Case study: SEO promotion of medical website on Google. A five-year retrospective - Rotgar
Case study: SEO promotion of medical website on Google. A five-year retrospective

Case study: SEO promotion of medical website on Google. A five-year retrospective

SEO promotion of medical website on Google.

The initial promotion stages were discussed on back in 2019, and now this is my full-fledged case with the results of a 5-year SEO promotion since the project start.

  • Organic traffic grew five times in 2021–2022 reaching over three million per month in 2023.
  • Promotion on Google for high competition queries worldwide.
  • Top 1 and 3 for priority high-frequency queries.

Organic keywords
The website is an in-house project of the team
  • Region: global, Google-oriented promotion.
  • Start of work on the website and promotion: 2017.
  • Project language: multilingual, 12 languages.
  • Website type: medical information portal, aggregator assisting in finding the drug analogues worldwide.
  • CMS — proprietary Symfony-based development.

Project team:

  • Manager, project leader
  • SEO specialist
  • Assistant SEO specialist: link builder
  • Two developers (1 senior, 1 junior)
  • Four pharmacists
  • Content manager
  • Moderator
  • Copywriter with medical education

Niche analysis, work plan for SEO promotion of medical aggregator

Top ten target queries in the medical niche rank the following types of websites:

  • Medical clinics by region.
  • Marketplaces, pharmacies selling medicines by region.
  • Forums and knowledge exchange websites, such as Quora.
  • Large mass media such as the BBC and various news sites.

The medical niche is distinguished by a high competition between trusted information websites and E-A-T factors. Rival service comparison showed that many domains and websites in this top-10 have already existed for 5 years or more. In addition, many top domains have about 70 Ahrefs DR which is a very high indicator. Also, the competitors had thousands of backlinks. This meant a newly created site would not be able to take high positions, and thus, promotion is to be planned for 1–2 years ahead.

Today, the website has caught up with and surpassed most major competitors in terms of trust.

backlinc profile
Ahrefs screenshot

The promotion plan is based on competition and the medical information website concept. This includes:

  • Naming: choosing a domain name that is understandable to people from all over the world who speak different languages.
  • Developing a project design with good usability that clearly shows the drug analogues in different countries.
  • Programming the project technical implementation with a convenient drug catalog in different languages.
  • Searching for drug databases in different countries, such as,, and alike, and further translating the active drug ingredients into different languages with the verification by a professional pharmacist.
  • Multilingualism: placing special focus on the hreflang tags, division of a large sitemap into pages in different languages and the website structure.
  • Also, this stage implies a separate plan of getting good trust links for the next year.

Google promotion methods for a medical site:

  • Initially, a thorough technical optimization of the site, interlinking, the introduction of necessary tags and links only to well-known reputable sources, for example, recommendations from the official WHO website.
  • Our advantage turned out to be working on what is now called E-A-T factors within the project back in 2017–2018. At that time Google did not have the algorithms and assessors in place to check the project expert level. There was mandatory verification of all data on active substances by doctors, experts and pharmacists.
  • Posting the project feedback, link building outreach with a strategy of searching for the most trusted donors. For example, links from Wikipedia or educational, government sites

link from

It was also a good decision to get a link from; this made the mass media from all over the world start writing about the project in different languages.

The gradual increase of backlinks, building PBN networks, crowd marketing, listing the company’s information in various directories and aggregators, and continuous article posting on high-quality websites, both through outreach and using exchanges to promote the project


Project work: year-by-year report

The project was released and started being promoted in 2017. After consulting English language experts, the domain was chosen.

In early 2017 the project was launched with only English language support, and later, the Russian version was added. By the end of 2017, the website had been already translated into 12 languages: English, Russian, French, Spanish, Chinese, Japanese, Portuguese, Korean, Italian, German, Arabic, and Turkish.

Initially, the pages containing the drug analogue information were created, such as


In the very beginning, these pages were the main content of the website; due to the parsing of drug databases over 10 million pages were placed on the site at once.

Apparently, since the site launch a well-thought-out internal linking was organized. In 2017, the Google search engine indexed around 200 thousand pages while the traffic kept steadily growing.


Promotion in 2017

The key task when creating the website was to search for databases with up-to-date drugs and to translate their active ingredients into different languages under the supervision of professional pharmacists and doctors. A separate parsing of the database of synonyms for active drug ingredients was required because they are called differently in different countries.

A correct and far-sighted decision was to involve pharmacists in the analysis of the database to have expert analysis on all active drug ingredients. Although the “medical Google update” happened a couple of years later in the fall of 2019, we believed that real expertise and verification of all medical data was extremely important from the very beginning.

Our team always adopts an individual approach to project expertise. Therefore, a separate manual doctor approval was used for all drug data. Gradually, everything was verified, with a note on the date and name of the pharmacist or doctor in charge for such check.

It should be noted that the manual processing of active ingredient data by synonyms took many weeks of a full-time work of each pharmacist.


The project’s multilingual nature called for a non-trivial solution. The task was to find a correct approach to building pages in different languages and the hreflang attribute used for determining which page version is to be displayed for a particular language and country.

It was decided to set the hreflang attribute parameters without geography specification. Google only displayed the language versions of the page without regional targeting, for example:

To avoid duplicates, GeoShape microformatting was used.

Promotion in 2018

In early 2018, the indexing of millions of pages quickly became a problem in Google Search Console. While the site has had good external links since its launch, they were not enough for the project featuring several million pages in the index. The weight of the millions of pages was diluted in relation to the number of external links, so the traffic dipped for a short period at the beginning of 2018.


Due to the large volume of pages, the traffic has a swing character as if the link weight is small relative to the huge number of pages, thus, for Google such sites sometimes look like doorway pages.

The problem was solved by intensifying the mass placement of external links to the site; within a year the traffic began to grow again.

To attract additional link weight, PBN networks were built. For example, sites were made under the real names of pharmacists or doctors. An important aspect of building satellite networks today is to make them not just looking like good small sites but actually being such sites. In addition, other external links were placed on the satellites to gain link power through tier 2.

  • Budget for placing external links: from $3000 per month.
  • Budget for PBN sites — one satellite from $150.

Promotion in 2019

  • Link weight kept increasing, new drug analogues were added, and the texts were improved. There was a lot of painstaking work with millions of pages.
  • In 2019, many medical websites lost traffic dramatically as Google updated its guidelines for assessors and algorithms regarding E-A-T factors. However, continued to grow in terms of traffic
  • The drug databases were constantly moderated and updated, and new functionality was added, such as an advanced filter and drug description cards, which led to additional and immediate traffic growth.


A certificate from (a non-profit organization that actually monitors health-related websites for errors) was added. In 2019, it was particularly relevant due to the influence of E-A-T factors for showing Google that the site was verified by independent specialists.


After further analysis of traffic sources, a new growth point was defined. Most site visitors use mobile devices, and while the site response has already been fast, efforts were made to improve loading speed for smartphones.


There is one common problem with smartphones in different countries: often the internet speed is relatively low. The task was to improve the website loading speed on mobile devices.


After improving the site response time and adding descriptions to drug cards, organic traffic grew even faster in 2019 than during the previous years.


Promotion in 2020–2021

In 2020, traffic growth was slower than in 2019, but the team kept looking for new growth points.


It was decided to improve the drug description cards, for example:


More text, interlinking with pharmacological groups, methods of application, descriptions, instructions, and prices in different countries were added.

Link building continued while the link mass was constantly growing. As the site has been already well-optimized technically, the additional drug description pages in different languages in combination with link building resulted in a fivefold traffic increase in 2021.


In 2021, as the website has already had an impressive link profile by that time, we also increased the number of placements for all link types: outreach, crowd, PBN networks.


Promotion in 2022

In 2022, we conducted various experiments on our own sites to integrate successful experiences into client projects. It is known that Google loves fast mobile pages, and in 2019, speed rise led to a sharp traffic increase.


The arrow indicates the date two weeks following the speed improvement — May 1, 2019.

Therefore, in 2022, further experiments and attempts were taken to maximize the optimization of page loading speed for mobile devices and computers.


However, Google’s algorithms did not perceive the changes as expected; this cause the decline in page usability although the tests showed that everything was better than before.


This problem was resolved logically: if Google did not like the change with maximum acceleration, then everything should be reverted back, and this is exactly what the team did. The effectiveness of mobile pages began to grow again resulting in a gradual traffic increase.


Thus, by the end of 2022, there was no significant growth in traffic as in 2021. The growth of the link mass slowed down but did not actually stop.


Despite a high competition in the niche of medical information sites, at the beginning of 2023 the traffic is growing well again. The project team is developing the next stage of growth points to further increase organic traffic.

Rival service comparison in 2023


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