Vira Health, a UK-based startup offering personalized digital therapy for women going through menopause has closed second-round funding. It received $12 million from Octopus Ventures as lead investor, and also participated in Optum Ventures’ US-based VC fund.
The latest round of financing was also open to existing investors who were part of the April 2020-founded business. Vira’s PS1.5M seed, announced last summer, included backing from LocalGlobe and MMC Ventures, Amino Collective, as well as other angels. The startup hesitates to call this “second raise” in standard fundraising terminology, but when asked, it refers to it as an equivalent to a Series A.
Stella, Vira’s mobile app, was launched in the UK in August 2013. It provides information and targeted support to women experiencing menopausal symptoms.
The app could offer exercise programs along with diet advice, cognitive behavioral therapy (CBT), to help combat mood disorders or insomnia, or any other combination of personalized support programs.
To further increase support, it is important to use a community approach. Users can be brought together for Zoom chats and Q&As on discussion topics to quiz experts or share their experiences.
This type of digital therapeutics is very familiar. In the past decade, we have seen many established therapies being digitized to scale to reach more people who need it.
The menopause has received less attention than other areas where digital therapeutics startups have been active for many years. There are a growing number players in this space, including Elektra Health and Gennev, Peppy, Lisa Health, and Lisa Health.
We’ve seen a boom decade in digital health. However, we have also seen the rise and prominence of femtech. This has led to increased funding for female-led startups which address issues that only affect women. The attention-value equation is changing. A UK startup that addresses a problem that ‘only’ affects a small subset of women (middle-aged females) can now close a double-digit second round in just a few years.
Andrea Berchowitz, co-founder and CEO of Vira, said that it wasn’t easy raising the latest tranche of funding.
“We spoke to one US investor — who I’m certain would not be thrilled if I told her who it was — she stated that she had seen 30 menopause startups but hadn’t done an investment yet.” She also recounted that one of the obstacles for the unnamed investor was the question of whether women in the US were actively seeking such care. This is because the discussion around menopause in the US isn’t as advanced as in the UK, where Berchowitz insists that the topic receives a lot of mainstream coverage
She adds that fundraising is difficult. “Fundraising is so hard,” she says. Sometimes you forget how difficult it was, but it’s hard.
“We know that it is difficult for women to raise funds… all data points show that. Let’s not pretend that it isn’t. When you raise money for a product no one has ever used — either they are young or older — we need someone who is at least 45 years old and probably 50. We also need someone who is female.
“But I think it’s an interesting test because… people that are unwilling to learn new things probably won’t be right for us as investors. Our approach was to target funds that have previously invested in digital therapies or women’s health. We knew that we could have a discussion with them about the things we were building.
Kamran Adle (health investor at Octopus Ventures), commented on Vira’s funding in a statement. “Menopause [is] an enormous, yet underserved, and underfunded market. One billion women (or approximately 12%) will experience menopause by 2025. We are excited to partner with the Vira health team.
Julia Hawkins, General Partner at LocalGlobe and Latitude said, “We are happy to invest in Vira health.” “There is strong interest in menopause healthcare right now, and this team is committed to building what women need and want.”
Image credits: Vira Health
Berchowitz said that the second raise will go towards building the app’s care path. This includes launching a Telehealth component to allow users to book a virtual consultation and receive prescriptions for pharmaceuticals (such hormone treatment). Instead of having to go to their regulator doctor, they can go online.
Berchowitz said that it is also preparing for a US launch.
It is difficult to deal with the many facets of menopause. There are many symptoms that can be caused by the menopause, including mood changes, sleep disruption, and brain fog. It can also cause changes in menstruation (i.e. Before periods stop, low libido, painful sex and night sweats can all be signs of a woman’s incontinence.
It personalizes the therapeutic package based on the information the user gives it to ensure it is focusing on the most relevant support.
Berchowitz explains that the app works by allowing women to log in and tell us which symptoms are most bothersome. This was done because menopause will be a completely different experience for every woman. No two women have the exact same symptoms, the same health history and preferences.
We ask that you tell us about what is bothering you most. If it’s incontinence or sleep, then we can help. We’ll help you if it’s weight gain, low mood or anxiety. Then we analyze the symptoms and create a 12-week program that will help you get relief.
She adds that each program is based upon the best science available for that particular symptom. “So, if it’s sleep, it’s built upon cognitive behavioral therapy or sleep scheduling. If there are pelvic floor issues, such as incontinence and painful sex, that’s done with pelvic floor activation.
Berchowitz says that the science behind these app-based interventions is based on current best practices per symptom. However, she confirmed that the app is not currently a regulated device for medical use (rather, it’s an information service).
The nature of interventions will change as Stella grows, notably when Stella goes beyond providing information-based support and becomes a telehealth platform that may be able to issue prescriptions for pharmaceuticals. Berchowitz also confirms that the product’s regulatory status could change, which suggests that a request for regulatory clearance might be an option for the company.
This is not a new trend. We have seen other femtech companies evolve from launching a consumer service to creating a regulated product. Period app Clue was approved by FDA for digital contraceptives.
As mentioned above, Vira is not the first to digitize CBT-based therapeutic approaches.
It can instead draw from all the existing success in digital health — drawing inspiration and ideas from the growing number of digital therapeutics implementations, such as those of Sleepio (which was recently funded with a $75M Series B from Softbank’s Vision Fund).
Berchowitz says that this (now) vast field of digital therapeutic startups has been passive support for Vira in the fundraising front.
Octopus, which has Quit Genius, Sleepio and other digital therapies in its stable, are our investors in this round,” she noted, adding about Optum: “They are in Kaia Health, Equip, which is a digital treatment for eating disorders.
“And that allowed for us to have an amazing conversation, like, you understand how Kaia works and how it was sold. What their challenges are and what opportunities they have. So let’s talk about menopause using that frame. It fits in that frame.
She continues, “We weren’t convincing people that digital delivery of lifestyles and behavior changes was a completely new idea.” We were saying that maybe you don’t know, but lifestyle and behavior changes are important to manage menopause symptoms. There are specific exercises, diet and cognitive behavioral therapy. Investors refer to this as a “horizontal roll-up”. It’s not reasonable that a woman would want to use Sleepio, NHS Squeezy for the pelvic floor, plus an Elvie trainer plus, plus and more.
“So, the explosion in digital therapies allowed us just to say — yeah that’s me. This is the way we see it.
“Optum [also] is very US-health focused so we’ve tried [to surround ourselves with] as many of that experience as possible while continuing to build here, because we do just get that feedback circuit faster because menopause [public/media agenda],” she says. She also elaborates on the strategy for the second raise and notes that Octopus’ “stated interests in taboo subjects” made it “easier [to] go to them.”
How about product efficacy? Some of the funding will be used to conduct clinical trials. Berchowitz also mentions the feasibility study that they did from December to February. It showed that 75% of Stella-treated women experienced better symptoms. She also notes that they poll users weekly to obtain a more informal “well-being score”.
Image credits: Vira Health
She suggests that both measurements are important as they help to determine if you have any symptoms. The thing about menopause, it’s a bio-psychosocial big thing. It’s possible for your symptoms to be out of control. However, you may feel a lot better because you have a lot of other things going on in your life. We try to trust our users. If they feel better, that’s great. If they don’t feel better, we should do something.
She says that while the startup cannot quantify the benefits users receive from using its app-based programs, it could be linked to a placebo effect. However, if women find the targeted support helpful in helping them navigate difficult times in their lives, does it really matter what or why?
Berchowitz says that sometimes menopause can be caused by fluctuations in your oestrogen. This means that even if you’re on hormone replacement therapy and performing pelvic floor activation, it might still be extremely difficult. There is no magic bullet that will fix everything for all women. I believe that placebo is one way to say it. But awareness and information can help remove some of the fear.
The Placebo question aside. One thing is certain: There is a large opportunity for startups to step in and provide specialized care for middle-aged women for a fee. (Including, evidently, in the UK where healthcare is available free-at-the-point-of-use.)
Berchowitz explains why a telehealth component was necessary. “Not everyone receives high-quality menopause care from [their GP] — that is something we hear time and again,” she says. We are not trying to become a GP service. We want to be a specialized service that women need to access care during menopause.
Vira won’t disclose how many users its app currently has, but Berchowitz says that the US will be a difficult market for the company to grow due to the fact that discussion about the menopause in the US is less well-developed than it is in the UK.
The US has a different healthcare system. She also notes that states can have a wide range of healthcare models. Vira will therefore spend time adapting content and localizing it to ensure that the tone and language are consistent.
Stella’s business model is two-fold for Vira: A direct to consumer subscription and a b2b2c strategy which targets employers to pay for the service and makes it available to employees as a benefit. Berchowitz confirmed that it will use the same approach in the US.
“The US model will be very similar because I believe the workplace angle is our priority. We have many conversations with employers who are making changes in their approach to benefits. The focus on women, particularly senior women, is growing — it’s not enough, but it is increasing. So the conversation turns to ‘if you offer better support for women during menopause, you can keep them more, and you can help them get that next promotion. This also means you have more role models.
It’s louder here than in the US, but it started in the US. The workplace benefits are one that we will continue to support, according to me.
Berchowitz’s workplace focus is also where it all began for him.
Vira says that the idea for the company was born out of a desire to make a difference in the under representation of women in senior leadership roles. She has worked for McKinsey for many years and for the Bill & Melinda Gates Foundation for many years.
She tells ProWellTech that she had been in senior positions, and that the lack of women at top positions was something that was discussed a lot. So I knew that I wanted to do something to help women get over that last promotion or in the workplace. I wasn’t sure exactly what issue I wanted to address, but I knew it was about women getting into senior positions.
As she researched the topic, she heard stories of women who had lost their jobs or struggled to deal with the demands of professional life.
Per Berchowitz, it was crucial to find the right cofounder for Stella. Her co-founder, Dr. Rebecca Love is a chronic disease epidemiologist who is also an expert in behavior modification. She brings the medical expertise necessary to support a digital recasting lifestyle change-based therapeutics.
Berchowitz recalls, “I was very lucky to meet Rebecca.” “She was concerned about obesity and diabetes at that time and we became friends. She believes that menopause is an amazing point to enter later life health. This is where she can manage her symptoms with nutrition, exercise, pelvic floor activation and strength training. This lifestyle and behavior change not only provides relief for immediate symptoms but can also improve long-term health.
“So, we sort of met over the idea that menopause could potentially be a really fascinating and untapped way for women to truly change their lives over time — and so Vira Health was created.”