Menstrual cycle is a monthly occurrence for women, but it seems that it is still plagued with misconceptions. Since many see it only as a part of ovulation, a lot of women overlook proper menstrual hygiene. And if complications happen, they are not addressed properly. Danielle Keiser acknowledged this must be resolved immediately, and so she built a career around her unflinching interest in all things cycle-related. Joining Alyssa Dweck and Rachel Braun Scherl, she shares how she changes the conversation and the amount of education around menstruation. Danielle explains how she takes a comprehensive approach to the intersection of emotions, physical, and lifestyle impact of cycles through Madami, bringing this topic to the attention of medical experts, lawmakers, and women themselves.

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Listen to the podcast here

 

Breaking Stigma Around The Menstrual Cycle With Danielle Keiser

Advocacy, Education, And Options

We’re having a lot more conversations about menstruation, which is good. There are more product choices and options and materials which is great. One of the things we keep hearing is that people who menstruate are not taught the basic fundamentals of what they should know. Is there Menstruation 101 for people who are reading that you can provide?

The standard definition of what’s “normal” means a cycle that is on or about every 21 to 35 days and that’s from counting day one of flow to day one of the next flow. The duration of flow is typically less than eight days. The onset of your period called menarche typically starts by the age of sixteen. If it doesn’t, then that may warrant a little bit of a workup to find out what’s going on hormonally. I think in the steam of things, those are some general definitions.

We usually talk about the menstrual cycle in a couple of phases. To make it very simple, there’s the menstrual phase, usually day one to about day seven when you’re flowing. There is the follicular phase after that where estrogen rises and you’re creating a dominant follicle from which you’ll ovulate. There is ovulation and then there’s the luteal phase, which is after ovulation, progesterone goes up. If you don’t get pregnant at that time or during ovulation, then menstruation occurs. It’s four essential phases. There is a lot more complexity for that but to keep it simple.

One of the things that’s interesting about the conversation we’re going to have with Danielle Keiser, who literally lives and breathes all things menstruation from an advocacy standpoint and from a business consulting standpoint is how far the conversation has come. As she points out, we’ve been having these conversations for a long time but I do feel so many things in women’s health now, we’re at a moment, we have some momentum where the real change is starting to occur.

 

 

We are so excited to have our guest, Danielle Kaiser, who’s the Managing Partner of Madami and a Menstrual Health Expert, and also a friend. We’re delighted to have you talk about all things menstrual health. One of the things that we spent a lot of time talking about on the show is how people got from point A to point B. How did you find yourself truly in the center of the conversation around menstruation and creating a worldwide language that people are using? Did you wake up one day and felt like this is what you needed to be doing?

My journey into the menstrual field came through toilets and toilet advocacy. My first job out of my Master’s program was working for a nonprofit organization in Berlin called WASH United. There, they focused on water sanitation, hygiene behavior change, awareness, training, advocacy, helping support World Toilet Day, and encouraging people in countries to hand wash with soap to prevent diarrhea diseases.

It was in this vein that we saw that there was one underlooked gendered toilet issue that wasn’t getting enough attention. At that time, it was called Menstrual Hygiene Management, or MHM for short. I came on board as a communications, social media, and advocacy person and fell head over heels in love with the topic, not even realizing that menstruation was pretty much the thing that turned me into a feminist working in this field.

I never had realized before that periods are the start of a lot of female oppression and things change at that time of menarche when the first period comes. We see a lot of gender equality indexes change from that point. Everything hit me real hard and it’s been years of working on menstruation. This journey started with helping snowball an awareness movement called Menstrual Hygiene Day, which is celebrated on the 28th of May and creating my own nonprofit organization called the Menstrual Health Hub which was predicated on the idea that if we want this to be big and we want menstruation to come out of the hiding place that it’s been forever, we need to take a different frame rather than hygiene.

Finally, to being a consultant now and expert and helping others understand the complexity of menstrual health in its glory beyond the menstrual phase but then also helping people understand specific industries, product innovations and periods through and through. I’m a big period nerd, if you can already see.

I know. Certainly, I would’ve loved to have met you when I went into puberty. Alyssa, you have all the tools to help educate people. Are you finding since the dialogue around menstruation has changed so much and often in positive ways that we’re having more conversations about it and we’re more conscious of the language? Are you seeing that in your patients or do they still require the same amount of education?

It varies. We always think of menstruation as a window into somebody’s health because there are so many things that occurred during, before, and after menstruation that may give key indicators as to whether there may be other medical issues or even emotional or psychological issues occurring. We consider it to be a real barometer of general health. As far as changes, the younger generations, I’d say Millennials and younger are surely more comfortable talking about menstruation.

 

 

Everybody’s got an app. Everybody has their favorite products. We don’t call them hygiene products any longer. We call them menstrual products. This is a step in the positive direction. I am curious. With your expertise, what is your thought about the change in all of the menstrual products that are available now? For example, the sustainability angle of menstrual cups or the ease of use but also concerned about exposure with menstrual panties. Do you have specific concerns or glory for these types of new innovations?

That’s a great question and a very pregnant with meaning type of question as well. First of all, it’s great that there are more than two choices on the market because that has been the norm for many years. It’s lovely to see that instead of this or that, there’s this and that that have finally come to the floor. You see the menstrual product aisle looking a lot more like the candy bar aisle, which has choices. Sometimes you want fruit, gummies, chocolate, and sugar-free until all those things are there and starting to become a wide variety of choices.

I want to say, Danielle, I’ve literally never heard that analogy.

Me neither. I’m never going to look at the candy aisle the same.

It’s true. The whole purpose of feminism, I believe, is to ensure that there’s a choice and you’re not persuaded into one direction or the other. I’m not going to sit here and say those reusable menstrual products are the best. The best is what’s best for the person who’s using them. When they are aware of the benefits and the risks of those, then that’s the ideal.

 

 

The menstrual cup itself was produced and created before the commercial production of tampons in the 1920s or 1930s even. It’s an innovation that’s been around for a very long time but was stopped so that we could continue to buy products like pads and tampons. We see something innovative but I don’t know if you can call it innovative. It had a grand comeback.

From then, we’ve been able to see that cups have expanded into disks, which has expanded into all sorts of other technologies that are looking at collection instead of absorption and I wouldn’t say going back but if you look at period panties and reusable menstrual pads, they are very similar to what our grandmothers and generations prior to us were using, which is what we could, cloth that we would change regularly.

This whole category is not that innovative when you think about these reusable options except for this insertable, the different nuances and features that we can see happening to menstrual cups and discs based on different shapes and sizes and preferences around vaginal length and whatnot. I’m concerned that there’s so much on the market because it’s a very unregulated Wild Wild West. At the same time, I’m happy to see that there’s been so much legislative action and advocacy that is talking about how dangerous it is for us to be relying on commercialized products and that there are links between dioxins and heavy menstrual bleeding.

We’re starting to see links between bleached cotton and the chemicals that go into those products and reproductive health disorders. It’s too early to say concretely but on the whole, we’re in a much better place where there’s a choice for people who menstruate and a lot more information around those choices because that’s the ultimate goal.

I did want to follow up on the advocacy piece because it’s something that’s not unique but very common and important in women’s sexual and reproductive health. To build on what you were saying before, as many people know or/and many people also don’t, you can’t buy a food product that doesn’t have the ingredients listed on it. In many states in the US, there’s no law or regulation that suggests that someone needs to put or the manufacturer needs to put on the package what is in a tampon or something else that you insert vaginally.

For people who are reading, there are so many different routes to advocacy but one of the ones that are very specific to menstruation is lobbying so that states require that manufacturers list the ingredients. Going back to your idea of choice, I can decide whether I want to put cotton intravaginally, or I can decide what silicone I want to use on whichever disc I decide to buy.

What’s interesting about the space you occupy is similar to where I think we sit. You bring an incredible understanding of the cycle and the physiology and the emotional impact and the phases. You also then connect it from a business perspective. I’m curious, looking at both perspectives, bringing the lens that you uniquely have, what do you see as the huge opportunities or the things that we’re expecting to change moving forward?

I want to comment on the thing that you were saying about advocacy before we move into that. There have been advocacy efforts since the 1970s. They were sidelined and ignored. There have been bills in the United States Congress that were continuously put through every single year. It’s only because of the momentum, feminism in general, Me Too, and this whole women’s empowerment movement that we’ve been able to see successes in the menstrual space.

It’s important that it’s not seen as happening in a vacuum but we have a whole big robust movement to enable us to push those things forward. In terms of opportunities, I’d say that there’s a lot happening around hormonal health, and people starting to zoom away from the menstrual experience as the first phase but looking at the entire menstrual cycle and tuning into what that means for them on a behavioral level and on a health level.

As you said, Dr. Dweck, seeing the menstrual cycle as the fifth vital sign and being able to understand menstruation is the response to the main sign which is ovulation. This has not gotten enough credit. You only menstruate because you ovulate, so what does it mean if you’re not menstruating or what does it mean if your menstruation is extremely painful or extremely heavy? These are all signs that the body is communicating that something might be wrong. A lot of people are trying to wake up and realize, “Intense period pain that puts me out for three days isn’t normal. Bleeding for twelve days on end isn’t normal. No one ever told me this before.”

They’re hearing about it now from influencers, Instagram, and their friends, more so than from doctors or from any institutional establishments. I’m excited about what this awakening around one’s health will mean for the market, looking at not just menstrual products but things around ovulation or the luteal phase, comfort, being able to rest more, looking at things across the cycle and not the period.

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Here’s our hot flash. Menarche which is defined as the first menstrual period in a female adolescent typically begins between the ages of 10 and 16 but can occur as early as 9.

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I notice what I get queried about in the media all the time, which are things that comes up over and over. Let’s talk about the color wheel of your period. What does it mean if your period is this color or that color? It is of interest for sure. A lot of the progress you speak about has to do with the apps and all of the data that we’re able to collect about people’s periods because we all used to have our secret little written calendar with our little codes that would go or maybe I’m dating myself about when your period is coming or how heavy it is or what-not.

The truth is now everything is digitized. In fact, many of my patients will bring in charts of what their app may have shown or be able to explain it in much more detail because they have an app. That’s been a big progress. There are two things that I would love to pick your brain about more on a medical level. Number one, what is your thought about the 28-day cycle? There are so many people that feel this is a farce that was made up by maybe birth control pill companies or that it’s an estimation but we’ve gotten so stuck on this concrete number of 28 days. I was interested to hear your thought on that.

The newest research reveals that an average link of a menstrual cycle is 29.3 days. If anything, we can start saying 29 instead of 28 but the reality of the matter is that every person is different and a normal menstrual cycle range is between 21 and 35 days. This all comes back to ovulation. The sooner you ovulate, the sooner you menstruate.

New research reveals that the average menstrual cycle is 29.3 days. But since every person is different, a normal cycle can range between 21 and 35 days. Click To Tweet

Some bodies are big and small, some have a faster metabolism, and some have different operations. We’re not all born with the exact same height with the exact same facial structure. We have to account for that variance and 29 days is the average. If you’re in that range and it’s not 16 days and not 40 days on the regular, then we’re okay. We need to bust the myth that 29 is the ideal.

The second thing which has a good amount of medical research behind it at this point is the implication of COVID and COVID vaccinations on menstrual cycles in general. For so long, and I’m in practice a very long time, so I feel like I have the right to say, anecdotally, I’ve noticed that during those first few months or years of COVID, there were issues that people were coming into the office for.

They were concerned about their periods being off. Now, this has been solidified with some research, even though they call it transient and mild. There are changes in duration, lane flow, etc. What’s your thought on that? Do you think it’s all related to stress or inflammation? What else do have to say about that?

I’m so glad you mentioned this because we were talking about this back when people first started reporting changes. We were told by our partners and our funders to shut up. “Don’t talk about this. This is going to get you into the anti-vax conversation. We don’t want to be affiliated with that.” We’re like, “This is not about whether to vaccinate or not. This is about providing correct information and not gaslighting women into saying that their experiences don’t matter.”

If you are someone who is psycho-religious like I am and you do notice small changes, even if it’s 1 day or 2, stronger cramps, or bleeding, that matters. Your experience matters. We were seeing a lot of that denial happening on the side of the medical establishment whether it was in pharmacies, by doctors themselves, or at places where the vaccine was being distributed.

First and foremost, we have to believe women when they say that something is wrong. Second, there has been reported evidence of other vaccines, mainly Rubella, that have caused similar experiences to the body. It’s just an anti-inflammatory response. Your body is being pummeled with a shot that is intended to protect it from getting severely sick later. This is going to happen with a lot of stress on the body. We can’t isolate this particular vaccine. We can look at it amongst portfolios, other vaccines, and the research that’s prepared.

To be clear, this is about vaccination but also about the actual disease. This was equally reported in people who had COVID.

This is also stressful to the system. Being under the weather for however many days, some people had it bad and some people had it mildly. Our bodies are very sensitive ecosystems and we are affected by things. As much as we want to generalize that everybody does this and this is how you should react, that’s not the case. In these last years, we can all say not just women but everyone’s experienced an incredible amount of stress with this global pandemic. One thing we do know for sure is that stress changes the menstrual cycle because it is transitioned.

The human body is sensitive to ecosystems that cannot be generalized. Click To Tweet

Stress affects everything else.

Cortisol, which creates estrogen dominance, also then leads to menstrual changes. We’re finally zooming out to look at a larger picture which, thank goodness, we can start to see all the component pieces working together to see that vaccinations are not bad, women are not crazy, and there’s a lot of science still to be learned.

Over the past few years, there have been cataclysmic events that have moved this space forward, like a woman running the London Marathon free-bleeding or even that concept of free-bleeding. Someone posted an Instagram photo where you could see through her sweatpants that she was bleeding, whether or not she meant to have protection or not. There were people who were horrified and there are lots of people who were talking about it.

When I look at some of the progress, I think of on a number of different tact. Miriam Webster said the word of the year was gaslighting. It’s this idea that women have been going into physicians’ offices for years, explaining symptoms, and menstrual cramps. Let’s focus on menstruation. Forget about the many other diseases where you were also minimized and told that you weren’t experiencing what you’re experiencing. That brings awareness.

Alyssa has said this and you said this about the period being the fifth vital sign. It is not normal to not be able to function during your period. It doesn’t mean there’s something wrong with you but it does mean that is not a desirable way to live. There are potential interventions or things you can look for and think about to explain that. It doesn’t have to be a fait accompli. Once you have horrible PMS, you’re doomed to live that way for the rest of your life. It’s not easy and our bodies are very complicated but it’s not a static situation.

 

 

One of the big delays in diagnoses, which we’ve spoken about before on the show is endometriosis which causes significant pain for so many people with ongoing ramifications as well. This is usually a delayed diagnosis on average about seven years. That would be something that gets overlooked for sure. Some of the irregularity and hormone imbalances, most notably Polycystic Ovarian Syndrome, PCOS is something that’s getting much more attention now.

These are all showing up as issues during the menstrual cycle. We need to be cognizant of that. Again, I feel like data from apps or calendars but mainly the digital data now is helping us to hone in on some of this. Even things like mood changes and whatnot are being tracked now. This is going to be helpful to bring these issues to the forefront.

One thing I wanted to comment on about that was something you had said, Rachel is that it’s not normal to not be able to function on your period. I would push back a little bit on that and say that we have been socialized to live in a man’s world. Everything that we do in our lives is programmed to this 24-hour circadian rhythm. You wake up, go to work, come home, go to sleep and do it all over again. You’re expected to show up the same every single day because that’s how men have done traditionally.

When you tune into what is characteristic of a follicular phase, this is what that looks like, showing up every day with the same, if not more energy up until ovulation. Once we hit past ovulation to the luteal phase, there is a tendency to have lower levels of energy and less of a desire to show up. That’s not because you don’t want to. It’s literally what the hormone of progesterone is calling us to do is, “Chill the F out a little bit, baby girl.”

That’s the medical term.

It’s not about not being able to perform. It’s about being able to make small adjustments and being able to take it easier when your progesterone is peaking or right before your period, you do feel a little bit out of sorts. I’ve noticed a lot of my colleagues in the menstrual space promoting either menstrual rest or being able to not call in sick but take those days off if they do experience such severe symptoms so that they can charge their batteries to optimize for their next cycle. We are not designed to be on all the time in this 24-hour male patriarchal clock that was not written for us. To push back what you were saying, we are now being able to work flexibly, and a lot more women are in entrepreneurial roles where they call the shots.

There is that flexibility that’s starting to form and more open conversations as well to be able to say, “I’m on day 26, I am not feeling my shot at this. Do you think we can push this meeting until my next week when my period will be over and I’ll be back at it?” There’s something to be said about that as well and being able to know yourself and know what you’re capable of and not push yourself past the limits. It’s when the limits are pushed, a lot of those pains and heaviness reoccurs.

We often talk about anticipatory guidance when it comes to managing some of these symptoms related to menstruation, especially when you are keeping a calendar of some sort. You can predict when will your mood be maybe a little bit off and you can prepare yourself and those around you. When might you be in pain, when might you feel like you need more sleep in this way, you can prepare. Again, approaching things from a more medical standpoint, I’m all into lifestyle changes and trying to mitigate stress that way.

Dietary manipulation can help with some of these symptoms. I prescribe lots of hormonal therapy to manage this, whether you’re in favor of that or not. It does work for some people. Pain medication is certainly helpful. Heating pads, exercise, and these things have all been shown to help with some of the symptoms for some people, especially magnesium. That will also help that premenstrual headache. People have to take a little bit of a proactive role and realize that there are some mitigating treatment options.

Even if the doctor is not the first person that they seek this from, hopefully, it’s a friend, a family member, or other people who they feel confident enough to speak to about their cycles. Just because we speak so freely about the cycles or rather the phases of the menstrual cycle, we probably should review that for those who might not be familiar. Feel free if you’d like to go ahead.

It’s funny, I have a menstrual cycle tattoo on my arm. The only reason I got this is because I had to answer this question so many times day in and day out. I figured I should stop wasting so much pen and paper and get this traveling PowerPoint.

Give us a tour of your tattoo and this way at least everybody will be familiar.

This is my menstrual cycle, so *This is not everyone’s menstrual cycle. Mine is 29 days, and so that’s how many dots here are indicating the days. I have three days of bleeding here, which is day one, starting the menstrual phase. As we move out of menstruation, come into the follicular phase which is when estrogen starts rising. It’s the phase where you’re feeling lighter and freer of all the lining that was lost and more energy.

This then comes to a peak with your estrogen right at ovulation. That’s indicated by this little circle egg here. As estrogen is decreasing, there’s a cross where progesterone starts to rise. If we look at progesterone, it’s like the opposite hormone to estrogen. Instead of, “Go. I can do it. I have endless energy. I only need maybe six hours of sleep per night,” it’s the pregnancy hormone.

Your body from ovulation to the height of your progesterone thinks it’s pregnant. It’s hoping that the egg went down, met a sperm, and there’s going to be a baby in nine months. Every single month, we trick out our bodies in a way. It’s during this time that progesterone starts to rise. For me, it’s my sign to say no to more social commitments and focus on more solo work.

Progesterone is the opposite of estrogen. Instead of giving you endless energy, it pulls you to rest because the body assumes you are pregnant. Click To Tweet

I don’t have that many bodily changes that happen. Maybe a little bit of bloating or a little bit of acne but that is just me. At some point, the body realizes that there was nothing to latch onto within the uterine lining. There was no sperm to meet the egg to be fertilized and so this beautiful home that was created throughout the month realizes, “We don’t have to have this home for anyone.” It starts to make its way and move down.

There’s something called prostaglandins that are the reason for more intense menstrual cramps because it’s the prostaglandins that are moving a lot of this endometrium down through the vaginal canal and out into a cup, a tampon, free bleeding, or removal. At that time, progesterone goes down to its lowest point and so does estrogen, which was also still present in the second phase. My tattoo is not correct though because this progesterone line technically should be 40 times as much as the estrogen but I didn’t want to make it unsightly.

It is important that we try to maintain high levels of progesterone during our second phase and not have estrogen dominance because this is what is responsible for so many menstrual-related discomforts and disorders whether it’s fibroids and the growth that are created from those tumors or heavy menstrual bleeding and extreme pain. There’s never been an occurrence of too much progesterone creation. That’s like, “You’ve been chilling too much.” No one ever says that. It’s always the opposite like too much dress, dietary, or life factors that are leading to an imbalance overall.

I was going to say, you live and breathe this and have marked it on your arms. It’s impressive.

Before we let you go, 1 or 2 thoughts about what you see coming in terms of the questions and challenges you’ll be asked to help your clients in this space solve. What are some of the themes you see emerging?

I see a lot of corporates who have been heavily involved in the disposable period product industry shaking a little bit and their boots being able to see that reusable period product options are standing a chance. A lot of consumers are navigating themselves towards more clean menstrual care and having a place for them too in this wide world of period products.

I also foresee that a lot more business and people in general working in female health will necessarily have to engage with the menstrual cycle because it is that entry point to health across the life cycle. Without engaging with it, pregnancy doesn’t make any sense. Menopause doesn’t make any sense and sexually transmitted diseases. So much that happens necessarily along the female health life cycle don’t make sense if there’s not a good solid evidence-based understanding of what the menstrual cycle is and what irregularities might look like.

I foresee a lot more mainstreaming of menstruation to everyone’s benefit and advantage. Lastly and what I’m seeing now around language is this constant fight between what we should be calling the people who menstruate. On one hand, it’s women. “No, we can’t just say women because what about all the other people who menstruate? We say people who menstruate.” There are problems with both of these approaches. We have to be inclusive and not just say women but we also can’t isolate women from the very experience that makes them feel so close to their womanhood or so close to their femininity.

I keep trying to add my thoughts to LinkedIn conversations around inclusivity to say, “Let’s say women and people who menstruate, done deal.” It’s everybody inclusive. Women are happy. People who menstruate are happy. Let’s move on to the actual issues instead of wordsmithing ourselves as a whole.

That’s a perfect place to stop and we’ll call that one a wrap. Thank you so much for being with us.

Thank you so much for having me. It was a real pleasure. If there’s any follow-up or anything that you need. Are there any resources that I mentioned that you maybe want me to send over? I can send my presentation to you, Rachel.

I don’t think so.

I’ll send the research that shows the 29.3 days.

That’s fine. I’d love that and I’d love to see the presentation. Maybe that’s something we should be doing going forward but we haven’t been doing it. We basically point out the highlights.

I can’t share the presentation far and wide anyway. I’ll send it over to you both to look at.

Thank you so much and I’ll talk to you soon. Hopefully, I’ll see you soon.

Thank you so much, both of you. I hope you have a good start to your week.

Thanks so much.

Talk to you soon.

 

Important Links

• Madami
• Menstrual Hygiene Day
• Menstrual Health Hub
• Me Too

 

About Danielle Keiser

Danielle is a consultant, speaker and expert on global menstrual health and menstrual cycle awareness. Since 2013, she has been advocating for collective impact around menstruation, first through helping launch and grow Menstrual Hygiene Day (28 May) with WASH United, founding the Menstrual Health Hub (MH Hub) in 2016, and serving as the Menstrual Health Innovation Consultant for the Duke-UNICEF Innovation Accelerator with UNICEF in 2019-2020. Danielle is currently the Managing Partner of Madami, a boutique, purpose-driven advisory and innovation agency specializing in women’s* health and wellness where she has consulted clients large and small, including Johnson & Johnson, Bayer, The Case for Her, Flo, Modibodi, Bfree Cup and The Body Shop, among others.