Why The Five & One?
Health care doesn’t fail women because we lack information. It fails because systems are slow to change and rarely built around women’s bodies, lives, or timelines. The Five & One exists to make those systems visible.
Each week, we share five signals shaping women’s health- across care, policy, research, and access- plus one thing just for you. Not trends. Not tips. The real forces that decide what care women can get, and when.
This week - why women experience longer-lasting pain, supply shortages in menopause care, retail players are reshaping fertility access, more gut health benefits, reimbursement and innovation, and the rise of peptides in women’s health.
01. Innovation Isn’t the Problem. Reimbursement Is.
51& Founder and CEO Jodi Neuhauser recently participated in a Milken Institute workshop bringing together payers, regulators, providers, and innovators to examine why so many women’s health innovations struggle to reach patients.
Case studies across cervical cancer, endometriosis, and cardiovascular disease revealed a consistent problem: even when new technologies receive regulatory approval, insurance coverage often fails to follow.
The discussion made one thing clear; reimbursement is the lever that determines whether innovation actually reaches women.
The Breakdown
FDA approval does not guarantee insurance coverage. Many technologies are cleared to enter the market but still aren’t reimbursed by payers.
Payment rules often discourage long-term investments in women’s health. Many conditions require care that shows value over years, while payer models focus on short-term costs.
Outdated coding and coverage structures limit adoption. Without clear reimbursement pathways, doctors are less likely to offer new treatments.
The Breakthrough
Across sectors, leaders are beginning to align around a simple reality: fixing reimbursement may be the single most powerful lever for scaling women’s health innovation.
Work is beginning on practical coverage playbooks and stronger economic cases to support new care models.
02. No, The Pain is Not in Your Head
Big Idea: Women may experience longer-lasting pain due to biological differences in the immune system.
New research suggests that certain immune cells that help “switch off” pain signals are more active in men than in women. Hormones like testosterone appear to play a role.
This finding challenges decades of assumptions that women simply perceive pain differently.
The Breakdown
Pain is still largely measured using subjective scales, which often overlook biological differences between sexes.
Women’s reports of chronic pain have historically been dismissed as emotional or exaggerated.
Research on sex differences in pain biology has been underfunded and understudied.
The Breakthrough
Scientists identified immune cells called IL-10–producing monocytes that help resolve pain faster in men.
Understanding these mechanisms could lead to new treatments for chronic pain, and may help reduce the medical gaslighting many women experience.
03. Menopause Care Meets Supply Chain Reality
Big Idea: A shortage of estradiol patches is exposing how fragile menopause care supply chains really are.
Demand for hormone replacement therapy (HRT) has been rising, especially after the FDA removed the black box warning tied to earlier hormone studies.
But manufacturing and supply disruptions have left many women scrambling for alternatives.
The Breakdown
Transdermal estradiol patches are widely considered one of the safer forms of estrogen therapy.
Demand for menopause treatment is rising quickly, but supply chains haven’t kept up.
When patches aren’t available, some women turn to compounding pharmacies, where formulations can vary.
The Breakthrough
Other delivery options, including creams and gels, can help fill gaps while shortages continue.
The disruption is also bringing new attention to menopause care, which may drive greater investment in manufacturing and treatment access.
04. The Microbiome Link Changing How We Understand PCOS
Big Idea: Gut bacteria may play a bigger role in PCOS than researchers previously understood.
New research suggests postbiotics, beneficial compounds produced by gut bacteria, may help improve insulin sensitivity, inflammation, and hormone regulation in women with polycystic ovary syndrome.
This could open the door to new treatment strategies that go beyond hormones.
The Breakdown
Most PCOS care today focuses on managing symptoms rather than addressing root causes.
Women with PCOS often see multiple specialists, leading to fragmented care.
Research investment in PCOS still lags behind its prevalence and long-term health risks.
The Breakthrough
Postbiotics may help regulate metabolic and hormonal pathways involved in PCOS- potentially creating new non-hormonal treatment options.
05. When Fertility Care Becomes a Membership Benefit
Big Idea: Retail giants are starting to reshape how fertility care is delivered.
Costco recently announced a partnership with IVI RMA fertility clinics and Sesame, a healthcare marketplace, to offer discounted IVF services to members.
The move highlights a larger shift: fertility care is increasingly being delivered through consumer and workplace platforms rather than traditional insurance systems.
The Breakdown
IVF remains financially out of reach for many patients.
Insurance coverage for fertility care is inconsistent across states and employers.
Many patients must navigate complex benefit structures to access treatment.
The Breakthrough
Large retail partnerships may help expand negotiated pricing and increase visibility around reproductive health needs.
They also signal a broader shift toward consumer-driven healthcare models.
Your+1: A Primer on Peptides in Women’s Health
Peptides have become one of the most talked-about topics in wellness, longevity, and metabolic health, but many people don’t fully understand what they are.
Simply put, peptides are short chains of amino acids that act as signaling molecules in the body. Some already play major roles in modern medicine.
Where peptides show up in women’s health
• Metabolic health & PCOS: GLP-1 medications are peptide drugs that help regulate blood sugar and weight.
• Fertility care: Peptide hormones like hCG and FSH are widely used in IVF treatments.
• Menopause & aging: Researchers are exploring peptides that may help with sleep, metabolism, and muscle preservation.
• Cardiovascular health: Some peptides influence inflammation and vascular function.
What to know
• Evidence is strong in some areas but early in others.
• Many peptides used in wellness clinics are off-label or compounded.
• Because regulation and research are evolving, medical guidance is essential before using peptide therapies.
• Many peptide therapies marketed today fall outside standard FDA-approved uses, which makes clinical guidance especially important.
(Much of the current research on peptides comes from endocrinology, metabolic medicine, and reproductive health studies.)
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P.S. If this issue helped you better understand how women’s health really works, consider sharing it with a friend, colleague, or family member. The more women who understand the system, the more power we have to change it.