Tag Archive for: sex differences

Sex-specific risk factors for cardiovascular disease in women

Author: Natalie Szakun, UBC Island Medical program, MD candidate, Integrative Cardiovascular Physiology Laboratory, Trinity Western University | Editors: Emily Anne Opala (Program Officer), Romina Garcia de leon, and Janielle Richards  (Blog Coordinators) | Expert Reviewer: Jennifer Williams 

Published: January 10th, 2025

The viral Instagram song “We’ve Never Really Studied the Female Body” by Farideh (@ilovefarideh) has struck a chord by humorously highlighting serious conditions like endometriosis and polycystic ovarian syndrome, shedding light on how women’s health concerns are often dismissed or trivialized. This song resonated with women who are frequently told their symptoms are exaggerated or imagined (as Ferideh ironically emphasizes). The song’s impact is evidenced by its 1,275 video responses and over 2.5 million views at the time of writing this blog, reflecting a collective frustration and desire for change. This surge in public engagement underscores a broader movement towards acknowledging and addressing the longstanding neglect of women’s health in medical research. 

Leading Cause of Death

Cardiovascular disease (CVD) has been the leading cause of death worldwide for over 20 years, with one in three women affected by heart disease. However, our understanding of the impact of CVD in women remains inadequate. Many still hold the misconception that CVD primarily affects men. Although more women die of CVD, a  2017 study surveying Canadian physicians found that 38% of primary care physicians and 32% of cardiologists believed more men die from CVD. 

Women continue to receive insufficient, suboptimal care, as evidenced by lower rates of diagnosis, preventative care, attention, and treatment.  For instance, women are less likely to be treated with guideline-recommended drugs (such as aspirin or blood pressure medication) after a cardiac event compared to men. Additionally, over 50% of women’s heart attack symptoms go unrecognized. Perhaps most starkly, women have a 40% higher population-adjusted risk of mortality from CVD compared to men.

Examining Sex-Specific Risk Factors 

It is incredibly frustrating that we know so little about the leading cause of death for a demographic that represents over half of the population. This is one of the driving forces behind the work of Dr. Anita Coté and her team at the Integrative Cardiovascular Physiology Laboratory at Trinity Western University.

Historically, the medical system has attributed the increased CVD death rate in women to a delayed onset of symptoms, as women typically present CVD symptoms about 10 years later than men. This often results in a delayed diagnosis for women whereby the disease is more advanced, resulting in a poorer prognosis. Recently, however, work in the Coté lab has made it clear that this logic is flawed. While delayed symptom presentation contributes to the problem, there are also the unrecognized sex-specific risk factors (SS-RF) that many women silently carry. 

Sex-specific CVD risk factors are specific conditions, attributes or exposures that increase one’s risk of developing CVD in the future. Some examples of SS-RF include, adverse pregnancy outcomes, polycystic ovarian syndrome, endometriosis, breast cancer treatments, and early age of first menstruation (before age 12) are linked to increased CVD rates and associated deaths. Many women are unaware of the relationship between these risk factors and CVD, yet a significant proportion of women are affected. For example, in a study by Dr. Coté, of pre-menopausal Canadian women, 41% had one or more SS-RF. 

Current CVD risk screening tools – when will we think of women?

Current screening tools often overlook significant SS-RFs, which reduces their sensitivity in predicting risk. In Dr. Coté’s research, 82% of premenopausal women were classified as low risk when considering traditional CVD risk factors (e.g. smoking, high blood pressure, diabetes); However, over a third of these women had one or more SS-RF. Given their young age and pre-menopausal status, their risk was expected to be low but when SS-RFs were included, Dr. Coté’s lab discovered that 47% of the women in their study may be at risk for developing CVD.

Incorporating SS-RFs into current risk prediction tools is more complex than simply adding a few checkboxes. Although this is a good place to start, more research in this area is urgently needed to develop effective strategies for reducing this future risk. 

Future Directions

The lack of comprehensive research on women’s health, particularly regarding CVD, is a significant issue that demands immediate attention. Farideh’s song, “We’ve Never Really Studied the Female Body,” poignantly highlights the common experience of countless women who have been misdiagnosed or dismissed.

As awareness grows and more voices join the conversation, hope for change exists. For example, the organisation Wear Red Canada raises awareness about women’s heart health by hosting yearly events on February 13th to increase women’s knowledge, curiosity and action to prevent CVD and improve heart health. The work being done by researchers like Dr. Coté, and organisations such as Wear Red Canada, is paving the way for a future where women’s health is no longer a secondary consideration but a priority.

Exploring Sex Differences In Body Size Using The Fruit Fly (Drosophila melanogaster)

Interviewee: Celena Cherian, PhD Candidate, Department of Cellular and Physiological Sciences, Life Sciences Institute, The University of British Columbia | Authors/Editors: Romina Garcia de leon, Janielle Richards (Blog Co-coordinators)

Published: December 6, 2024

Can you tell us about your research?

In the animal kingdom, there are sex differences in body size across many species. This is true for Drosophila (fruit flies) as well, where females are larger than males. Furthermore, sex differences within species exist in multiple aspects of physiology and metabolism. Therefore, my research project involves exploring sex differences in body size using the fruit fly with the aim of elucidating the mechanism for these differences. I am particularly interested in the larval adipose tissue biology as it is important for systemic growth.

What led you to undertaking this research?

I was searching for labs that used imaging techniques to study cell biology, and mitochondrial biology in particular. This was the only lab that I came across which employed these techniques while exploring sex differences. I was then struck by the fact that nobody was studying sex differences in this area. This was the primary reason I wanted to do research in the area; the research was novel and I wanted to be involved in generating data on physiology and metabolism within females. Additionally, I really loved the way my supervisor wrote her papers. They were very easy to understand and I could see how passionate she was about science communication. I was sold before I got into the lab and luckily I was able to secure a position.

Are there any findings in the field and/or your study you wish to highlight?

Prior literature shows that ribosome and mitochondrial biology in the larval adipose tissue are both important for cellular growth, organism growth, and body size. However, these papers didn’t use both sexes separately and instead mixed sex populations were used. Many studies also classically only use males to study for metabolism, because female hormones were presumed to be confounding factors which has created a gap in the contribution of mitochondrial and ribosome function in cell growth. 

This was the starting point for our research and so far we found that female larval adipose tissue has significantly higher levels of mitochondrial and ribosomal protein genes than males. We are currently working to investigate the cellular significance of this exciting finding.

Where do you see your research going?

I hope my research encourages others to analyze males and females separately in the field of metabolism and physiology as data in this area is limited. I hope to understand the role of protein synthesis and mitochondrial function in regulating sex differences in growth. I would like to find which pathways are involved and also look at the effect of nutrients on these sex differences. Eventually, I am interested in looking at the impact of sex determination genes / sex chromosomes on these cellular functions.

17 Years Too Long: Advancing Women’s Health Through Medical School Curricula

Authors: Naomi (Catie) Futhey, MD/PhD Student, University of British Columbia Faculty of Medicine & Graduate Program in Neuroscience | Editors: Romina Garcia de leon, Janielle Richards  (Blog Coordinators)  | Expert Reviewer: Dr. Liisa Galea

Published: September 20, 2024

Women face disproportionate barriers to healthcare, including longer time to diagnosis and differences in disease presentation, severity, and medication response. Such differences are often ill-defined in the clinical literature. This health disparity is multifaceted but can largely be traced back to a well-intentioned movement at protecting women of childbearing potential after the infamous thalidomide tragedy.

The initial safety concern settled into a blatant exclusion of women from both clinical and preclinical research, under the disillusioned rationale that women’s health can be inferred from studies conducted only in males. Despite this restriction’s reversal in 1993, for NIH-funded clinical trials, the implementation of proper research techniques to analyze sex and gender differences has only begun recently.

It is often said that it takes 17 years for discoveries in research to make their way into clinical practice, a disconnect thought to be related to systemic barriers between research and medicine. Given this timeline, it will be at least a decade before we can expect to see changes to women’s health. Bridging this gaping research-medicine divide is critical, and targeting medical schools is a viable starting point.

We know now that what happens in the male context cannot be blindly generalized. Unique anatomical and physiological contexts yield distinct responses to the same diseases, as well as different diseases entirely. There are many conditions which affect far more women than men, and vice versa. There are also disorders which are gender-specific, such as menopause-related conditions and prostate cancer.

Women have lower body weight, smaller organs, and higher fat content than men, factors which all modify performance of medications. Sex differences have in fact been documented at every stage of pharmacokinetics, the branch of pharmacology focused on how drugs move through the body. Despite this, medications are generally prescribed at the same dosage regardless of sex or gender. It is unsurprising then that women are twice as likely to experience adverse drug reactions. Specifically, studies have shown that antipsychotics—drugs commonly used to treat psychotic disorders, depression, and anxiety—are metabolized differently in men and women. One study found that olanzapine, one such medication, had 59% higher bioavailability in women. To some extent, this is a generalizable phenomenon, suggesting that women are largely being overmedicated.

Despite so many topics demanding dedicated study, research related to women’s health receives disproportionately low funding. This is depicted visually and intuitively in a recent Nature feature. Various initiatives have been enacted in response, including the mandate of sex and gender based analysis as part of the evaluation criteria for each CIHR grant in 2019, and the Canadian Government’s announcement of a $20 million National Women’s Health Research Initiative in 2022.

Despite such enticing proposals, we have yet to see actionable change manifest downstream in the care women receive at the doctor. A British Columbia Women’s Health Foundation 2019 report stated that over half of women in the province felt that a physician had diminished or overlooked their symptoms. Similar qualitative reports broadly echo these patient perspectives.

Patient care isn’t the only thing that suffers from this disparity: poor health translates to lost productivity and missed work. Importantly, a recent report by the World Economic Forum estimates that not only do women spend 25% more time in “poor health” than men, but that prioritizing women’s health research could boost the economy by $1 trillion by 2040.

17 years is too long to wait for clinical change. Augmenting the medical education system is one way to bridge this gap and ensure new and accurate research makes its way into the doctor’s office in a timely manner. Established physicians are often set in their practices and changes can be challenging to integrate. Targeting students early on in their training before these routines set in, however, is a logical solution.

Medical school curricula have changed substantially over the years, but better education in women’s health is still an area of need. In particular, a 2021 Toronto survey of 16 Canadian medical school program and course descriptions found that women’s health may not be adequately incorporated into clinical training programs. Only approximately 15% of curricular documents examined specifically mentioned “sex/gender” or “women’s health”. Additional surveys of clinical trainees in the United States have found that the majority feel ill-equipped to deal with sex and gender differences in healthcare.

Bolstering the clinical education of future physicians has the capacity for exponential change in the betterment of women’s healthcare delivery. Doctors of all specialties have direct communication channels to the general public through their patients. This is important not only for individual care, but for the communication of valuable medical knowledge to the population at large. Informed patients are better equipped to understand their own health and when to seek care. Prioritizing medical school curricula has the potential to deliver equitable, quality healthcare to a population which cannot afford any further time delays.

Keep up with Catie Futhey’s work on Twitter/X: @CatieFuthey

Unveiling the Gap: Understanding Heart Disease in Women

Authors: Najah Adreak, MD, MSc in Surgery, University of British Columbia | Editors:  Romina Garcia de leon and Shayda Swann

Published: February 16th, 2024

Have you heard that heart disease is a man’s disease? In fact, heart disease is the leading cause of death for women worldwide. Since 2015, Canada and other nations have reported an increase in female deaths from heart disease, highlighting the urgent need for comprehensive understanding and targeted interventions. In Canada, every 20 minutes, one woman dies from a heart attack,  every 7 minutes one woman is diagnosed with heart disease, and women are 7x more likely to die of cardiovascular disease than breast cancer. Heart and vascular disease stand as the leading causes of hospitalization and premature death among women in Canada, affecting one in three women globally. Despite these alarming figures, women remain understudied, underdiagnosed, and under-treated, with healthcare providers often unaware of their unique risk factors and atypical presentation of heart and vascular disease. 

How Heart Disease Differs in Women: Unveiling the Discrepancies

The distinct nature of heart disease in women compared to men emphasizes the need for specialized attention. Factors such as different symptoms, risk factors, and causes necessitate unique diagnostic and treatment approaches.

Heart attacks in women often go unrecognized. The Hollywood-style chest pain:” Chest-clutching, crushing pain’’ may not be the predominant symptom, with women more likely to present with 3+ symptoms, including jaw, neck, arm, or back pain, excessive sweating, shortness of breath, stomach discomfort, and more. Downplaying symptoms and attributing them to non-heart-related issues can lead to misdiagnosis or underdiagnosis. Proactively seeking medical help is important to ensure proper diagnosis and treatment. 

Did you know that the early signs of heart attack are missed in 78% of women, especially if they are young or come with less common symptoms? Women and their doctors can be slow to identify the signs and symptoms of a heart event. According to a study published in The New England Journal of Medicine in 2000, women are 7 times more likely to be sent back home from the ER while having a heart attack, when compared to men. 

It is imperative to also acknowledge the often overlooked burden placed on women due to caregiver responsibilities and the strain arising from juggling work and household duties. Women — particularly younger women — may have their signs attributed to anxiety, heartburn, or other “female” issues and are less likely to get immediate treatment.

 

Causes of Heart Disease in Women: Beyond the Basics

Heart disease can manifest differently in women and men, presenting with various types. 

Women, in particular, are more susceptible to distinct conditions, such as a tear in the large blood vessels of the heart (spontaneous coronary artery dissection, SCAD), tightening of the large heart blood vessels that restrict blood flow (coronary vasospasm), small vessel disease (microvascular dysfunction), weakened heart due to a stressful event (Takotsubo cardiomyopathy), and weakened heart during or after pregnancy (peripartum cardiomyopathy). The prevalence of SCAD, for instance, is notably higher in women, making up to 35% of heart attacks in women under 50. Notably, smoking, diabetes, high blood pressure, and a family history of heart disease serve as notable warning signs specifically for women. For instance, women living with diabetes are 3x more likely to die from heart disease compared to men. 

Several unique risk factors contribute to an elevated risk of heart disease in women, including specific pregnancy complications such as premature birth, diabetes or hypertension during pregnancy, and preeclampsia. Additionally, early menopause, polycystic ovary syndrome, and systemic inflammatory and autoimmune disorders like rheumatoid arthritis and lupus can increase the risk. Indigenous women in Canada and those from particular racial and ethnic groups such as South Asian, Chinese, black and Afro-Caribbean descent experience higher rates of heart disease and poorer outcomes compared to Caucasian Canadians. They are also at a higher risk of cardiovascular disease. 

 

Empowering Women: Mitigating Heart Disease Risks

Despite the concerning statistics, more than 80% of risk factors for heart and vascular diseases can be prevented through proactive measures:

  • Be Active and Keep Moving: Regular physical activity is crucial for maintaining heart health. Check this guideline for more 
  • Eat a Variety of Nutritious Foods
  • Manage Stress
  • Live Free from Commercial Tobacco and Vaping
  • Limit Alcohol and Substance Misuse
  • Get Regular Health Checkups

Wear Red Canada: A Collective Effort for Women’s Heart Health

In 2018, the Canadian Women’s Heart Health Alliance was established to transform clinical practice and enhance collaborative action on women’s cardiovascular health in Canada. The annual Wear Red Canada awareness campaign, set on February 13, aims to improve heart health for women of all ages.

Participation in Wear Red Canada is open to all, with activities ranging from wearing red to sharing key messages on social media using hashtags #HerHeartMatters and #WearRedCanada. Participating in virtual movement challenge events, attending webinars, and engaging with the Wear Red Canada community on Facebook are impactful ways to support women’s heart health.

Understanding the nuances of heart disease in women is essential for effective prevention and treatment strategies. By acknowledging the differences and taking proactive steps, we can work together to reduce the prevalence of heart and vascular diseases in women.

 

Personality and Sex Differences in Depressive Symptomatology

Authors: Jessica Stewart, PhD Candidate, Health Psychology, University of British Columbia | Editors:  Romina Garcia de leon and Shayda Swann

Published: January 19, 2024

It’s not hard to believe that people with tendencies toward anger or aggression will end up with more health problems than those who have a positive outlook. Many studies have shown that personality traits are associated with physical health and mortality.

Personality traits can be identified as patterns of feelings, thoughts, and behaviours that take shape in one’s childhood and become consistent throughout one’s life.

The Five-Factor Model of personality is a common method of describing personality traits and separates the traits into agreeableness, conscientiousness, extraversion, neuroticism and openness to experience.

Hostility, which is an attribute of neuroticism, is associated with coronary heart disease and mortality, while conscientiousness predicts longevity.

Depressive symptoms, which approximately 350 million people around the world currently experience, have been linked to personality traits. A 2023 study showed that all five dimensions of personality were linked to changes in depressive symptoms but neuroticism has the strongest association with depressive symptoms, with people who are high in neuroticism being more likely to experience depressive symptoms.

Personality traits may also be a cause of the considerable sex difference in depressive disorders that exists between males and females across sociocultural contexts. This difference exists across the lifespan, with females around twice as likely as men to experience depressive disorders from adolescence to late adulthood.

Neuroticism and depression in women

In a 2022 study, neuroticism was correlated with the prevalence of probable major depressive episodes for both men and women. Still, the effect of neuroticism in the incidence and persistence-recurrence of probable major depressive episodes was only found in females. In other words, the study found a neuroticism-related vulnerability in women for the incidence or persistence-recurrence of a major depressive episode.

Past research has suggested one neural mechanism between neuroticism and depression found only in women. It has been described as a correlation between neuroticism and resting-state regional cerebral blood flow in the hippocampus and midbrain, and neuroticism predicted depressive symptoms through greater activity of these regions, which are used in emotional processing and regulation.

Conscientiousness and depression in women

Conscientiousness affects men and women differently as well. In the same 2022 study, the interaction found between gender and conscientiousness for the incidence of depressive symptomatology demonstrated a larger protective effect of conscientiousness for men compared to women. In other words, being high in conscientiousness helps men prevent depressive symptoms more than it does for women.

Considering the impact of personality traits and gender on depressive symptoms, researchers recommend including personality and gender-specific strategies in mental health and depression intervention or prevention programs.

Understanding Sex Difference in Addiction: The Road to Tailored Treatments

Authors: Tanisse Epp, PhD Student, Carleton University, MSc Neuroscience, University of British Columbia | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators) 

Published: Dec 1, 2023

For a long time, society believed that alcohol and drug use was primarily a problem for men. As a result, research has mostly focused on studying addiction in men. But in recent years, there has been more attention to women and how they use drugs and alcohol. As the number of women using drugs and alcohol keeps increasing, closing the gap between men and women has become extremely important. Recently, there has been a promising rise in research looking at sex differences within addiction research. This research has highlighted significant differences in how addiction develops and progresses differently in men and women. These differences have important implications for treatment and relapse risk.

Consumption Patterns 

Despite men having higher rates of substance use disorders than women, women are more vulnerable to many aspects of the disorder. For example, women have a shorter time period from initial drug use to meeting the criteria for substance use disorder and seeking treatment compared to men. This phenomenon is called the ‘telescoping effect.’ It means that women tend to develop problematic substance use issues in fewer years compared to men. This effect has been reported across multiple drug classes, including cocaine, methamphetamine, alcohol, opioids, tobacco, and cannabis, and non-pharmacological addictions, such as gambling

Pre-clinical research has proposed a potential mechanism underlying this sex difference in the nucleus accumbens (the dopamine centre involved in addiction) and the dorsal striatum (the action-oriented center driving the physical action of taking substances). For instance, when exposed to drugs, female rats show a smaller response in the nucleus accumbens at first, but they have a quicker and stronger reaction in the dorsal striatum, driving an escalation in drug use. Additionally, gonadal hormones have been proposed to be involved. Research, both in clinical and pre-clinical settings, has demonstrated that estradiol, a female hormone, can lead to an increased ‘high’ from smoking cocaine and a stronger drive to obtain cocaine. This suggests that estradiol may play a role in the quicker progression from casual to chronic cocaine use in females compared to males. 

Craving

While the telescoping effect plays a significant role in the early stages of addiction, craving becomes a crucial factor in sustaining addiction and raising the risk of relapse after quitting. Exploring potential sex differences in craving will contribute to a greater understanding of how we can support both men and women during abstinence to decrease the risk of relapse. Current research on the sex differences within craving is mixed. Some studies have found no significant differences in craving between men and women for cocaine or alcohol use disorder. In contrast, for opioid use disorder, women have greater craving scores than men. These mixed findings may be related to the involvement of sex hormones in the changes in spine density in neurons and how this impacts craving. Changes to neuronal spine density (how neurons connect in the brain) in the nucleus accumbens are thought to promote craving over time. Sex hormones impact spine density, where testosterone decreases and estradiol increases spine density. The interactions between sex hormones, types of substances used, and their impact on neuronal connections likely contribute to variations in craving.

Psychosocial Factors 

Psychosocial factors are known to impact the onset of addiction, such as stressful life events and childhood trauma. One study found that greater severity of childhood emotional trauma, sexual trauma, and overall childhood trauma was associated with higher cocaine use and an increased risk of relapse in women with cocaine use disorder, and this association was not found in men. This association is not limited to childhood trauma, but previous research has shown that women have a greater daily use of cocaine following stress-induced relapse compared to men. Both stress and trauma-related findings are theorized to be related to hypoactivation observed in the ventromedial prefrontal cortex (vmPFC; a key brain region contributing to reward and decision-making) in women. The dysregulation of the vmPFC is suggested to increase relapse and drug-seeking behaviour in women as it creates a more significant obstacle in self-regulation and control over emotionally regulated behaviours.

Implications and Treatment

While acknowledging the neural and behavioural sex differences in addiction has gained research interest, sex has not been well-considered in the development of treatment options for addiction. While some specific targets, such as noradrenergic, cholinergic, antidepressants, and GABA, have been examined in addiction research, there is a lack of focus on how sex differences affect these areas. Only noradrenergic targets consistently show that women tend to have better outcomes with tobacco and cocaine addiction. However, other treatment strategies, like withdrawal treatment or reinforcement blocking, do not have apparent sex-specific effects. Sex considerations should influence addiction medication and treatment development, given that women often experience more stress-related vulnerability, quicker addiction onset, and severe withdrawal symptoms, making research into these areas essential for sex-informed treatments.

 

*This blog was posted in honour of Substance Use Awarenss Week

Behind the Science: The Bidirectional Relationship of Behaviour and Stress

Authors: Romina Garcia de leon and Shayda Swann, Women’s Health Blog Coordinators | Interviewee: Dr. Annie Duchesne, Ph.D., University of Northern British Columbia

Published: Nov 17th, 2023

Can you give us a brief explanation of your research? 

I’m particularly interested in understanding how variations in hormones influence or regulate our behaviour, but also how our behaviour may regulate our hormonal processes. 

Over the years, I’ve been interested in understanding how contexts such as stressful situations might be influencing ovarian hormones (estrogens and progesterone). There’s a lot of interplay between the stress and endocrine systems. They often tend to regulate the same or similar affective and cognitive processes, but they’re often studied independently. I have a lot of interest in understanding the two systems together, and I’ve developed various approaches. 

The first approach involves measuring hormone levels and exposing people to different tasks. The second approach is to use observational studies where we take advantage of already accessible databases to try to answer these questions. These studies allow us to add a bit more complexity, given the larger sample sizes.

Studying this interplay is also relevant when we’re interested in questions of sex and gender. The sociocultural constructions of sex-related traits is a central dimension of gender. These constructions inform the way in which people are expected to behave in general and with respect to sex-related traits and situations. And often, our gendered constructions transform sex-related phenomena into specific sources of stress. So I do believe there’s a lot of relevance in studying the handover between stress and the gonadal system, particularly when interested in understanding the ramifications of sex and gender. 

How did you get into the field of women’s health? 

My undergraduate degree was in molecular biology. From these studies, the question that remained was how do people adapt to their environments. My first foray into this question was through conducting research on materno-fetal physiology within Dr. Julie Lafond’s laboratory. Specifically, understanding the metabolic physiology of the placenta. At that time Dr. Lafond’s laboratory was interested in how maternal variation in lipidic and toxicological profiles could influence fetal development through placental physiology. This research experience allowed me to realize the central role that the endocrine system plays in communicating what’s going on in the environment and adaptively relaying this information to all other physiological systems so that the organism is best prepared for a variety of upcoming situations. 

During my Master’s degree, I channelled my interest in endocrinology, development and adaptation to investigate the development of the biobehavioural stress processes. Fascinated by Michael Meaney’s research – which transformed our neurobiological understanding of the interplay between the environment, maternal behaviour and the development of the hormonal stress response, I went to work with Dr. Ron Sullivan who was one of the few researchers who looked at the sex difference in the role that maternal behaviour could have in the development of the stress responses. There, I discovered that variation in the environment can differently impact male and female rats, but also realized how we systematically excluded female animals from most behavioural neuroscience research. I continued to research the interplay between stress and sex-related variables during my PhD which I conducted in humans under the supervision of Dr. Jens Pruessner where I studied the interplay between stress and the menstrual cycle on affective processes. Finally, during my postdoctoral research, I continued to investigate neurobehavioural underpinnings of reproductive phenomena by investigating the cognitive correlates of menopause-related endocrine changes in Dr. Gillian Einstein’s lab. Findings from this project support that the type of menopause, in particular whether you have had a spontaneous or surgical menopause moderates the neurocognitive correlates related to menopause.

Could you highlight some of your most important findings or highlights from your research?

One central idea is that the relationship between hormones and behaviour is context-contingent. For instance, during my PhD, I demonstrated that the relationship between cortisol levels and participants’ reported levels of stress changed completely depending on which menstrual cycle they were in. These are crucial findings! Once you have recognized that how hormones can influence brain and behaviour is contingent on context, the second important question is what are the contextual dimensions that are relevant?  

What has been an increasingly important field of investigation in behavioural neuroendocrinology, particularly about women’s health, is the use of feminist theory and feminist research to articulate and operationalize aspects of women’s experiences as relevant contextual dimensions, to then investigate how that particular context may moderate the interplay between hormones, brain and behaviour.  

For example, the menstrual cycle is best characterized as a biosocial phenomenon. Seminal work by feminist scholars has demonstrated how sociocultural attributions about women’s bodies inform how menstruating people feel and behave when menstruating, for example, feeling pressured to conceal one’s menstruation. By understanding women’s endocrine phenomenon as biosocial, relevant, yet often overlooked, contextual dimensions can be incorporated into our understanding of the neuroendocrine underpinnings of reproductive phenomena such as the menstrual cycle.    

Such an approach allows for the necessary resolution to advance bio-behavioural understandings of women’s health that avoids biological essentialist biases and prevents the belief that women are determined by their sex-related biology.

What impact do you hope to see with your work 10 years from now?

I hope I continue to complexify and nuance my understanding and investigation on behavioural neuroendocrinology, stress and reproductive phenomena. I wish that my ideas allow for a more refined and inclusive perspective. We all come to our object of study from a specific perspective or standpoint and therefore carry biases. I hope that more researchers within women’s health and behavioural neuroendocrinology (including myself here!) continue to critically engage and self-reflect on their own biases as well as the ones carried by their fields of research. 

I hope that approaching reproductive phenomena as biosocially entangled becomes more of the norm than the exception in biobehavioural research particularly concerning sex and gender. More generally, I hope that culture is no longer pinpointed against nature but rather that an organism’s biology, culture and environment are embraced as constitutive, dynamic and interdependent. 

Lastly, I hope for a continued diversification of the research in behavioural neuroendocrinology and women’s health. This includes but is not restricted to, who is conducting the research, the geographical locations from where the research is being conducted, the participants being included in the research, and the questions, methods and epistemologies used to advance understanding. 

If you’re interested in joining the NeuroGenderings Book Club, check it out here

Check out more of Dr. Duchense’s work here and here

If you’re interested in more about the processes and impact of racism and whiteness within the Canadian academic context, check out this collective.

What I’ve Learned Living with Migraines

Author: Negin Nia, B.A. & M.J.,University of British Columbia. Editors: Romina Garcia de leon & Shayda Swann (Blog Co-coordinators).

Published: June 23, 2023

Living with migraines means every day is uncertain. When my first migraine attack happened, I experienced intense pain and went to the hospital as a precaution. The doctor said my symptoms were normal migraine signs. 

Migraines, which are described as a neurological disorder, are a common health condition, especially for women. But, it can be hard to distinguish them from a regular headache as they are easily misunderstood or dismissed. That’s why for migraine awareness month, we want to help educate others on migraines. 

Defining a migraine attack 

Migraine attacks are a moderate to severe intense pain on one side of the head. A migraine can manifest differently for each person – some have mild impairments, others may require medical attention. 

Migraines can result from a combination of genetic, environmental, and lifestyle factors which make the brain vulnerable to specific stimuli and trigger an attack. Common triggers include stress, lack of sleep, alcohol, diet, and more

Migraines are the world’s third most common ailment and the leading cause of disability in those aged 15 to 49. Migraines are more common in females than males  — one in every five females have migraines compared to one in every 15 males. 

This overrepresentation is initially seen after the onset of puberty, suggesting the role of sex hormones. There is also evidence that menstruation is a time of increased risk for migraine attacks, and a subset of people (approximately 10-20%)  report migraines exclusively during menstruation.  

Researchers suggest that fluctuations in hormones such as estrogens and progesterone have an impact. This is why for many people, migraines may lessen or worsen during pregnancy and menopause, with the use of hormonal contraceptives or hormone replacement therapy.  

The symptoms and stages

In most patients, there are four migraine stages. The first is prodrome, which is the pre-headache. Symptoms may include fatigue, yawning, insomnia, food cravings, anxiety, depression, and more. You can catch a migraine at this stage but it is often hard to distinguish it from other issues

The next stage is aura, which is associated with sensory disturbances such as loss of sight, blind spots, and flashes. It is also common to feel nauseous or sensitive to light and sound. Auras are not experienced by all –  only one-third of migraine patients experience them. Females are more likely to experience these factors compared to males. 

The third stage is the throbbing one-sided headache. Although the exact neural underpinnings remain unknown, there are some theories. The neurovascular theory explains that this pain is due to the activation of the trigeminal-nociceptive pathway and the inflammation that follows. Some work seems to link the role of serotonin in activating this pathway. Interestingly,

Raising Awareness 

There is a clear lack of public information surrounding migraines. Migraines are an invisible disability that requires more attention and care. There is also a shared feeling of shame and stigma amongst migraine patients when being downplayed for just having a “headache.” 

Given this, it is important to raise more awareness and set up proper support systems for migraine patients. By talking more about this neurological disorder, we can break stigmas and help create an environment of empathy.

An Honest Look into Sex & Gender Health Research in Canada

Authors: Tori N.Stranges, MPK, B.Kin, PhD Student | Editors: Romina Garcia de leon, Shayda Swann  (Blog Coordinators) 

Published: May 19th, 2023

It is well understood that sex and gender impacts individual and population health across the lifespan. It is also well understood that marginalized and systemically oppressed groups including women—particularly women of color, Indigenous women, disabled women, and immigrant women, as well as members of the Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, and Asexual (2S/LGBTQIA+) community—face health disparities when accessing health care in Canada. Differences exist in disease manifestation, diagnosis time, misdiagnosis, treatment efficacy, and progression of disease resulting in devastating health effects in these populations.

These disparities can be partially attributed to the lack of funding for women’s and 2S/LGBTQIA+ specific health. Studying sex and gender influences is only one step in understanding why health disparities exist across sex or gender. Gender identity and sexual orientation are also key considerations for health research from a health equity lens. The large knowledge gaps in the health of these populations has prompted the Canadian Institutes of Health Research (CIHR) to mandate the incorporation of sex and gender into research. First by recommending the inclusion of Sex and Gender-based Analysis (SGBA) in project proposals in 2010 and then by mandating the incorporation of SGBA into grant proposals in 2019.

A group of recent grads and current grad students (including Tori Stranges, Amanda Namchuk & Tallinn Splinter) were curious how these changes in SGBA resulted in increased mention of sex or gender in funded research proposals. With the leadership of Dr. Liisa Galea and the Women’s Health Research Cluster (WHRC), we searched the publicly available database of grant abstracts funded by CIHR. We analyzed the amount of funded research that mentioned sex or gender in the abstract as well as funded grant abstracts that mentioned either female-specific health research or research within the 2S/LGBTQIA+ community. 

In total, we reviewed 8,964 Project and Operating grant abstracts awarded from 2009-2020. We found that under 3% of research funded by CIHR explicitly mentioned SGBA, with 1.94% of grants mentioning sex, and 0.66% mentioning gender within their abstracts. As one of the goals of SGBA is to inform on health equity and understudied populations with respect to SGBA, we also found that 5.92% investigated female-specific outcomes, and 0.35% focused on the 2S/LGBTQIA+ community. 

So, what does this all really mean? Our findings suggest more work needs to be done to increase researcher utilization of SGBA as well as to advance health equity in research. It is important to highlight that much of the existing work in this field has unfortunately been focused on binary understandings of sex and gender. Looking beyond this narrow focus allows for a more nuanced understanding of complex issues that include multiple perspectives. Although our understanding of the need for, and recognition of, SGBA in research may be improving, it has yet to be translated into increased research focus and funding. The research community needs to acknowledge that for publications, clinical trials, and grant funding applications, SGBA has not been fully realized despite numerous attempts to support its integration.

So, where does this leave us? The hope of SGBA is that widespread adoption of its principles will result in an equitable future for health where female-specific health, 2S/LGBTQIA+ health, racialized, disabled and gendered experiences, and more are considered. Together we have the power to improve health and reduce disparities, one SGBA at a time.

 

Figure 1: An infographic depicting the change in percentage of grants and funding between 2009 and 2020 for awarded Canadian institutes of Health Research (CIHR) grants for the different categories. The change in percentage (%) of grants (A) and funding amount (B) in the years 2009 and 2020 that “omitted” mention of sex and gender in their grant abstracts or mentioned female-specific health, female-specific health not including cancer based grants, sex, gender, or 2S/LGBTQIA+ health. Reprinted with permission from Stranges et al. 2023

Key Takeaways:

  • The percentage of funded grants in which the abstracts mentioned sex or gender in health research remained largely unchanged from 2009 to 2020 with the largest increase of 1.57% for those mentioning sex.
  • Total funding amounts for grants that mentioned sex or gender in the abstract stagnated or declined from 2009 to 2020.
  • The percentage of funded grants in which the abstracts focusing on female-specific health did not change across 2009-2020, but the percentage of funding dollars increased by 3.47%.
  • The percentage of grants in which the abstracts mentioned 2S/LGBTQIA+-specific health more than tripled across 2009-2020 but remained less than 1% of all funded grants. 

 

Same Disease, Different Risks & Symptoms: Cardiovascular Disease in Women

Authors: Nabilah Gulamhusein: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Elaha Niazi: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Smriti Juriasingani: Cumming School of Medicine, University of Calgary 

Editors: Romina Garcia de leon & Shayda Swann (Blog Co-coordinators).

 

Cardiovascular disease is the leading cause of death among women worldwide, and in fact, women are more likely to die from a heart attack than men. This often surprises women and their care providers because cardiovascular disease has traditionally been considered a male-dominated disease. Deaths due to cardiovascular disease have declined in the last 50 years in men, but have risen in women, especially in younger women. It is increasingly apparent that there are both sex-based (related to biological attributes) and gender-based (related to socially constructed identities, expression, roles, and behaviors) differences in cardiovascular risk factors, as well as the development and progression of cardiovascular diseases. Though we have made great gains in improving men’s heart health, women remain under-researched, under-diagnosed, under-treated, and under-supported; consequently, many women are unaware of their cardiovascular disease risk. 

 

Though many consider cardiovascular disease only a disease of older women, it affects women at all life stages. Reproductive-aged women have been developing increasingly disadvantageous cardiovascular disease risk profiles, including obesity, physical inactivity, an unhealthy diet, and stress; these factors appear to have a larger impact on women than men. While these are certainly important considerations in cardiovascular disease risk for young women, it is time to adopt a broader understanding of female-specific risk factors.

 

In addition to traditional risk factors, female-specific and female-predominant factors contribute to cardiovascular risk. Conditions related to fertility, such as polycystic ovarian syndrome and menstrual irregularities, have been associated with an increased cardiovascular disease risk. In addition, certain pregnancy complications can increase heart disease risk, including gestational hypertension and diabetes. It is critical that women have the opportunity for informed discussions with healthcare providers to mitigate reproductive and pregnancy-related risks. There is also a multitude of medical conditions disproportionately impacting women that result in increased cardiovascular risk. These include depression, diabetes, hypertension, autoimmune diseases, and chronic kidney disease. Awareness of these important female-specific and female-predominant risk factors can empower women in making heart-healthy choices. 

 

There is no question, however, that as a woman ages, cardiovascular risk increases considerably due to changes in the heart and blood vessels. The timing of the onset of menopause, as well as perimenopause (when the transition to menopause begins, but before a final menstrual period), may influence a woman’s cardiovascular risk. Premature menopause (before age 40) and early menopause (before age 45) are significantly associated with increased cardiovascular risk. Additionally, cardiovascular disease risk commonly increases after menopause, which is attributed to changes in hormone levels (e.g., estrogens).

 

Early heart attack symptoms are missed in more than 50% of women and therefore, it is important to recognize that women may have different symptoms compared to men during a heart attack. While women experience symptoms such as sharp chest pain, they may also have aching sensations across the back and stomach, pain in the jaw, neck or arm, shortness of breath, abnormally excessive sweating, nausea, indigestion, and extreme fatigue. Unlike men, women are more likely to present with three or more symptoms in addition to chest pain when having a heart attack. Being informed and spreading the word about heart disease symptoms in women is the first step towards protecting the women in our lives. 

 

Knowing that women have unique cardiovascular risk factors and subtle symptoms can be overwhelming, however, heart disease is largely preventable. First, following Canada’s 24-hour movement guidelines, including getting 150 minutes of moderate to vigorous physical activity per week, reducing sedentary time, and getting enough good quality sleep is recommended for a healthy lifestyle. Research shows that consuming 7-10 servings of fruits and vegetables every day, while limiting processed foods, sugar and salt are key ways to reduce cardiovascular risk. It is also important for women to have regular check-ups with their healthcare providers and take their medications as prescribed. Finally, living free from commercial tobacco and vaping while reducing alcohol intake and actively managing stress can also be beneficial.  

 

To learn about women’s cardiovascular health, including risk factors, symptoms, treatment, and support, you can participate in Wear Red Canada or visit WearRedCanada.ca! Wear Red Canada is run by volunteers across the country, including healthcare providers, scientists, and people with lived experience. Wear Red Canada Day is celebrated annually on February 13th to raise awareness about women’s heart and vascular health. Each year, you are invited to attend presentations by leading experts, join the Wear Red Canada Movement Challenge, and visit local landmarks that will light up RED in support of women’s heart health. On February 13, wear RED and join us on social media to share selfies or pictures of your participation in these events with the hashtag #HerHeartMatters and tag @WearRedCanada to share this important message. By starting conversations about women’s cardiovascular health and getting informed, we can increase awareness and improve the health of the women in our lives.