Expanding the treatment options for uterine fibroids

Uterine fibroids are a common but potentially debilitating gynecological condition.  Approximately 70% of women develop them before the age of 50. They are typically benign tumors that develop inside the wall of the uterus and can cause heavy menstrual bleeding, infertility and severe pain. Traditional treatment options include surgical treatments such as hysterectomy and myomectomy but these often require longer recovery times and can be quite invasive.

Dr. Elizabeth David, an interventional radiologist and affiliate scientist in the Odette Cancer Program, recently led a successful clinical trial, exploring the use of non-invasive MRI-guided focused ultrasound (FUS) for the ablation of uterine fibroids. Following the success of the trial, the device developed by Arrayus Technologies Inc., a Sunnybrook Research Institute spin-off company, received Health Canada Approval.

The Arrayus FUS system uses high-precision acoustic energy to precisely target and treat tissue deep within the body while protecting nearby tissue, without the need for incisions or general anesthesia. This research and technology are paving the way for Canadian health-care providers to offer a safe, non-invasive alternative to traditional surgical options thereby giving women with fibroids more treatment options and hopefully improving their quality of life.

Bridging gaps in stroke research and care

In the fall of 2024, a research team led by Dr. Amy Yu, neurologist and senior scientist in the Hurvitz Brain Sciences Program, was awarded $5M from the Heart & Stroke Foundation, Canadian Institutes of Health Research (CIHR) and Brain Canada Foundation for its work improving stroke care, treatment and recovery for women.

Every year, more than 30,000 women in Canada experience a stroke, and despite this prevalence, gaps in awareness, research, diagnosis, and care threaten women’s heart and brain health.

The pan-Canadian initiative, Stroke in Women: Growing Opportunities to Realize optimal Evaluation, Diagnosis, and outcomes, or StrokeGoRed, is the first formal research network in Canada dedicated to studying stroke in women. The interprofessional group aims to advance knowledge on how and why stroke affects women differently and provide mentorship to the next generation of stroke researchers and clinicians.

Personalized support for young patients with breast cancer

Sunnybrook is home to PYNK, the first program of its kind in Canada, designed to support Sunnybrook patients who are newly diagnosed with breast cancer at age 40 or younger.

Doctors are seeing a rise in breast cancer rates among young women in their 20s, 30s and 40s, and while women under 40 make up a small amount of all breast cancer patients, they have unique physical, psychological and social care needs. Young patients with breast cancer are more likely to experience fertility concerns, social isolation, financial and career-related distress, and difficulties caring for young children, among other hardships as a result from their cancer diagnosis and treatment.

The PYNK program provides patients and their families with a continuum of support from the time of referral through treatment and follow-up. PYNK educates patients about their breast cancer diagnosis and the impact of treatment, empowering them to make informed decisions about their care. PYNK also helps patients navigate a complex medical system involving multiple specialists, such as plastic surgeons and oncofertility experts.

PYNK offers professional and peer psychosocial support, as well as resources on nutrition, exercise, and hair preservation options like cold capping and wigs. Patients also have access to specialized support for their children, including age-appropriate books about a parent’s cancer experience, childcare resources, and a child life specialist who can provide in-home therapy sessions.

The PYNK program bridges gaps that young women may face during their cancer journey, and can help those recovering get back to a “new normal” life, including returning to work or dealing with long-term effects of treatment.

Championing endometriosis diagnosis and care

Endometriosis, affecting approximately 10 percent of patients with a uterus, occurs when tissue similar to the lining of the uterus grows outside of the uterus, which often results in pain or infertility. On average, patients wait 9-10 years to be diagnosed with the condition, delaying appropriate care and impacting their quality of life.

Dr. Jamie Kroft, an obstetrician gynaecologist in the DAN Women & Babies Program specializes in minimally invasive surgery, and cares for patients who have lived with endometriosis for years without a proper diagnosis, which can end up impacting other major organs, like the kidneys, GI tract or lungs.

Dr. Kroft is working closely with other specialists in the GTA to form a central intake clinic for patients with endometriosis. Her advocacy is helping women in the GTA gain access to first consult sooner, advancing earlier diagnosis, treatment and pain management of their endometriosis and ultimately improving quality of life.

The post 4 ways Sunnybrook is advancing women’s health research and care appeared first on Your Health Matters.

In 2017, undergraduate student Dr. Julia Hamer and I reviewed the literature to determine what evidence-based lifestyle changes women could make to improve their overall health and reduce their risk of dying of recurrent breast cancer. Our review of 67 published scholarly papers was published in the Canadian Medical Association Journal. Here is a summary of our findings then, what’s been learned since and some helpful resources that are available now.

Exercise

Aside from following their recommended treatment plan, exercise is the single most important thing women with breast cancer can do. That means starting or continuing exercise right from the moment of diagnosis, through active treatment (chemotherapy, radiation, surgery) and beyond. We found that even a small amount is beneficial; 30 minutes per day, five days per week of moderate exercise, may boost survival rates by about 40 per cent. More hours per day (but not more vigorous exercise) may be even more beneficial. It appears that a mix of aerobic exercise and muscle strength training is ideal. Importantly, exercise is also linked to a reduction in treatment side effects like nausea, fatigue, anxiety and depression.

A more recent study, looking at women at high-risk for recurrence, supported the benefits of exercise. It found women who met the above minimum exercise guidelines before their diagnosis, as well as two years after treatment, had a 55 per cent lower risk of recurrence and a 68 per cent reduced risk of death from any cause. Women who did not meet the guidelines prior to their diagnosis, but did at the two-year follow-up, had almost a 50 per cent lower risk of breast cancer recurrence and a 43 per cent lower risk of death from any cause.

Weight gain

Weight gain of more than 10 per cent of one’s initial body weight has been shown to increase the risk of breast cancer recurrence and death. Exercise, as well as guidance from a registered dietitian, can be helpful in maintaining a healthy weight.

Diet

No specific type of diet has been shown to reduce the risk of breast cancer recurrence. Evidence shows that patients do not need to avoid soy, and it may actually help with weight management if used to replace higher-calorie meat proteins. Women should aim for a diet high in fruits, vegetables, lean protein and fibre, and low in saturated fats, simple sugars and alcohol. A high-calcium diet is helpful for maintaining bone health, and is preferable to supplements.

Vitamin supplements

Moderate consumption of vitamin C may be helpful, but more evidence is needed. Because chemotherapy and hormonal treatment can reduce bone density, vitamin D supplements should be taken by all women to maintain adequate levels for bone strength. As vitamin D requires fat to be absorbed properly, be sure to take it with a meal if choosing the pill form.

Smoking

Simply put, stop smoking. While it’s unclear if quitting after a breast cancer diagnosis affects recurrence, the risk of death from smoking-related health issues is a strong reason to butt out.

Alcohol intake

Limiting alcohol intake doesn’t affect the risk of recurrence but will reduce the risk of developing a new breast cancer. Aim to hydrate with water. All women, especially those on chemotherapy, should try to drink two litres of water daily. Having water available during and after exercise is particularly important.

Final thoughts

As powerful as lifestyle changes can be, they are never a substitute for the standard treatments your health-care team has prescribed. The breast cancer patients who benefitted from lifestyle changes in the reviewed studies were also receiving conventional anticancer therapy.

Most importantly, I want this to be clear: no woman should ever be made to feel guilty that her breast cancer has come back and spread because she didn’t make enough positive lifestyle changes. Some breast cancers have aggressive biology and will recur despite the most meticulous lifestyle behaviors.

I hope that this review and its key findings will help point women in the direction of lifestyle changes that could have a positive impact on overall health and on reducing breast cancer recurrence.

Helpful resources:

Exercise

• Toronto Rehab’s Health, Exercise, Active Living and Therapeutic Lifestyle (HEALTh) program
• Wellspring
• Moving Through Cancer

Smoking Cessation

• Sunnybrook Health Sciences Centre

Alcohol and Drugs

• Sunnybrook Rapid Access Addiction Medicine (RAAM) Clinic

The post Lifestyle changes that impact breast cancer risk appeared first on Your Health Matters.

For others, difficult emotions can also arise during pregnancy and the postpartum period, including the kind of stress or worry that can often accompany a major life change. While that is not necessarily anything to be alarmed about, doctors say that if such feelings interfere with a person’s ability to enjoy or carry out their daily routines, they should speak with their healthcare provider about whether they might need additional mental health supports.

At Sunnybrook’s latest Speaker Series, leading experts in perinatal mental health discussed how depression and anxiety can affect pregnant people and those who have recently given birth — and what treatment options are available.

According to Sunnybrook psychiatrist Dr. Sophie Grigoriadis, head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions, perinatal mood disorders affect about 20 percent of women. That translates to approximately 28,000 people in Ontario each year.

Risk factors can be biological, psychological, and environmental. Experts also say there are some groups, including people who have experienced intimate partner violence, people with disabilities, people with a history of depression or anxiety, and people who have been through a birth trauma in the past, who are at greater risk of developing a perinatal mood disorder.

Symptoms of perinatal depression and anxiety — such as low mood, difficulty sleeping, or recurring anxious thoughts — can persist for several years postpartum if left untreated, Dr. Grigoriadis explained.

The good news is these mood disorders are very treatable with methods such as psychoeducation, psychotherapy, psychosocial interventions (e.g. self-care or breastfeeding support), or antidepressant medication.

New approaches such as mindfulness-based group therapy delivered online to treat anxiety in pregnancy are also being studied, said Dr. Grigoriadis, who is also a scientist with the Hurvitz Brain Sciences Program.

In addition, Dr. Grigoriadis along with research teams at Sunnybrook, Women’s College Hospital, and CAMH are recruiting patients for a clinical study into an innovative treatment called Transcranial Direct Current Stimulation for Depression in Pregnancy.

Transcranial Direct Current Stimulation is a non-drug treatment involving a small device that can be used at home. It is already approved by Health Canada – but Dr. Grigoriadis and her colleagues hope to evaluate whether it is effective in treating depression in pregnancy.

The treatment could provide a useful alternative for patients who are reluctant to take antidepressant medication during pregnancy, Dr. Grigoriadis explained. “If we can show that it is helpful, it will be revolutionary because this is a treatment you can do at home with minimal side effects,” she said.

Sunnybrook obstetrician Dr. Anne Berndl, Director of the Accessible Care Pregnancy Clinic and Associate Scientist with the DAN Women & Babies Research Program, said getting help is key to the health of the person who is pregnant as well as the baby.

Untreated depression during pregnancy significantly impacts quality of life and can lead to an increased risk of preeclampsia or substance use. There are also health risks for the baby, such as preterm birth or low birth weight.

Postpartum depression that is not treated can increase the risk of self-harm for the birth parent. It can also have a negative effect on infant attachment, breastfeeding, and development.

Dr. Berndl encourages people who are experiencing symptoms of depression or anxiety during pregnancy or postpartum – such as a feeling of hopelessness, loss of appetite, frequent irritability or tearfulness, severe sleep deprivation, or simply feeling ‘stuck’ — to reach out for help.

But the first step might be acknowledging that pregnancy and new parenthood doesn’t automatically come easily to everyone.

“One of the things that makes this really hard for people to understand are motherhood myths, which are a real barrier to accessing care,” Dr. Berndl explained.

“There are myths that once you become a mother you will have complete joy and fulfillment, or that motherhood is easy and you will naturally know what to do, or that being a mother always means sacrificing your own needs but these are all myths,” she added. “The problem with these myths is that people have a sense of shame when they feel otherwise, and it can delay asking for and receiving help.”

Mental health supports should be personalized based on a patient’s needs, Dr. Berndl said. For instance, a patient who has experienced a prior stillbirth or neonatal death might need more appointments with an interdisciplinary care team and a greater focus on birth planning.

People with disabilities, who have higher rates of depression and anxiety, also benefit from an interdisciplinary approach to perinatal care that includes medical management of the birth parent, pain management, early access to lactation consultants, psychiatry, and if needed community resources.

The take home message, Dr. Berndl said, is that “anxiety and depression during pregnancy and after birth can happen to anyone – but they are treatable so talk to your care provider about it.”

 If you are looking for more mental health resources please speak to your doctor or see some of the resources listed here.

The post Understanding depression and anxiety during and after pregnancy appeared first on Your Health Matters.

Sonia Racco was 35 when she gave birth to her first child, a healthy baby girl named Genna.

Twenty months later, Sonia was diagnosed with breast cancer.

“I found the lump while I was breastfeeding,” says Sonia, “but I didn’t think it was anything.”

She knew that it was normal for breast tissue to change with pregnancy and breastfeeding. She also knew there was no history of breast cancer in her family, nothing to suggest that she might be one of the thousand or so Canadian women under the age of 40 who are diagnosed with breast cancer every year.

When the lump didn’t go away after a couple of weeks, Sonia went to her family doctor. Her mammogram was worrisome enough for a referral to Sunnybrook’s rapid diagnostic clinic.

“I had the mammogram, the biopsy and the diagnosis within 24 hours,” she recalls. “I kind of knew as soon as they did the biopsy on my breast and under my arm. My husband was a lot more overwhelmed than I was when we got the results,” says Sonia.

“But later, when I got home and I was with my 20-month old calling me mommy, I was completely overwhelmed. There were a lot of very scary moments: ‘What is happening to me? What’s the prognosis?’ All the uncertainty.”

But there was also the Young Women With Breast Cancer (PYNK) Program, Sunnybrook’s support and research program for young breast cancer patients.

Because Sonia was under 40, she immediately qualified for the special care provided by PYNK.

Sonia Racco, pictured with daughter Genna. (Photography by Tim Fraser)

It’s a fact that women diagnosed with breast cancer at a young age have lower survival rates and experience poorer quality of life than women diagnosed when they are older. They experience more physical side effects, depression and fear of the cancer returning.

They often sense that they may be facing mortality early, leading to the worst fear of all for any young parent – not being there to see their children grow up. And if they survive, they’ll be dealing with possible premature menopause and infertility related to treatment.

“We’re taking away their hormones and destroying their libido,” says Dr. Ellen Warner, referring to some of the lesser known side effects of cancer treatment. She had these concerns in mind when she initiated PYNK, a groundbreaking team effort to deal with the complicated issues, including infertility, of young women diagnosed with breast cancer.

“We have a nurse navigator*,” she says. “Our women are getting extra nursing care, but a lot of it is also psychological.”

She cites an example: “We had one young woman who was newly married. Sex became very painful and she would bleed. She was dealing with physical symptoms and psychological stress.”

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The critical issue for a high percentage of these young women − after survival − is fertility[/mks_pullquote]

The young patient, sent into early menopause by the cancer treatment, was experiencing vaginal dryness. Fortunately, there was a simple solution, says Dr. Warner. “She wasn’t using lubricants properly. We also have a counselling program online for these young couples.”

PYNK patients range in age from 17 to 40 years old, with an average age of 35. However, the average woman who gets breast cancer is 61, notes Dr. Warner. For those older women, a breast cancer diagnosis brings with it many questions and concerns.

“But for a younger woman, the questions and concerns can be different. Maybe she’s 30 and single, and she’s thinking, ‘Oh my God. I’m going to lose a breast, never get married, go into menopause, never have a baby.’ Or maybe she has young children, a big mortgage, has to quit work and hire babysitters for appointment and treatment days. Maybe she wanted to have another child.”

The critical issue for a high percentage of these young women − after survival − is fertility. Endocrinologist and infertility specialist Dr. Karen Glass has been part of Dr. Warner’s PYNK team from the beginning, harvesting eggs before chemotherapy, offering in vitro fertilization (IVF) and freezing the fertilized or unfertilized eggs for later implantation.

“For young women with cancer,” says Dr. Glass, “it’s now the completely normal, expected thing to do.”

A focus on breast cancer research

Research has always been a major focus of PYNK. Studies have looked at the uptake of genetic testing among women born outside Canada, what percentage of women wanted prophylactic mastectomies and the relationship between young patients with breast cancer and their mothers.

Sunnybrook’s successful PYNK program is the prototype for a new Canada-wide research project called RUBY (Reducing the Burden of Breast Cancer in Young Women).

Co-sponsored by the Canadian Breast Cancer Foundation and Canadian Institute for Health Research, the four-year study will enroll 1,200 women newly diagnosed with breast cancer at age 40 or younger – including PYNK participants – at 29 sites across Canada.

RUBY will build on the PYNK research model developed at Sunnybrook, collecting blood and tumour samples in addition to detailed clinical data and patient-reported outcomes, which are kept in a special PYNK database. The data collected will include detailed information about their family history and other risk factors, treatment, disease outcome and quality of life.

Dr. Karen Glass advises PYNK program patients of their fertility options, such as freezing eggs, before they go through chemotherapy. (Photography by Doug Nicholson)

“Some of it is hereditary,” says Dr. Warner, “but we don’t really know what causes it (at a young age). It’s all part of the research challenge.” She calls RUBY a “PYNK copycat” on a larger scale.

RUBY encompasses several substudies, including genetic testing for abnormalities that may have caused the cancer, and determining the effect of lifestyle factors on breast cancer recurrence.

Dr. Warner and Dr. Glass are guiding research within RUBY that is intended to encourage referrals of young women with breast cancer by breast surgeons to fertility specialists who specialize in this patient population. They are also working on a study to better predict the effects of cancer treatment on fertility.

“Ultimately, we’re hoping that the research will come up with better treatment, that recurrence rates will drop, and that quality of life will be better for young women with breast cancer,” says Dr. Warner.

While Dr. Warner’s and Dr. Glass’s research is helping create a better future for young women with breast cancer, there’s much joy every time a young breast cancer survivor is able to bring new life into the world because of the PYNK program.

“I just found out today that another PYNK graduate is pregnant,” Dr. Glass says, with a touch of pride.

Five years after her lumpectomy, radiation and chemotherapy, Sonia is now celebrating another milestone; she gave birth to her second daughter, Gia, in July, making her six-year-old Genna a big sister.

“Dr. Glass is incredible,” Sonia says. “One of the first conversations I had after the diagnosis was, ‘Do you want to extend your family?’ She took me through the procedure and was with me every step. It was a comforting experience, how she and Dr. Warner worked together.

“My husband and I decided to freeze embryos. And last winter, we decided, let’s give it a shot. And it took. And everything is going great,” she says. “Having a second child was a hope. A hope of a possibility.”

*In 2023, PYNK changed models from Nurse Navigator to Physician Assistant as the lynchpin of the PYNK program.

The post Breast cancer program supports young women through the ‘complicated issues’ appeared first on Your Health Matters.

“She had the same little button nose as my grandson,” says Fran, with a smile.

Delilah passed away in August 2018, after her mom was diagnosed with placenta previa and was bleeding heavily at 23 weeks of pregnancy. Fran felt very fortunate she was able to meet her granddaughter, and hold her, at the hospital. The meeting helped greatly with her grief process.

Fran Savelson and her grandchildren

The loss spurred Fran to support other grandparents whose children have had a miscarriage or stillbirth. As a peer counsellor at Sunnybrook’s Pregnancy and Infant Loss (PAIL) Network, she has found new meaning in Delilah’s death. On Grandparents Day, on Sunday, September 10, Fran will guide an online session called “Grandparents cry twice: Grieving the loss of a grandchild and the loss for your child”.

Fran admits losing a grandchild is a complicated mix of emotions, with worry for your own child and their partner, while also experiencing your own grief. “It is really hard not having anyone to talk to. I didn’t want to burden my daughter who was dealing with such heavy emotions herself.”

She has advice for fellow grandparents: “Don’t hide your feelings, talk about the baby and use their name! Do something positive to honour your grandchild. I visit Delilah’s grave and draw little happy faces on rocks. It’s my way of connecting with her.”

Fran also encourages that you take care of yourself and give yourself permission to do what you need to do. That may mean taking a pass on baby showers or other situations that would be difficult. Allow yourself to grieve in your own way, as everyone grieves differently.

Her work at the Pregnancy and Infant Loss (PAIL) Network has helped reframe her perspective on losing Delilah. “I feel like I’m doing something positive to honour my granddaughter’s death. I really feel like it’s my calling,” adds Fran, who has five living grandchildren, including the two pictured.

Learn more about support services offered by the Pregnancy and Infant Loss (PAIL) Network. You can sign up for the grandparents’ session here.

The post The double grief of losing a grandchild appeared first on Your Health Matters.

Each week, Dr. Grigoriadis, head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions at Sunnybrook, sees patients who are pregnant and have depression. After reviewing general risks, like the increased likelihood of giving birth to a preterm baby at a lower birthweight, she talks with patients about treatment options.

Psychotherapy, or ‘talk therapy’, can be very helpful. “A lot of people prefer it over medication because there is no fetal drug exposure,” says Dr. Grigoriadis. “One of the problems is that therapy can take weeks to months to help with depression, so the patient and baby can be exposed to the negative impacts of depression during that time.”

Antidepressant medication can improve symptoms of depression very quickly and with very few side effects. However, medications do cross over to the baby to some extent and some patients may be hesitant to take them while pregnant.

This new approach, tDCS, uses a small electric current to locally stimulate a part of the brain that functions abnormally when an individual is depressed, requiring 30 minutes of daily treatment over three weeks. It can be done by patients at home after receiving training, while also continuing to see their regular health care team, including pregnancy care provider and psychiatrist.

“Our team has already done a small study with 20 pregnant patients with depression, which had promising results for safety and effectiveness. We’re looking for more patients for a larger study to see whether this should be offered widely during pregnancy,” adds Dr. Grigoriadis. The study is randomized, meaning patients will have a 50/50 chance of receiving tDCS or being placed in a control group which receives a similar looking device but does not deliver any electric current.

For more information and to enroll in the study, please visit https://sunnybrook.ca/content/?page=tdcs-pregnancy-depression-research-study.

The post Depression in pregnancy: Studying a new treatment appeared first on Your Health Matters.

It’s also a good time to focus on sexual and reproductive health which is connected to many human rights, including the right to health, the right to education and the right to non-discrimination. The Canadian government and several international bodies such as the United Nations recognize that sexual and reproductive health and rights are essential to gender equality.

Contraception is one important component of sexual and reproductive health — and the options have come a long way since the pill, whether the ring, the patch or implants. Dr. Sharon Domb, a physician with Sunnybrook’s Department of Family and Community Medicine, walks through some of the alternatives people can choose from.

The birth control pill was first approved in Canada in 1960. Is it still a common form of contraception that patients often ask for?

It’s still a very commonly used form of contraception. Absolutely, patients often ask for it.

There’s also a birth control shot. How does that work?

Some kinds of hormonal contraception have two hormones: progesterone and estrogen. And some have just progesterone.

The birth control shot is just progesterone with long-term release. You have to get a new shot roughly every 12-13 weeks. It has to be prescribed by a physician or a nurse practitioner, but it can be injected by a nurse or other health-care provider.

Then there are methods like the vaginal ring or the patch. Can you explain how those compare? 

I generally try to categorize contraceptive options into hormonal and non-hormonal methods.

Some people will say you know what, I don’t want anything with hormones and prefer to use some kind of barrier method instead.

When we talk about hormonal methods, there are various ways in which you can get hormones into your body. The combination estrogen and progesterone options generally work in the same way to suppress ovulation.

The main combined hormonal methods that have both estrogen and progesterone are: the pill, the patch and the ring.

With the pill you need to take it every day pretty much at the same time.

The patch is like a sticker that you stick on your body. You have to change it once a week. You do one patch each week for three weeks, and then for the fourth week you don’t have a patch and that’s normally when you would get your period.

The vaginal ring you put high up in your vagina. It stays in for three weeks and then you take it off for the fourth week and that’s when you get your period.

Other than the birth control shot, what are the hormonal methods with just progesterone?

The progesterone-containing IUD (intrauterine device) and the implant.

The implant that is available in Canada is Nexplanon. It’s inserted into your arm through a little surgical procedure. You can leave it there for up to three years.

The contraceptive implant is a relatively new method — it was approved in Canada in 2020 — and as you said, it’s longer lasting. Why might that appeal to some people?

When you look at what appeals to people, part of it is whether someone wants to think of their contraception every day and can remember to use it every day.

A lot of people find the pill easy to use because you don’t have to do anything surgical. But you’ve got to remember to take it. And there are lots of ways to remind yourself — there are different apps you can use, or you can set your alarm on your phone or stick it by your toothbrush. But some people still struggle with actually remembering to take it every day.

If you want something you don’t have to think about there is the implant or an IUD because those last years at a time.

There are so many options out there and each one has pros and cons in terms of effectiveness, possible health impacts and convenience. How should people decide which method is best for them?

 I usually go through the basics with people to better understand what they’re looking for and then refer them to the Society of Obstetricians and Gynaecologists of Canada website if they want further information before making a decision. It goes through details in lay terms of the pros and cons of each one, how you use them, the effectiveness rates, which things you need a prescription for and which things you can get over the counter.

How does access fit into the equation? Are all of these methods equally accessible to patients who want or need them?

No. And it depends on what you mean by access. There’s access in terms of can somebody get in to see a physician? And there’s access in terms of financial means or whether somebody has health insurance coverage.

For any of the hormonal contraception methods you do need to see a physician or a nurse practitioner to get them because there are some considerations that need to be thought about in terms of whether or not the risks are warranted.

If you are talking about some of the barrier methods or spermicide, you don’t need to see a physician. Those are available at the pharmacy with no prescription.

We’ve got a lot of people who don’t have a family physician right now but there are still ways to access health care. If you need it, there are family planning clinics and walk-in clinics so there are ways to access the health-care system and contraception that way.

In terms of ability to afford contraceptives, some can be quite expensive, especially for those without private insurance coverage for medications. Prescription options are generally covered for patients under 25 in Ontario who do not have private insurance coverage. If finances are a concern, speak to your healthcare provider, as they may be able to recommend lower cost options or refer you somewhere that provides contraceptives at a discount.

When is the best time for people to talk to their doctor about sexual and reproductive health?

Ideally before they are sexually active to make sure they are paying attention to both contraception and STI (sexually transmitted infections) prevention.

We haven’t touched on emergency contraception. What should people know about that?

If you do end up in a situation where you’ve had intercourse without protection and you are concerned about being pregnant, there is something called Plan B (and there are other brands too). That can be obtained at the pharmacy without a prescription, ideally within 24 hours but it’s okay in the first five days after unprotected sex. It decreases the risk of pregnancy by about 80 percent.

If you are past that five-day window you can also have an IUD inserted by a health-care provider and that is quite effective if done within the first week.

The post Spotlight on sexual and reproductive health: a Q & A with Dr. Sharon Domb appeared first on Your Health Matters.

“This is a very serious disease that often causes intense pain, leading to missed work, as well as a negative impact on relationships and mental health,” says Dr. Kroft, a gynaecologist who specializes in minimally invasive surgery at Sunnybrook.

Endometriosis occurs when tissue similar to the lining of the uterus grows outside of the uterus, causing pain and infertility. It’s estimated that ten per cent of patients who identify as women have the condition, with an average time to diagnosis of nine to ten years.

“Roughly 10 years to receive a diagnosis – it’s not acceptable,” says Dr. Kroft. “On top of that, many don’t understand that endometriosis can impact major organs.”

When Johana Kouadio met Dr. Kroft, she was feeling hopeless. The 35-year-old mother of two had spent 17 years with heavy painful periods, so debilitating that she regularly missed work as an early childhood educator. Doctors over the years prescribed her with pain medication and a drug that stopped her periods.

In late 2019, Johana couldn’t breathe properly and was experiencing terrible pain in her shoulder. This was happening every time she had her period. She went to a local Emergency Department, where staff ordered a chest X-ray. They found blood in her lungs. Her undiagnosed endometriosis had spread to not only her lungs, but her heart, kidneys, bowels and bladder.

She was referred to Dr. Kroft, where Johana says she cried because “I finally found someone who listened.” Dr. Kroft recalls their first meeting, and remembers the relief her patient experienced when she had clinical affirmation of the toll endometriosis had taken both physically and emotionally.

After two years of taking medication to prevent periods, Johana said she was ready to have another child. Surgery was the best option to optimize her chances of getting pregnant.

Since Johana’s disease had impacted major organs, Dr. Kroft assembled what she calls an all-female “a dream team” for a combined thoracic and gynaecology surgery in the summer of 2022. The surgery was the first of its kind in Toronto and took ten hours. Dr. Negar Ahmadi, a thoracic surgeon, operated on Johana’s lungs and pericardium, while Dr. Kroft took the lead on the gynaecology portion of the surgery.

Dr. Jamie Croft and the all-female surgical team who cared for Johana

Johana is now in a very different place. “I have zero pain and I’m happy every day,” says Johana, who hasn’t missed any work since the operation. “If you feel pain, it’s not okay. Something is going on in your body. Stop listening to others that say it’s okay.”

Dr. Kroft is now working closely with St. Michael’s Hospital and Mount Sinai Hospital to form a central intake clinic for patients with endometriosis in the Toronto area. The clinic would improve access to a first consult, so patients can receive specialist care sooner, ultimately improving quality of life and pain management.

“I don’t want another patient in front of me who has needlessly suffered for years,” she says.

The post The missed disease: improving access to care for endometriosis appeared first on Your Health Matters.

Tip 1: Exercise

Regular physical exercise helps maintain mental health and boost our mood. In fact, regular moderate physical exercise has been studied and included in our psychiatry guidelines as an approach to help treat depression.

Tip 2: Sleep

Good sleep habits can help improve our mood and prevent mental illness. One third of our lives is spent sleeping, so learning good sleep habits is definitely worthwhile.

Tip 3: Balanced Thinking

We can change our mood by changing how we think. If we notice we are having all or nothing thinking (for example,  “nothing goes my way”, or, “no one likes me”), practice making those thoughts more balanced by seeing the other side of things (“some things don’t work out for me but other things do”, or, “some people like me while others don’t like me”).

This is a key component of cognitive behavioural therapy and can actually help us start to change our moods to become less depressed or anxious and more positive and balanced.

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Investigators from Sunnybrook Health Sciences Centre studied 38,071 heart attack survivors aged 18 to 55 years who were hospitalized in Ontario, Canada in a 10-year period (2009-2019). They discovered that young women are more likely to be readmitted to hospital following a heart attack compared to young men, and that risk factors for heart disease for young women continue to rise.

Their findings appear in the Canadian Journal of Cardiology published by Elsevier.

Dr. Mina Madan, lead investigator and cardiologist at Sunnybrook, shares insight on what this latest research could mean for the health care system and what younger women can do to prevent heart disease.

What inspired you to pursue this research?

Dr. Madan: There’s been a lot in the literature about how women are getting the short end of the stick: they don’t get to the hospital on time, and when they do arrive maybe they aren’t taken seriously. Or there are delays in diagnosis and procedures. I wanted to look with an objective eye as to what’s happening now in Ontario.

How are younger women doing compared to younger men?

Dr. Madan: The good news is that younger women are universally getting coronary angiography when they come to the hospital with a heart attack, similar to their male counterparts; and mortality rates are now very similar. The bad news is that women have more cardiac risk factors relative to men, and they’re being readmitted to hospital for both cardiovascular and non-cardiovascular causes at a much higher rate.

The reason they are being readmitted to hospital or may not be receiving certain procedures could be due to the cause of their heart attack. While coronary artery disease or blockages in the heart are more common for men, younger women are more likely to experience heart attacks from conditions caused by a tear in the coronary artery (SCAD, Spontaneous Coronary Artery Dissection), stress (stress cardiomyopathy), or a dysfunction of tiny blood vessels (micro vascular dysfunction), for example.

What is really concerning, is that our findings showed younger women have more cardiac risk factors. Over the 10-year period, we discovered a 10 per cent increase in the rate of diabetes in younger women, compared to a four per cent increase in younger men. This underscores the need for ongoing efforts from the entire health system to improve our prevention strategies.

What can the health care system do better?

Dr. Madan: Overall, the health care system is providing high-quality of care for both men and women following a heart attack, but with the significant disparities in hospital readmission and comorbidities, more needs to be done. Perhaps women have different needs after they go home from a heart attack. They may benefit from more frequent or earlier check-ins after hospitalization, or earlier intake into cardiac rehabilitation programs. It may also help to screen for heart conditions and risk factors earlier in a woman’s life, maybe in their 30s or 40s to help prevent a bad outcome.

What can women do to help prevent heart disease?

Dr. Madan: People, regardless of their sex, need to take care of themselves and make sure that they are living the best life possible in terms of physical activity, eating properly, reducing stress, and avoiding smoking. Speak to your doctor if you are concerned about your heart health, even if you consider yourself too young.

» Read the full study in the Canadian Journal of Cardiology

This study identifies sex and gender as reported by the patient. For the purpose of this study, “young” is defined as individuals aged 55 years or younger.

The post Behind the Research: Do women still get the ‘short end of the stick’ when it comes to heart attack care? appeared first on Your Health Matters.