"Lessons for Phlexxi from Kotex: Innovating Through Disruption"

My journey to tackling the topic of innovation and disruption in the women’s health space began with curiosity and purpose. As someone who has spent years working at the intersection of strategy, innovation, and healthcare, I’ve always been fascinated by how transformative ideas take shape—especially in industries that face persistent stigma, inequities, and systemic inertia. One such industry is women’s reproductive health. When I first read about Evofem Biosciences’ journey, I was struck by how the principles of Clayton Christensen’s The Innovator’s Dilemma could serve as a lens to evaluate their success and challenges. But the story starts even earlier, with the disruptive lessons we can glean from an unlikely innovator: Kotex.

Learning From Disruption: Kotex’s Case Study

In the 1920s, Kotex pioneered the commercial production of disposable sanitary pads—a breakthrough product that responded to a clear unmet need. Before Kotex, menstrual hygiene solutions were limited, often improvised, and taboo to discuss openly. What made Kotex’s innovation so compelling wasn’t just the product itself but its boldness in tackling the cultural stigma head-on. They created a new category by leveraging disruptive principles:

1. Identifying Non-consumption: Kotex recognized that many women weren’t using formal menstrual products due to cultural, financial, and availability barriers.
2. Affordable and Accessible Solutions: Mass-producing disposable pads offered an inexpensive alternative that simplified women’s lives.
3. Marketing Courageously: At a time when menstrual health was a societal taboo, Kotex ran advertising campaigns that brought the conversation into public consciousness.

Kotex’s approach aligns closely with Christensen’s framework for disruption: addressing an overlooked market, providing a simpler and lower-cost solution, and redefining the conversation.

Christensen’s Principles of Disruptive Innovation

To better understand how these lessons apply to Evofem Biosciences, let’s briefly revisit the core tenets of Clayton Christensen’s theories:

1. Disruptive innovations often begin by serving underserved or non-consuming markets. These products typically start as simpler, more affordable solutions compared to existing ones.
2. Disruption challenges incumbent players focused on sustaining innovations—improvements to their core products that target the high-end market.
3. Success hinges on market redefinition. By reframing the value proposition, disruptive products create a new “job to be done” that resonates with customers.

Evofem Biosciences: A Modern-Day Disruptor?

Evofem Biosciences’ Phexxi—an FDA-approved, non-hormonal contraceptive gel—is an intriguing case study in innovation. Positioned as a unique alternative in the $7.7 billion U.S. contraceptive market, Phexxi had the potential to disrupt an industry dominated by hormonal birth control and devices like IUDs. By reflecting on their journey through the lens of Christensen’s principles, we can assess how Evofem tackled (or failed to address) the challenges of disruption.

1. Identifying Non-consumption: Much like Kotex, Evofem targeted an underserved segment—women seeking hormone-free contraceptives. Surveys consistently reveal dissatisfaction with hormonal methods due to side effects and the lack of control they offer users. Evofem correctly recognized this gap in the market.
2. Reframing the Conversation: Evofem’s marketing sought to empower women, presenting Phexxi as a liberating, on-demand option. Their bold messaging aimed to address the cultural stigma around contraception by promoting choice and individuality—echoing Kotex’s early efforts to break taboos.
3. Simpler, More Affordable Access? This is where the parallels begin to diverge. Phexxi’s prescription-only model and high cost created barriers to accessibility. For a product meant to empower women, affordability, and ease of access are critical. Kotex succeeded because it simplified women’s lives; Phlexxi’s price point and the effort required to obtain the product limited its disruptive potential.
4. Sustaining vs. Disruptive Innovation: While Phexxi positioned itself as a disruptor, some of Evofem’s decisions reflect a sustaining innovation approach—marketing heavily to an already established, high-end market instead of focusing on widespread adoption among non-consumers.

Lessons for Phlexxi: Bridging Innovation Gaps

Reflecting on these examples, Evofem can draw several key lessons to maximize Phlexxi’s impact:

• Start with Non-consumption: Understand and address the unmet needs of underserved populations, such as teens, low-income women, or those with limited access to traditional healthcare. Offering an affordable, over-the-counter solution could bridge accessibility gaps.
• Simplify the User Experience: Just as Kotex transformed women’s lives by offering convenience and affordability, Phlexxi must prioritize ease of use and eliminate barriers.
• Reframe the Conversation with Bold Marketing: Cultural stigma remains a formidable challenge in reproductive health. Phlexxi can succeed by embracing fearless, inclusive messaging that resonates across demographics.
• Focus on Affordability and Accessibility: Disruption thrives when innovation is accessible. Strategic partnerships with insurers or subsidies for low-income consumers could dramatically enhance adoption rates.

Closing Thoughts

Christensen’s work reminds us that disruptive innovation isn’t just about having a great product; it’s about addressing unmet needs, simplifying solutions, and creating markets where none existed. Kotex’s century-old playbook and Evofem’s modern journey offer complementary lessons for the future of women’s health innovation.

For me, this exploration is more than academic. It’s a personal mission to see industries that matter—especially those tied to health and human dignity—innovate in ways that make a tangible difference in people’s lives. Phlexxi represents a chance to embrace those principles, learn from the past, and create a future where innovation isn’t just bold but also accessible and empowering.