Ep. 166: Diva Cup 101 with Dr. Nicole Bullock

Fed & Fit
Fed & Fit

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On today's episode, I'm chatting with Dr. Nicole Bullock about menstrual care options, including the Diva Cup, and more.

Fed and Fit podcast graphic, episode 166 diva cup 101 with Dr. Nicole bullock with Cassy Joy

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Episode 166 Transcription

Cassy Joy: Welcome back to another episode of the Fed and Fit podcast. I am your host, Cassy Joy Garcia. And I am pretty dang pumped about today’s episode! You guys have been asking that we talk about this for literally years now! {laughs} We’ve been doing this podcast for multiple years, and I’m so excited to introduce you all to Dr. Nicole Bullock.

I’m going to read you a little bit about her bio, so I can briefly introduce her. She can do a much better job of it, of course, and then we’ll jump into some really fun Q&A.

Nicole has been a practicing OB/GYN in Abilene, Texas since 2011. She graduated medical school in 2004 from the University of North Texas Health Science Center. The Texas College of Osteopathic Medicine. She is now an adjust clinical assistant professor for the UNTHSC. That’s a lot of letters.

Dr. Nicole Bullock: I know! {laughing}

Cassy Joy: {laughs} And recently finished a graduate certificate in lifestyle medicine. Also through the same program. She is truly passionate about women’s health. Is an active leader in her community. And feels that it is a privilege to give back to her hometown. She’s also been interviewed multiple times with Refinery 29 and the Strategist of New York Magazine.

She wrote a guest blog for Diva Cup blog back in 2014, which is one of the things we’re talking about today that’s really been the most requested topic. And it is her goal for her patients to think better, feel better, and live better. She became obsessed with the Diva Cup around 2008-2009, and first contacted them in 2010 when she did the Susan G. Komen 3-day breast cancer walk.

She sent an email through their contact link on their website, explaining that she was a huge fan of Diva Cup, and asked if they would sponsor her OB/GYN office team. They said no; but, they sent a few cups to give to patients, and she continued to drop the occasional note just to tell them how much they loved their product.

A few years later Sophie asked her to write the blog post about vaginal health, which is what we’re going to talk about today. And that’s how she started her relationship with Sophie Zivku; did I say that right?

Dr. Nicole Bullock: I think so.

Cassy Joy: OH my gosh. That’s incredible, I got that right. Diva International Communications manager. Fun facts about Nicole; she teaches yoga. She loves CrossFit. She’s a nutrition nerd by hobby. Paleo for 10 years. It’s like we’re sisters. And she married her high school sweetheart. I met mine when I was 18, so almost close to high school. I was close.

Welcome! That was such a wonderful intro. Thank you so much for sending it over. Welcome to the show, Nicole!

Dr. Nicole Bullock: Thank you, Cassy! This will be so much fun.

Cassy Joy: Oh my goodness. I’m so tickled. I’m looking forward to this conversation for a long time. I did a pretty good job, I feel like, of covering the bases. But is there anything else you’d like to tell folks about your background and really what inspired your interests in promoting true women’s wellness in this way?

Dr. Nicole Bullock: I think I grew up with parents who were just always interested in overall health. My parents didn’t just run to the doctor or give us antibiotics. In fact, one of my favorite stories to tell; I went to osteopathic medical school, and I knew I wanted to be a D.O. And when I was growing up, I can tell you the name of my chiropractor, from when I was 5 years old. I do not know the name of my pediatrician. {laughs}

Cassy Joy: Nice.

Dr. Nicole Bullock: So that’s kind of the background I came from, where my parents; nutrition always mattered, health always mattered. And so when I finally decided on medical school; choosing the osteopathic route. In practice these days, there’s not much difference between a D.O. and an M.D. But the foundation of medicine, what we’re taught in med school. I still think there’s a foundational difference between an osteopathic physician and an allopathic physician. And those lines get blurred, but I knew that was the path I wanted to take. Just to get through med school.

And then women’s wellness; I liked the continuity of care. My favorite attending in residency used to tell us; if you want to change the world, all you have to do is change mom. Because they have such an impact on that tribe. That nuclear family. Mom does the grocery shopping. Mom does the cooking. Mom makes the decisions. It’s so centered around mom taking care of everybody, that if you can change mom you can change the world. So I have absolutely taken that to heart. So that’s what I do every day, is try to change mom, so I can change the world. {laughs}

Cassy Joy: What a beautiful mission. I love that.

Dr. Nicole Bullock: Thank you.

Cassy Joy: That’s really lovely. And that’s the first time I’ve ever thought of it that way. That’s really incredible. Wow, what a really neat thing that you're doing. And you’ve been practicing for a while now.

So is the Diva Cup and other menstrual hygiene products; is that a question that comes up a lot for you in your practice?

Dr. Nicole Bullock: Surprisingly it does not come up that much. I have, in my office, Diva Cup brochures, things like that. So every now and then a patient will ask, just because it’s out and around. But it is surprising that it doesn’t get brought up more often.

Cassy Joy: Yeah, definitely. I kind of want to jump right into it. And I have a couple of other questions for you; I might surprise you with. But I’m curious, if you could just folks; for folks listening that have never heard of a Diva Cup.

Dr. Nicole Bullock: {laughs}

Cassy Joy: Because there’s probably a good chunk of them. Do you mind giving them a brief introduction and where that would fit into a normal routine?

Dr. Nicole Bullock: Yeah. So a Diva Cup is an alternative to using a pad or a tampon during a menstrual cycle. It is usually a silicone or latex; there’s actually hundreds, probably, of different menstrual cups on the market. Which I’ve only learned about in the last few months. Diva Cup is pretty popular and easy to find. But it is a name brand. So a menstrual cup in general is a medical grade silicone, and it sits inside the vagina, and it collects menstrual blood.

The advantages are that it is super convenient to use. And periods are messy, no matter what you do. So there are just a lot of advantages of using a menstrual cup over a pad or a tampon. And I think the biggest one is that it’s reusable. And I think that’s kind of; I don’t remember how I even found out about it, honestly. But once I started using it, the menstrual cups do come in different sizes. And you can leave them in for 12 hours; which pads and tampons have to be changes more frequently. So that’s where convenience is a little bit better with a menstrual cup. And that it’s reusable. You don’t have to buy tampons every month. That just; all of a sudden, this was life changing information.

Cassy Joy: That’s incredible. Wow. That’s really neat. 12 hours, I had no idea. I have not jumped on the ship yet, but I have a feeling after our conversation today. I mean, let’s just get really personal on this episode. I had a baby; she was born in January. So I haven’t had to deal with this in about a year and a half.

Dr. Nicole Bullock: Sure! {laughs} But what better time to make the transition? When those periods come back.

Cassy Joy: Yeah, absolutely. We’ll just start fresh. That’s really fascinating. What are some of the other advantages of a reusable menstrual cup like that?

Dr. Nicole Bullock: It is comfortable. Similar to that learning curve of learning to use a tampon; you kind of feel it in the beginning. Or, I don’t know, when you're 14 and you think tampons are the grossest thing ever. There is definitely a learning curve to using a menstrual cup. But once it’s in place, it should definitely be comfortable. Pretty unnoticeable really. It’s good for 12 hours at a time.

If you're really heavy with your cycles. If you're using super tampons or super pads, and you’ve got to change them every three to four hours, you might have to change or empty out your cup maybe at the 8-hour mark. I get questions a lot about; “What do you do in a public bathroom?” Well, if it’s good for 8-12 hours, you should have a moment that you're not in the public bathroom. And you can, there are ways to get around that. But that’s not something that you should encounter very often, just because you can wear it for so long.

So even overnight, you should be good. It being reusable; it will kind of discover over time. But really they only have to be replaced maybe every two years. So we’re talking two years’ worth of saving on pads and tampons. That’s a lot. That’s a huge difference. So you can look at that from an economical standpoint, or from the environmental standpoint. Either way, that’s a huge benefit that you're able to reuse this menstrual cup for your cycles.

The other biggest benefit that I hear from people; from patients, from friends, reading online. Is that for a lot of people, it decreases their menstrual cramps. Which I cannot explain even from a scientist/physician side. I can’t explain why it would decrease cramps. But I hear that many, many times. That it decreases cramps.

Cassy Joy: That is fascinating. That really wants me to go digging. I’m sure you’ve dug up all the research.

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Cassy Joy: That’s really interesting. Do you mind if I ask some very detailed questions? The people who have also; I’ve heard about it, and I’ve just been negligent. {laughs} By not jumping on the board yet, which I will this next time around. So you have a single cup, and obviously ideally you're in the privacy of your own home. So the mechanics are, you pull it out, and I’m assuming then you empty it in the toilet. Is that right?

Dr. Nicole Bullock: Yep.

Cassy Joy: And rinse it, and reinsert?

Dr. Nicole Bullock: Yep. Wash it with soap and water and reinsert.

Cassy Joy: Got it. Wow. Very, very neat. Ok, I’m really impressed. What a market disruptor.

Dr. Nicole Bullock: {laughs} You would think.

Cassy Joy: Yes, you would think. We’re going to try to help!

Dr. Nicole Bullock: {laughs} I have been known to stop girls in the grocery store tampon aisle and be like; “Let’s look at this. Let’s see if I can talk you into trying something.” {laughs}

Cassy Joy: Oh my goodness! That’s wonderful. You know, you're an educator at heart when you stop people at the grocery store.

Dr. Nicole Bullock: I’ve been to parties where the conversation turns, and pretty soon you’ve got your cup out demonstrating how to do the different folds.

Cassy Joy: {laughing} That’s fantastic. Oh my goodness, that’s wonderful. Ok, so I would like to then jump in; I’m sure a lot of these are mirrored. But what are some of the disadvantages of using a more conventional tampon or pad; aside from, of course, the economical and not as environmental.

Dr. Nicole Bullock: Tampons specifically probably carry the highest risk. This has been over 20 years ago, where they changed how absorbent a tampon could be. I don’t know what it was exactly but they called them the super absorbency tampons. And they pulled those off the market because people were leaving them in for 8 hours and 12 hours at a time, and that’s what lead to the increase risk of Toxic Shock Syndrome. Which is a really serious, life and death type of staph infection.

And so that’s the importance of a tampon really should be removed at least 4 hours to decrease those risks. And it is rare, and it has gotten better. Just because of limiting the absorbency of the tampons, and the size of the tampons that people are using. But this is why you should never double up with tampons. And really they should be removed and replaced every four hours or so. So that one actually has probably the highest health risk.

And pads, again, periods are just messy. There’s higher risk of breakthrough bleeding with the wearing of pads, or having to replace it. I think everybody has had those experiences bleeding through your jeans. Where are you when it happens. So something like a Diva Cup; menstrual cup in general; like I said, just that convenience factor is such a life change. {laughs}

Cassy Joy: That makes a lot of sense. If somebody is listening, and they’re thinking, “ok. That’s nice; but. I don’t think, I’m not ready to jump on the Diva Cup train.” Is there anything you would want folks to look for in a pad or a tampon if they’re just looking to make a minor improvement?

Dr. Nicole Bullock: There are so many options out these days. There are ones that are kind of marketed as organic; and again, just like reading food labels. You’ve got to read the labels and read the fine print, and find out what that really means, and what does natural really mean.

But I think with tampons, avoiding the plastic applicators. Because again; that is just waste. There’s comfort, I guess, for the insertion part of it. But that is an easy step, and it has a huge reduction in plastic waste that’s filling our landfills. So that’s an easy step without really changing that you can still use a tampon.

In fact, getting ready for the podcast, I ran across, somebody is even making a reusable applicator. So it’s your applicator. And then you can just buy your cotton tampon to insert, but the applicator part is reusable, which is kind of interesting.

And then pads; there are reusable pads. They’re cloth. Kind of like the argument for disposable diapers versus cloth diapers. Disposable is obviously easy, but cloth is reusable and a little bit more environmental friendly. So there’s also cloth and reusable pads for the same thing. You’ve just got to clean them and reuse them.

Cassy Joy: That makes a lot of sense.

Dr. Nicole Bullock: So, still good options with; either, again, environmental impact or trying to avoid toxins. If you're cleaning up your makeup routine and you’ve started to eliminate all of your sulfates and phthalates, and now you want to avoid your toxins in your tampons. That’s just one more step where there are options out there, for sure.

Cassy Joy: And how neat it is that we do have options now? I think that it wasn’t that long ago most folks, the thing that came to mind of; you know, I just want to live a healthier lifestyle. And all that that could possibly encompass and mean, to include economically, environmentally. We used to think that really; we probably just thought about our food, and our cars.

Dr. Nicole Bullock: {laughs} And things have definitely started to change over the years. And even personally, as you start to make changes, again, you start to avoid, I don’t know, the SLS, sodium laurel sulfate in your soaps. Like that’s one change, and pretty soon you're changing all your makeup. And then you're changing all of your housecleaning products. You know how that snowball effect happens.

Cassy Joy: Absolutely. You can’t unlearn something like that.

Dr. Nicole Bullock: Right.

Cassy Joy: If you're suffering from eczema and you realize that sodium laurel sulfate, like you just said, could possibly be aggravating it, and you turn around your shampoo bottle and it says SLS on it; {laughs}. It’s so interesting once you learn stuff like this you can’t unlearn it. And then it’s very powerful moving forward.

Dr. Nicole Bullock: And I do think it’s interesting that; just from a mass production standpoint. Again, there are just more and more options in everything. But even if we’re still talking about specifically pads, tampons, menstrual cups. I did another; it was the interview I did with the Strategist magazine, where we were talking about menstrual cups. Found a website; or even just on Amazon. I heard of Diva Cup, I’ve heard of Luna Cup. There’s like 100; I had no idea there were so many cups to choose from.

And then period panties are also kind of a new thing.

Cassy Joy: Yes! I meant to ask you.

Dr. Nicole Bullock: There was one brand, and now there’s 20. Overnight, it has exploded. That’s another interesting option.

Cassy Joy: That is interesting. That’s another one that kind of has me scratching my head a little bit. I think I’ll start with the Diva Cup.

Dr. Nicole Bullock: Yeah. My idea for the period panties; I see one, it’s kind of for those in between days. You think you're going to start; you're not sure when you're going to start, so wear your period panties instead of your really cute, fancy lacy ones. It’s kind of that catchall, in case you do need it.

And then another really interesting place where I have; again, contacted the companies to let them know my thoughts. For period panties, for people with mental health disorders, or that have physical handicaps. Again; talk about life-changing. These poor women and health care providers are suffering with them trying to change pads, and they’re messy. If you think about someone with a learning disability that functions at a 7-year-old level, but she’s really in her 30s, and she’s having periods. It can be a really messy, embarrassing situation. For the family and for the patient. So something like period panties for them, where they can just wear the underwear and not have to worry about changing pads out. But it’s not going to be such a mess. I think that’s a huge place where they can have an impact.

Cassy Joy: Oh my goodness, that’s wonderful.

Dr. Nicole Bullock: Isn’t that interesting.

Cassy Joy: That is interesting. That’s another thing I hadn’t thought about. Very true.

Dr. Nicole Bullock: Yeah.

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Cassy Joy: Oh my goodness. I would love to know; change mom, change the world. Slightly deviating from what we’re talking about. But what are some other things that you wish women out there would know?

It’s one of those things. Me as a nutritionist; I just kind of want to shout from the rooftops that diet sodas aren’t as good for you as you think they are.

Dr. Nicole Bullock: {laughs}

Cassy Joy: You know? That’s my one thing. Granted, I followed a real food/paleo lifestyle for about a decade. But those diet cokes, they’re still out there. And people are grabbing them, thinking they’re making positive health choice. That’s my one shout it from the rooftop. I’m really curious; what are some of the other things that come to mind that you want women to know?

Dr. Nicole Bullock: I think so much of it is still just not being afraid to talk about being a woman. Not being afraid to talk about periods. Not being afraid to talk about miscarriages. And for the love, show each other some grace! It’s building each other up, and trying to be understanding. Showing grace when someone is struggling, and we’re not going to make the same choices. Everyone is really, probably, trying their best.

Cassy Joy: Mm-hmm. That’s so true. That’s really beautiful. I am; so my daughter is 5.5 months old, and as a blogger, I blogged about my pregnancy throughout. And it’s really interesting. I find myself writing her birth story; she’s going to be half a year old before I get it published! {laughs} But I find myself; I’ve been writing this birth story over months. And you want to know the biggest reason why I haven’t written it yet? I’m so afraid of feedback.

Dr. Nicole Bullock: Yeah!

Cassy Joy: And a part of that has to do with just the lack of sleep that I’ve had. I’m not thinking as clearly as I have in the past to just say; well, I’m just going to do it. But it is interesting. It’s a very interesting world to come into.

Dr. Nicole Bullock: It’s harsh. It’s a harsh world. The pregnancy world, and the mommy world, both.

Cassy Joy: Yes. Because there are very well-meaning opinions on drastically different ends of the spectrum.

Dr. Nicole Bullock: Yeah.

Cassy Joy: And it is. It’s very interesting. But I love that. Give each other grace, and know that we’re doing our best. It’s also taught me a lot, going through the journey myself, what to say to a pregnant woman or a new mom.

Dr. Nicole Bullock: {laughs}

Cassy Joy: You know? And that’s changed in the past. Before having kids, I used to think; “I’ll just ask them how’s the baby sleeping?” {laughs} I don’t want to talk about that!

Dr. Nicole Bullock: {laughs} You know the answer is going to bad!

Cassy Joy: Yeah, exactly! And often times, those conversations have drifted into advice on how to help the baby sleep. And I’m just like; we’re doing. People do what works for them. But it is interesting. Change the mom, change the world. I love that. Give each other a whole lot more grace, and don’t be afraid to talk about stuff.

We as women; I just think it’s interesting. We are such incredible creatures. We can shoulder so much. And I think that in difficult times of life, we tend to be heroes.

Dr. Nicole Bullock: Absolutely.

Cassy Joy: And not just kind of letting things be. Well that’s interesting. Do you have any other I wish folks would know? I’m surprising you with these questions. {laughs}

Dr. Nicole Bullock: No. Then again, I feel like that could be a really long list. I do talk a little bit about nutrition. Again, reminding them. And maybe the general blanket statement in all of these topics; nutrition, choosing if you're going to use pads or tampons, is that baby steps also add up. So making small changes. Doing what you can. If you're going to decide that you can eliminate soda, but you're not ready to eliminate your coffee creamer. That’s an ok step. And you don’t have to change everything all at once.

Again; then be nice to each other. Everybody is trying their best. Everybody is making small choices every day. But I also think that one choice begets another choice, and the grace in that is that one bad choice doesn’t have to mean more bad choices. And I see that in big picture stuff. For women who end up with unintended pregnancies, or women who come to me because they’ve got sexually transmitted diseases. For me, part of that counseling to them is reminding them that one bad decision doesn’t mean you have to keep making bad decisions. You can still get out of this relationship, or you can still change your path in life. You don’t have to be stuck. There’s always a way out.

Cassy Joy: Yes. Absolutely. I think that’s really well put. It’s very easy to feel almost like we’re drowning in a circumstance, when there’s very much a ladder that we can climb right out.

Dr. Nicole Bullock: That’s what I tell my patients all the time. If they don’t know what to do, just call us. At least I’ve got resources. At least I’ve got somebody else I can call, or check with, or can get them set up with counseling, therapy, specialists, safe houses, anything. So I always tell them; if they just don’t know what to do, just call my office. At least call us. Because we’ll help.

Cassy Joy: Oh my goodness. What a wonderful resource you are for them! Your patients are very fortunate to have you. That’s wonderful.

And you're in Abilene, right?

Dr. Nicole Bullock: Yes.

Cassy Joy: Ok, I just wanted to remind people listening. {laughs}

Dr. Nicole Bullock: Yep. Cute little Abilene, Texas.

Cassy Joy: I love it. Well that’s really sweet. Man, I’m trying to think if I have some other chicken scratch here. As far as women’s wellness, do you note any correlations between; I’m assuming you have from your perspective, you obviously follow a very real food/paleo-based lifestyle yourself. But in terms of women’s wellness, is there a correlation between how women are eating…

Dr. Nicole Bullock: Absolutely. Yeah. And again, this is stuff I’m sure you know, and I’m sure you also preach just from the other side of it. But it has a huge impact on your hormones. What you eat, besides just regulating your cycles, can also help with your PMS symptoms. If you're eating a high enough fat diet, you should have less nausea with your first trimester in the pregnancy. There’s lots of those overlaps. Transitioning through menopause, eliminating sugar helps with hot flashes.

It just is that overall hormone control that if we’re on a whole food, no processed foods, low, hopefully no sugar. Hormones should just be in their optimal ranges. And you should feel better. They should feel better. Pregnancy; you should get pregnant. You should feel ok during your pregnancy. Not everything is going to be eliminated 100%. And again, how I tell my patients; PMS should just get better. It may not be gone, but it should still be improved. Cramps, endometriosis, PCOS. All of that responds to nutrition.

Cassy Joy: Wonderful. I have a feeling, Nicole, I’m going to be asked by listeners to ask you back on to this podcast in the future. {laughs}

Dr. Nicole Bullock: {laughs} That would be so fun.

Cassy Joy: That would be so fun. It’s interesting. When I was going through this pregnancy; Greyson is our first. And my dad, of all people, who; I get my nerdiness, definitely, from him. I get excited, let’s dig into the science. And I felt fantastic during my pregnancy. And a lot of that, I’ve been trying to approach it with a; I don’t know where this is coming from yet because this is my one experience. But I felt great. I had migraines in my first trimester, but I found out what they were triggered by and nixed that. But I really, really felt really good. Had a very healthy baby. Which I’m sure there’s a lot that plays into it. But my dad was sitting there thinking; “I bet a lot of it has to do with how you eat.” {laughs}

I want to nod my head at that and talk about it, but I also feel like I need to do a little bit more research in it because it’s such a big, big topic. But that’s wonderful to hear you say that.

And it’s interesting. I did not know the correlation between high fat foods in your first trimester and reduction of nausea.

Dr. Nicole Bullock: Yeah.

Cassy Joy: Very interesting. Wonderful! This has been such a pleasure. I don’t really have any other notes jotted down. But I really appreciate you taking the time, Nicole.

Dr. Nicole Bullock: I’m so glad we got to do this.

Cassy Joy: I am too. It really means a lot. Thank you so much for making the time. Everybody, thank you for dialing in and listening. You can catch the full transcript over at www.FedandFit.com. And if you have more questions for Nicole in the future, please leave a comment on that blog post so we can get some ideas. I’m pre-inviting her out right now. {laughs}

Dr. Nicole Bullock: Yeah. There’s lots of things we can talk about. And again, this is what I mentioned. I think women; there’s still that social stigma of avoiding talking about normal women topics, you know.

Cassy Joy: Yeah. Let’s get into it. So needed. And this audience is really going to enjoy hearing from you. Thank you again Nicole. Thanks everybody for dialing in. As always, we’ll be back again next week.


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  1. Caroline says:

    Yes! I’ve used a Diva Cup for almost five years now and I love that I don’t have to worry about when I might bleed through a tampon throughout the day. I was hoping Dr. Nicole would touch on whether or not they should be boiled for extra sanitization at the end of each month. Maybe next time she’s on?