into the foundation of care.

• Integrated clinics and hybrid care: Models that combine in-person and virtual care are making comprehensive support more accessible. Rather than requiring women to navigate separate systems for hormone evaluation, therapy, and primary care, integrated clinics offer coordinated services under one roof—or one platform.
• Care navigation and fast routing: The right level of support matters. Some women need crisis intervention; others need ongoing management; still others need a single consultation to rule out conditions. Effective models triage quickly and route accurately, reducing the time between symptom onset and appropriate care.
• Outcomes measurement: The shift from engagement metrics to outcome metrics is critical. Companies that track symptom improvement, treatment adherence, retention across life stages, and quality of life can demonstrate real value—to patients, payers, and employers.
• Life-stage awareness: Rather than treating each hormonal transition as a separate condition, leading models recognize that puberty, pregnancy, perimenopause, and menopause are connected phases requiring continuous, adaptive care. A woman's mental health history at 25 should inform her treatment plan at 45.

Partners in Women's Health: The Care Model That Scales Real Support

What does effective partners in women's health look like in practice? It's not a single provider or a single platform; it's a coordinated ecosystem.

• Patient + clinicians + care team + tools: The patient is at the center, supported by clinicians who share information, care coordinators who manage transitions, and digital tools that track symptoms and enable proactive outreach. This isn't one-off support; it's continuous partnership.
• Continuity across providers: When a woman's therapist knows about her perimenopause symptoms and her OB-GYN knows about her depression history, care becomes coordinated rather than fragmented. Follow-ups happen. Adjustments are made based on response. Plans are modified as life circumstances change.
• Comprehensive health in action: This is the practical definition of women's comprehensive health. Not a checklist of separate services, but an integrated approach where mental health is woven through every touchpoint—from initial intake to long-term management.

What Investors Should Look For in Women's Mental Health Innovation?

The market opportunity in women's mental health is significant—but not all solutions are created equal. Investors should evaluate companies across several dimensions.

• Clinical credibility and outcomes: Engagement metrics are insufficient. Look for companies that measure symptom improvement, treatment adherence, time to diagnosis, and quality of life. Peer-reviewed evidence and FDA pathways where applicable signal seriousness about clinical impact.
• Distribution that scales: Direct-to-consumer models can validate product-market fit, but scaling typically requires B2B channels. Companies with pathways to employers, payers, and health systems can achieve reach that consumer-only models cannot.
• Retention across life stages: Women's health needs evolve. Companies designed for single-moment interventions (fertility treatment, postpartum support) face churn when that moment passes. Models that retain patients across life stages build more durable value.
• Trust by design: Mental health data is sensitive. Women-specific protocols for privacy, safety, and data handling aren't optional features—they're table stakes for building trust and adoption.
• Proof of reducing misdiagnosis: Companies that can demonstrate shortened time-to-correct-diagnosis or reduced misdiagnosis rates are solving one of the most persistent problems in women's mental health. This is measurable value that resonates with patients, providers, and payers.

Why Portfolia: Investing in Women's Comprehensive Health Beyond Fertility?

Portfolia pioneered women's health investing and is now the most active investor in the space globally, with 46+ portfolio companies and 100+ investments. But our thesis extends beyond fertility—because women's health is a full-life category, and mental health is a core driver of outcomes at every stage.

We back companies building care infrastructure, not isolated point solutions. That means prioritizing models that integrate mental health into comprehensive care, demonstrate measurable outcomes, and scale through clinical validation rather than marketing alone.

The women's health market represents a $600+ billion opportunity. Mental health—when properly integrated into women's comprehensive health—is one of the largest and most underserved segments within that market. We invest at the intersection of unmet need and emerging innovation.

Invest in Portfolia Funds Advancing Mental Health in Women

The gap between women's mental health needs and available solutions won't close on its own. It requires capital, expertise, and commitment to building the care infrastructure women deserve.

Portfolia's women's health funds invest in companies addressing the full spectrum of women's health—from reproductive health to menopause, chronic conditions to mental health. We look for clinical credibility, scalable distribution, and outcomes that matter.

• Investing accelerates solutions: Capital enables companies to expand research, scale operations, and reach more women with effective care.
• Investing expands access:  Funding B2B partnerships brings women's mental health solutions to employers, health systems, and underserved communities.
• Investing improves outcomes: Companies that can demonstrate reduced misdiagnosis, faster time-to-treatment, and better quality of life metrics create value for patients and investors alike.

Ready to learn more? Explore Portfolia's women's health fund thesis and discover how you can participate in advancing mental health in women—from overlooked crisis to integrated care. Contact our team to learn more about Portfolia.

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