Pollie is a telehealth solution for female hormonal imbalances founded by Jane Sagui and Sabrina Mason. Their mission is to streamline support for reproductive hormone imbalances like PCOS, endometriosis, and amenorrhea, which impact over 20% of women and lead to issues like infertility, diabetes, heart disease, and more. The platform currently connects women to virtual hormonal health specialists who can help them manage their hormonal imbalance symptoms in a more efficient and effective way, and their vision is to create a one-stop-shop for hormonal health.
What is the story behind Pollie? What inspired you to form this company?
I started Pollie along with my co-founder Sabrina Mason to solve the problem of female hormonal imbalances like PCOS.
I was diagnosed with a condition called polycystic ovarian syndrome (PCOS for short), which impacts at least 1 in 10 women, when I was a freshman in college. For me, symptoms were bad hair loss and terrible acne – neither of which someone wants to experience as a college student, but fairly superficial. It took a year to get a diagnosis and included endless bouncing around between my PCP and different OBGYNs, and then an additional year to find specialists who were effectively able to help me manage my symptoms.
Throughout the years, it has amazed me how difficult it is to find proper support for my PCOS. To properly advocate for myself I have effectively become an expert in my own specific case, and still experienced instances of doctors not listening to me when I said something felt off. I found myself pouring hours into researching specialists at certain points – a difficult task during a strenuous work schedule – and knew this was a problem that other women were facing with PCOS as well as other hormone-related conditions like endometriosis, various forms of amenorrhea, fibroids, and more.
After years of analyzing digital health companies as a consultant and VC analyst, I was thinking about what I wanted to do next. I had coffee chats with a handful of women’s health startups but kept coming back to the same issue: there was nothing focused specifically on solving for hormone imbalances like PCOS, endo, and amenorrhea, which impact a combined total of 20 -25% women (and that is conservative!).
I started Pollie off the side of my desk while still working full-time at a venture fund as a simple tool to pair women to virtual hormonal health specialists based on preferences like communication style, treatment methods, specialty areas, and more. I made the decision to leave my job in March to start building Pollie full-time; this is when my co-founder Sabrina jumped in.
Sabrina and I met on a study abroad trip in college (we were roommates in a single-room quad, imagine that!). We were fast friends and stayed in touch over the years as we graduated college and both pursued careers in health tech. Sabrina, who has her MPH and is obsessed with all things public health and access to quality care resources, was astonished when I explained the stats for hormone imbalances and abysmal diagnosis rates (half of cases go undiagnosed, and depending on condition it can take 10 years to receive a diagnosis).
Sabrina’s experience working with health systems along with previous operational and product-related roles within health tech companies was very complementary to that of my own. She immediately added a much-needed perspective to Pollie’s vision and mission in terms of tactfully planning for how we will one day make this a scalable, affordable, and impactful solution.
Why is it so complicated to manage a hormonal imbalance? What are the implications of an imbalanced hormonal system?
Hormonal imbalances are highly complex conditions often caused by some combination of genetics, metabolics, lifestyle, inflammation or autoimmune issues, and other factors. This makes it difficult to pinpoint the root cause, and also can make them difficult to diagnose: no one case is the same.
When it comes to conditions like PCOS and endometriosis, they are lifelong disorders: symptoms can be managed in many cases, but women will always need to be aware of them and the predispensities to other health risks that come alongside them.
Let’s look at PCOS risks as an example. While it is most widely known as being the #1 cause of infertility, it is not just a fertility disorder. It also leads to a 50% chance of developing diabetes by age 40, increases your risk for heart disease by 4x – 7x, makes you 8x more likely to develop anxiety or depression, and increases your risk of estrogen-related cancers by 3x.
That said, these risks are manageable to a large extent. If you are one of the 70 – 90% of women with an insulin-resistant case of PCOS, you need to be aware of your heightened risk for diabetes and also heart disease and eating a lower carb diet can be very effective. If you have PCOS and do not menstruate frequently (one of the most common symptoms of the disorder, but manageable with lifestyle changes, medication, or a combination of the two), endometrial cancer is something you should watch out for, as built-up endometrial tissue (which should shed every month during menstruation) can lead to cancer over time. Birth control can help lower this risk (but does not solve the underlying problem itself), as can working with a specialist who is able to help regulate ovulation and your cycles with diet, exercise, and other lifestyle factors.
That said, there is no one-size-fits-all approach even within individuals. For example, my PCOS symptoms in college were largely catalyzed by the type of birth control pill I was on, which caused high androgens. But today (or at least last time I checked!) my adrenals and an inflammatory response to some foods actually tend to be more responsible for any symptoms that do pop up.
TL;DR: The complicated factors that cause a hormone imbalance as well as the ability of these factors to shift over time makes them highly individualized conditions to manage. But, it’s incredibly important that people do learn how to manage their specific condition, because there can be serious health consequences if a hormone issue is left untreated.
What are the best treatments and diagnoses for women who suffer from PCOS, Endometriosis, Hypothalamic and Infertility? How common are these health conditions?
PCOS is an ovulatory disorder that impacts 1 in 10 women. It is characterized by fulfilling 2 of 3 of Rotterdam’s criteria: high androgens, polycystic ovaries, and irregular or absent ovulation.
Endometriosis is a condition where your endometrial cells (e.g., cells that line your uterus) start to grow in other parts of your bodies, often around your ovaries and fallopian tubes and even digestive tract. It can cause immense pain and is often catalyzed by an underlying hormone issue such as estrogen dominance. Endometriosis also impacts 1 in 10 women.
Amenorrhea is defined as period loss. In adults, the primary type of amenorrhea is a condition more specifically known as functional hypothalamic amenorrhea (FHA), which often impacts female athletes. This is when your body stops ovulating out of a fear of scarcity, and can often be solved by eating less, moving more, and more effectively managing stress. It’s estimated that at any given time, up to 5% of women are experiencing FHA.
Infertility can have a variety of causes, most commonly due to one of the three aforementioned conditions. It is currently defined by the medical community as when a heterosexual couple (a parameter that is a problem in and of itself!) tries to conceive unsuccessfully for 12 months. In the US, 1 in 8 couples experiences fertility problems.
While treatment varies by condition, in general we like to bucket this into two main groups: conventional strategies, which generally involve pharmaceuticals, and more lifestyle-based treatments. Some people fall squarely into one bucket while others use a combination of the two. In terms of conventional strategies, there are a few commonly-prescribed medications:
- Hormonal contraceptives: These are one of the most commonly-prescribed treatments for PCOS, endometriosis, and in some cases hypothalamic amenorrhea. With the exception of some hormonal IUDs, all forms of hormonal contraceptives (e.g. the pill, the rod, the ring, the patch) puts your body into a state where it is actually going through its monthly fluctuations, and you do not ovulate. As a result, your uterine lining does not build up. This can help protect against endometrial cancer. However, birth control is just a “band-aid” treatment and does not fix any underlying issues, so if your birth control method is helping control your symptoms and you discontinue use to start a family (or for other reasons!) your symptoms will return.
- Metformin: Metformin is a medication often prescribed to women with insulin-resistant PCOS. It can be very useful in cases of uncontrolled insulin resistance, as this metabolic state can ultimately lead to diabetes and more indirectly heart disease. Some women may try metformin for a short time to regulate their insulin before trying a more lifestyle-based approach. Digestive problems are a common side effect of this drug.
- Spironolactone: Otherwise known as “spiro,” this drug is often prescribed to help combat acne and hair loss. In some people, spiro is quite effective at lowering “androgens,” or male hormones like testosterone. High androgens are commonly seen in women with PCOS and lead to the aforementioned symptoms.
- Clomid and fertility treatments: Irregular ovulation is a hallmark of PCOS and functional hypothalamic amenorrhea. Clomid can help kickstart ovulation for couples who may not be ready to try an IUI or IVF, but oftentimes the latter treatments are attempted also. Endometriosis can also lead to irregular ovulation; if this is mostly due to a hormone issue a drug like Clomid may work, but if one’s endometrial cells are disrupting their ovaries or fallopian tubes directly an IUI or IVF may be more helpful.
- Lifestyle strategies, on the flip side, do address underlying imbalances in a way that medication does not. That said, patience is key when it comes to these approaches: while everybody is unique and some people may see rapid changes with adjustments to their routines, it takes most people at least several months to see a change:
- Nutrition: In general, eating an anti-inflammatory diet that is high in antioxidants is what is best for hormone balance. This means different things for different bodies; for example, while colorful vegetables, high-quality protein, complex carbs, and healthy fats are generally “good” for everyone, some bodies may have an inflammatory response to healthy foods like eggplant or tomatoes. Diet should be an individualized tool, and before making adjustments it’s recommended you work with a nutritionist or registered dietitian who can help steer you in the right direction (and ideally take labs and / or a food sensitivity panel before starting you on a protocol). As noted, there is one general guideline when it comes to insulin-resistant PCOS: maintaining balanced blood sugar is even more important for these cases, and that may mean being more mindful about refined carbohydrates and total carb intake in general.
- Movement: Movement is also a good tool for hormone regulation. Like nutrition, movement is not a one-size-fits-all! For example, if you have insulin-resistant PCOS, you may find that short high intensity workouts help with insulin regulation most effectively, but if you have PCOS that is catalyzed by your adrenals, or even endometriosis that is caused by internal inflammation, exercise like pilates and yoga may be a better option. FHA is one case where people should be particularly mindful of how much movement they are getting: since this condition is caused by a caloric deficit and high cortisol levels, it can be helpful to take a break from formal exercise and stick to easy walks until periods return. In general, it’s important that you find a type of movement that is not “too much” for your body, which gets us to…
- Stress Management: Cortisol, a stress hormone produced by our adrenal glands, is the “fight or flight” hormone that arises in times of stress. Thousands of years ago, it would help humans run away from saber-tooth tigers. Today, we don’t have any saber-tooth tigers, but our adrenals still produce cortisol in response to what we perceive as stressful situations (e.g., a crammed work schedule, scary news headlines, fighting with a partner or roommates). Notice anything interesting about these examples? They are everywhere, meaning most of our bodies, unless we are mindful about stress management, can easily get into a state of constant stress. Short-periods of high cortisol are good for us – they can help us reach fast in a dangerous situation or nail an important meeting at work – but chronically high cortisol can lead to inflammation and severe hormone disruption. For this reason, knowing your stress threshold is incredibly important for hormone balance, and developing habits that can help you manage stress (e.g. meditation, taking a bath, playing with your dog, baking cookies, putting your phone away for a day…) more effectively is incredibly important.
How are you helping these women to find a virtual hormonal health specialist?
Right now we match women to virtual hormonal health specialists. We have a 2-minute signup form where members share their preferences in terms of budget, communication style, treatment preferences, desired specialities, and more. Upon completion of the form and account creation, each new member is then matched to 3 of the dozens of verified providers in our directory. Our team provides a concierge booking service from there, and all 15-minute discovery calls are free.
The very specific pain point we are solving for with the current platform is finding a specialist that fits your style. In my experience and the experience of others I’ve spoken with, there is nothing worse than working with a provider that does not jive with your goals, priority, and lifestyle. But, it can take days if not weeks of Googling to find that “perfect” provider, and that time spent Googling is a privilege that we do not all have. We have turned that process into a 2-minute process.
Soon we will be launching on booking and billing, meaning you will be able to schedule all appointments directly through Pollie, and in the future we will be bringing in additional features that we are very excited about including HIPAA-compliant messaging, video, support groups, care teams, symptom tracking, and more.
What is the vision of Pollie? How are you aiming to disrupt this under-served market?
Our vision is to be a digital therapeutic for hormonal health, so that members can receive all of their care and manage their symptoms directly through our app. Over time we hope to build in automation to the platform, so that there can be an offering for everyone no matter where they are on their hormonal health journey: at some points (e.g. during symptom flares), more intensive human support may be needed, while at others, predictive insights and suggestions will hopefully be enough. Our intent with eventually creating a partially-automated product is not only to lower costs, but to create a platform that are ingrained in people’s routines.
Beyond product, we have lofty goals when it comes to our brand’s impact on research, education, and awareness. A large part of the problem with hormone imbalances is that many people just don’t know about them, and the concentration of those that are aware is generally within wealthy circles. Hormone issues impact BIPOC communities more frequently and intensely than white women for a variety of issues, and research funding for these disorders has been abysmal at best. It’s time to change that.
From a business model standpoint, we are starting with a B2C model to learn from the end-user what is needed from a product like this as well as show early health and cost outcomes, but our ultimate goal is to create a reimbursable solution with health plan partners so that the subscription is covered by insurance.