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Pia Mancini knows what it’s like to sense that something has changed and still be told you’re too young or your labs are fine. After developing debilitating migraines at 37, she spent years looking for answers before learning that perimenopause could be part of the picture. That experience became the starting point for Give Zero, and it’s what drew us to this conversation: her determination to help other women understand their hormonal health and feel heard.
In this conversation, we explore what Pia’s search for answers taught her, how other women’s stories shape what she’s building, and why serving Spanish-speaking women means more than translating an app. We also discuss her hopes for Nova, Give Zero’s AI companion, and how tracking patterns could help women have clearer conversations with their doctors. Throughout the interview, Pia returns to a question she doesn’t want another woman to have to ask: “How come no one told me this before?”.
1. You’ve written about developing debilitating migraines at 37 and spending years hearing “you’re too young” or “your labs are fine.”
How did that experience change the way you saw your own health and what you needed from the people supporting you?
I’ve always been quite a health geek. I tried biohacking, experimenting with devices, and doing functional medicine before it became a buzzword, but nothing prepared me for developing chronic migraines. It helped me to really focus on myself and prioritize and protect my sleep, as well as drop alcohol and gluten. It was hard, because I live in a place with a late-night dinner and drinking culture. Eating at 7 p.m. is a bit of social suicide in Madrid! My girlfriends carried me through.
There’s nothing as powerful as a network of women there for you during life adjustments.
2. Was there a particular moment when searching for answers for yourself became a decision to build something for other women?
Totally! Because nothing I was doing helped me, I was convinced that I was doing something wrong. I was only getting worse. I went into founder mode and read everything I could about the female brain. That’s when I found out there was something called perimenopause (think seven years ago) and that the variations in hormonal levels that came with it could be making my migraines worse. I went to see my OB-GYN with all my literature, my APOE4 gene, my mom’s menopause age (45), and he dismissed me like I was talking nonsense. He (naturally) sent me home because I was too young and didn’t have hot flashes. That’s when I thought, if this is my experience when I am quite well informed and can go to an out-of-pocket provider and can advocate for myself, what’s the experience of other women like? That was the beginning of this journey.
3. Your story raises a bigger question about the support available to women who know something is changing but don’t yet have an explanation.
From your perspective, where is the biggest gap in how women experience perimenopause: research, recognition, access to care, or help making sense of their own symptoms?
All of the above! Where to start? Research on menopause is very limited, considering this is something all women go through and that impacts longevity so heavily. This effect is now compounded by AI that trains on biased and incomplete data. While this is true for all female health, menopause is even worse. Only nineteen (19) meta-analyses on menopause and health care records show how menopause is almost never recorded in patient intake forms and history. So there is no data that can look at crossing conditions with menopause because doctors simply do not ask or do not record her reproductive state. We have no way of looking back. I think everything else stems from this darkness.
4. Language is a personal part of how we describe what we’re feeling and ask for support.
What role do Spanish-speaking women play in your vision for Give Zero, and what does serving them well require beyond translating an app?
What a great question! All of us in our team are bilingual Spanish native speakers, so we simply make Spanish a peer language to English. We don’t translate. We write in both languages. I have to admit we are a tiny bit obsessed with the tone and how we speak to women. We pore over texts to find a balance between caring, informing, science-based, not patronizing, not infantilizing. We are that knowledgeable friend who treats you like the grown-up you are and always has your back.
5. Your own experience gave you a starting point, but every woman brings a different story.
What have conversations with other women helped you understand about perimenopause?
Some I will never forget. That woman who told me she spent two years thinking she had no desire for living, while her care provider loaded her with antidepressants and anxiolytics, and no one told her to check her hormones. Her testosterone had plummeted. She needed MHT, not Xanax. Or that girl who approached me after a talk recently to share how her sister had to have her ovaries removed, and the first time she heard about hormone therapy was during my talk. No one had told her she would plunge into menopause overnight and would need HRT. Another reached out on LinkedIn to share how her doctor mentioned that she might have endometriosis nine years after she had asked him if that could be what she had. These conversations are why I built Give Zero. I do not want another woman to say, “How come no one told me this before?”.
6. Building with the people you serve also means giving them space to shape what comes next.
How would you like the women using Give Zero to contribute to its development?
I need to get better at this, to be honest. We do outreach and schedule calls with women, but I would like to have a better, more open and continuous way of doing it without it feeling like another burden on women. It’s a hard problem.
7. Give Zero presents Nova as an AI companion that connects a person’s symptoms, sleep, cycle and other health data over time.
How do you hope Nova helps women make sense of what they’re experiencing?
I want Nova to make women’s lives easier. The other day I was at my OB-GYN appointment, and I was telling her about some random spotting I’ve been having for a couple of months. She asked if I felt my migraines were in sync with the spotting. Instead of feelings, I asked Nova, which cross-referenced both symptoms and gave me the exact answer with examples. Nova is amazing at finding patterns across data. Are your brain fog days cyclical? Are they perhaps worse when your HRV dips? Are your cycles becoming a bit erratic, and can your basal temp help you anticipate windows? Is that nagging feeling of irritation coming up more often?.
Give Zero is a toolbox, one that helps you own your hormonal health, make sense of this rollercoaster of symptoms and feelings and talk to other women (and soon doctors) who can support you.
8. Your story highlights how difficult it can be to explain what you’re experiencing when you don’t yet have the words or a clear pattern to point to.
How do you hope Give Zero helps women feel more informed and confident when discussing their symptoms with a healthcare professional?
This is so important. Give Zero generates a report on the fly with all your data for you to share with your doctor. It includes a highlight of your biomarkers in the context of your symptoms and needs, your cycle data, symptom tracking data, and any wearable data that changed significantly. It is not the same to show up saying, I think I have had a couple of hot flashes, or I don’t feel quite like myself as to show up armed with clear data that helps you advocate for yourself.
9. Some readers may recognise parts of your story but feel unsure whether their own experience is worth bringing up.
Looking back at the beginning of your journey, what would you want to say to a woman who senses that something has changed but worries she won’t be taken seriously?
I would say two things.
First, your symptoms are real, and they matter, regardless of what your labs say.
A perfect lab test does not mean your symptoms are in your head. They are clinical data and if your doctor is dismissive, change doctors.
Second, it is never your fault. You are not doing anything wrong.
Whatever you are suddenly feeling has roots, and you should not have to suffer or endure it.
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While this blog discusses health topics, it is not a substitute for professional medical advice. Always consult your doctor or other qualified healthcare provider regarding any question you might have regarding your health.
In Conversation With
Pia Mancini is Founder & CEO of Give Zero, a digital health solution for women in perimenopause and menopause. Previously, she was co-founder & CEO of Open Collective, a transparent finances platform that unlocked over $200M in financing for communities around the globe, and co-founder of Democracy Earth and DemocracyOS, open-source civic technologies deployed worldwide.
Some other articles on a related topic you may like to explore:
Hormonal and Other Changes in Your 30s and 40s: A Conversation with Lauren A. Tetenbaum, author of Millennial Menopause
In Conversation with Cynthia Thurlow: Your Gut and Hormones Have Been Talking Your Whole Life
In Conversation with Dr. Jessica K. Lebental: Bioregenerative Skincare, Perimenopause, and What Women Deserve to Know