Tag Archive for: women’s health

The BC Women’s Health Foundation on Embedding Equity

 

Author: Mita Naidu, Senior Manager, Public Engagement + Education, BC Women’s Health Foundation Editors: Negin Nia & Romina Garcia de leon (Blog Co-coordinators)

Published: June 3rd, 2022

“We do not learn from experience. We learn from reflecting on experience.” – John Dewey

BC Women’s Health Foundation (BCWHF) is a medium-sized philanthropic organization dedicated to advancing the full spectrum of women’s health. We help ensure women have equitable access to the highest quality healthcare when, where, and how they need it.

While our mission is clear, the work can be complicated when put into practice — especially when viewed through the lens of underrepresented communities. At BCWHF, we recognized we had work to do and committed to a journey of learning how to meaningfully embed equity and equality practices throughout our organization.

We knew that Equity, Diversity, and Inclusion (EDI) training would help provide clarity, support, and a sense of safety to our team. So, we began this journey with dialogue and exploration — and speaking truth to power.

The Path

This year, we honoured Black History Month, which was a new experience for us. With no organizational blueprint, our approach was experimental but not haphazard. For such a significant month, we wanted to ensure that we were on the right trajectory in approaching equity and inclusion at an organizational level, first and foremost. Not just in how we show up internally but also alongside the communities we collaborate with. 

We began our process months prior and kept two questions at the forefront. How can we meaningfully engrain the foundations of equity and inclusion in our organizational DNA? And why does it matter in the first place?

We asked these questions reflectively while also looking forward and considering the trajectory of BCWHF. Primarily, we wanted to assess if/how equity existed in our organization, policies, and culture and where we needed to fill gaps with action. We knew this internal ‘unpacking’ was a critical step towards earning the right to join conversations surrounding equity and inclusion. 

This is what we learned:

1) Stop stalling and start.

Our organization, like most non-profits, has a big mission with finite resources and capacity. This creates the perfect conditions for pre-empting equity work with “what-ifs.” Moving beyond fear and courageously addressing the gaps is crucial. Not starting can undermine organizational trust, especially among IBPoC staff who don’t get to walk away from inequality because it gets “uncomfortable.”

2) It starts at the top.

It is critical to collaborate on equity work across the organization. But EDI is transformational and, therefore, must start at the top. Leaders have to take charge in guiding through potential discomfort, friction, and difficult conversations, which requires a considerable investment of time. Leaders must also provide adequate support and feedback and not place this responsibility on IBPoC staff. This investment from leadership is essential, no matter how difficult the journey.

3) Authenticity is more than a buzzword.

Bringing our truths (safely) to EDI work reveals our privileges, biases, values and power dynamics. In doing so, we can build trust and connection through our actions. This is the nexus where EDI work takes hold. Through transparency, discomfort, and mistakes, impactful change can yield positive ripple effects that become organizational best practice. No longer considered a “soft skill,” — being an authentic organization can help develop community engagement. 

4) Be on the same page.

An organization may have many different voices, but having a unified institutional voice is vital in EDI work. Partners, staff, and community must know that an organization proactively drives forward initiatives that bring about parity and inclusion. This voice demonstrates that an organization is serious – and that there are no debates when it comes to fairness. Additionally, while workplace consensus is important, so is striving to understand the legacies and histories of systemic oppression and instilling those learnings within the organization.

5) Be consistent.

Being consistent is more difficult than it seems, but with consistency comes hope. Anti-oppressive language, strategies for all teams, inclusive branding, revising policies, recruiting IBPoC staff, check-ins and call-ins, and measuring outcomes are tools that can help an organization remain on track with EDI goals. Unyielding effort is required for organizations to transform a commitment to EDI into action. 

6) Community engagement is key.

Primarily, it’s to walk the talk of equity and earn public trust. Communities best understand real and tangible action and know when their voices show up in policy. They also know when they’re being tokenized and when EDI actions feel performative and temporary. Authentic community engagement, deep listening, creating space for dialogue, and committing to action matter most.

7) Mistakes are inevitable.

No organization has ever gotten it right. But for many IBPoC, just knowing an organization is applying these lessons is significant. While mistakes bring discomfort, this can be a good thing. It allows individuals to learn, adapt, and potentially change their perspectives. As staff, community stakeholders, and the public watch your EDI journey unfold – remaining open to criticism, dialogue, and assessment is paramount.  

Equity work takes consciousness, commitment, and consistency while recognizing that equity work isn’t for IBPoC. Ultimately, it is a chance for organizations to catch up and mitigate systemic gaps. At BCWHF, we have learned that the journey is as meaningful as the outcome. And this makes us better advocates as we undertake the actions in serving, supporting, and growing the community.

Behind the Science: Working in the Women’s Health Field


Interviewee: Arrthy Thayaparan, B.Sc., M.J., University of British Columbia |

Authors/Editors: Negin Nia & Romina Garcia de leon (Blog Co-coordinators).

Published: May 20th, 2022.

The Women’s Health Research Cluster (WHRC) blog started back in 2020. The blog aimed to showcase work by women and gender-diverse people wanting to make a change in the women’s health field.

We spoke to Arrthy Thayaparan, one of the first WHRC Blog Co-coordinators, about her experience working for the blog. She shares what got her initially interested in pursuing work in women’s health.

Why did you decide to pursue work as a Blog Co-coordinator?

I have an academic background in both science and journalism. Therefore, I was seeking a job that would allow me to continue to learn and share stories in the science and health realm. When I found out about the blog through the UBC Work Learn website, I knew it was the perfect fit. I ended up applying to every single option available with the WHRC, but glad I was selected as a Blog Co-coordinator as it was a much better fit to help finetune my writing skills.

As a lover of science who was starting her journalism career, the WHRC was just a great way to help me learn and expand on those essential communication skills. It also let me stay in touch with the world of academia. I got to work with a thoughtful and energetic team, while also peering behind the scenes of a research cluster taking on valuable work in the field.  

Out of all the scientific fields you were exposed to, why women’s health?

I got into science journalism because I became aware of the lack of science-trained journalists who knew the field and could communicate it to a general audience. From there, I began to realize that women’s health is underrepresented, especially in the media. 

For example, there were a lot of worries and myths about fertility, pregnancy, and vaccinations during the start of the COVID-19 pandemic. So, the WHRC prioritized this in our blog topics and got the conversation going. That realization and effort to engage worked out to our benefit since the pregnancy vaccination blogs are some of our most widely read blogs to this day.

What impact do you hope the blog will have in the field of women’s health going forward?

When the blog first started it was pretty small and we didn’t have too many readers or much engagement. Now, we can see how the work that we’ve done over the past two years has grown. Recently, we were voted the 9th top Women’s Health blog by FeedSpot. 

Seeing that growth in just two years was motivating for everyone on the team. I think with that momentum, the blog could go on to become a staple in women’s health awareness and education. This is especially true with how diverse the WHRC members are both globally and knowledge-wise.

Do you see yourself integrating women’s health into your future roles?

Oh, absolutely! I think working here has opened my eyes to so many topics within the field of science. I’ve always associated my best journalistic work with experts or researchers I have interviewed from the WHRC. For example, Dr. Jade Boyd was a huge help for one of my biggest stories last year on understanding overdose reversals in B.C. I covered what impact that had on frontline workers of the overdose crisis. I’ll always keep coming back to the WHRC and the blog to keep myself up to date and to stay connected. 

Is there anything else you would like to mention?

I’m grateful to everyone at the WHRC for having me on, the writers of the blogs for their passion, and the readers for allowing us to continue sharing this essential work. I’m especially thankful to Alex Lukey and Negin Nia, my blog co-coordinators, for bearing with me when things got stressful with school and supporting each other with the work.

Also, I don’t think enough credit is given to the support we receive from Katherine Moore, Director of Operations & Strategic Initiatives, and Liisa Galea, Cluster Lead. No matter what crazy idea we brought forward, like the Behind the Science series or creating a Medium page, they were always on board and excited. None of this would be possible without their vision or passion for knowledge translation and women’s health. I’m beyond grateful to have had the opportunity to work with them.

Other than that, I’m excited to see how the blog continues to grow, and I hope that one day I can write for the blog or about the blog.

How can people reach you?

People can follow me on Twitter (@ArrthyT) to keep up with my work. Feel free to message me to talk about potential stories or anything science-related.

Understanding the Lived Experience of Perimenopause, Menopause and Post-Menopause


Author: Bhairavi Warke, PhD Student, Simon Fraser University Editors: Negin Nia and Arrthy Thayaparan (Blog Coordinators)

Published: April 8th, 2022

What is lived experience of Menopause?

Menopause is when one has gone an entire year without a menstrual period. The average age for menopause is 51 years. It is preceded by Perimenopause, when women start noticing physical and psychological changes, and followed by post-menopause. This transition can be challenging for many due to symptoms like hot flashes, night sweats, mood swings, etc. Not only does it affect women’s physical and psychological well-being, but it may significantly affect their personal and social lives. For example, menopause symptoms can cause limitations in family life, relationships, professional activities, and more. Additionally, every woman’s experience can greatly vary in terms of the severity and duration of symptoms. For some, the symptoms of menopause can last over a decade and thus, significantly lower their Quality of Life (QoL). 

The World Health Organization (WHO) defines Quality of Life as, “an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns. QoL is a multi-dimensional concept affected in a complex way by the person’s physical health, psychological state, level of independence, social relationships, personal beliefs and their relationship to their environment.”  

Although it is a natural phase of life, most women struggle to find relevant information that may help them navigate the menopause journey. Women often feel a sense of isolation or lack of support in social settings. Now-a-days, women exchange information in smaller close-knit groups or over online menopause forums to seek help and support beyond their doctors. Despite the sheer number of people who experience menopause, it still seems to bear stigma and is not yet a commonplace topic in public discourses. Menopause is seen as a personal and private health condition than a regular aspect of life and women are expected to “just figure it out” themselves as they go through it. In addition, post-menopausal women are more vulnerable to heart disease, osteoporosis, and breast, ovarian, or uterine cancers. Thus, understanding the impact of the menopause transition on women’s day-to-day lives, i.e. the lived experience, is crucial to address some of the challenges they face.

Why is it important?

We know that menopause is influenced by more than the physiological changes associated with it. The socio-cultural understandings of menopause have a significant impact on women’s experience of it. However, we know little about how this affects women’s ability to adapt to the new phase of life. Menopause and aging women’s needs are often ignored or rarely discussed in mainstream healthcare product and service innovations. This makes it a hidden reality that not only impacts women’s preparedness for this journey, but it also influences how they can participate and contribute to society. Moreover, the socio-economic burdens and costs of healthcare for women in menopause can be very high. Studies have shown that education, appropriate guidance and effective management can have real benefits in improving women’s QoL as they go through this transition.

Opportunities in Personal Technology

Personalised self-care technologies are becoming more and more ubiquitous. For example, we are surrounded by a large number of fitness trackers and health apps. These technologies focus on tracking personal data like weight, energy levels, physical activities, time usage, sleep and learning strategies, and are intended for self-improvement and behaviour change. Despite their growing success, the existing landscape of interactive self-tracking tools for menopause care is sparse, often limited to period tracking, coaching and information sharing applications. There are a lack of meaningful interventions that could help women through their menopause journey, beyond just tracking symptoms, and seamlessly integrate it within their lifestyles to improve their quality of life.

Where can we start?

To design better self-care tools that are useful for women experiencing menopause, we need to: a) talk to experts in women’s health, and b) understand the lived experience of menopause from women themselves. 

In the initial stage of this research, we, the researchers at the Pain Studies Lab in SFU, are planning to conduct a participatory workshop to explore the lived experiences of menopause from experts in women’s health and from women who are experiencing perimenopause, menopause or post-menopause. The workshop will be conducted online via video conferencing (like Zoom) and participants will discuss how the different stages of menopause affect the day-to-day realities of someone’s life. The workshop will conclude with a short brainstorming activity to explore ideas of what may help women during this transition and benefit their long-term quality of life.

How can we get in contact with you?

If you are an academic researcher or professional expert working in fields related to women’s health or menopause care, WE NEED YOUR HELP! 

Please contact me at bwarke@sfu.ca if you would like to participate in this 2.5-hr online workshop. Participants will be compensated with $20 for their time and contribution.

(Note: We refer to all individuals experiencing symptoms of menopause as ‘women’ in this article. However, we acknowledge all individuals who may or may not identify as ‘women,’ but experience menopause or like symptoms, as a part of this research.)

Should Domperidone Be Reconsidered as a Treatment For Low Breastmilk Supply?

Author: Janet C. Currie, MSW, PhD, Research Collaborator at the UBC School of Nursing. Editors: Suzanne Hetzel Campbell PhD, RN, FCNEI, IBCLC, CCSNE, Negin Nia and Arrthy Thayaparan (Blog Coordinators)

Published: March 11th, 2022

Domperidone is a dopamine blocker that is being increasingly prescribed off-label in British Columbia and other provinces to treat low milk supply (LMS). Domperidone increases prolactin, which can stimulate milk production, an unintended side effect.

There is a global consensus on the importance of at least six months of exclusive breastfeeding because of its overwhelming health benefits. An average of 90 per cent of Canadian mothers intend to breastfeed and go on to initiate it. However, by three months the rate of mothers exclusively breastfeeding their newborns has decreased to 51.7 per cent and by six months to 14.4 per cent. One of the most common reasons mothers give for stopping breastfeeding early is because of LMS.

Low milk supply

Physiological factors can contribute to LMS. These include conditions such as mammary hypoplasia, which is limited breast glandular tissue. The prevalence of physical barriers to breastfeeding is thought to be low – from 1 to 15 per cent.

In most cases, LMS appears to be caused by other factors that affect milk supply. These include a mother’s confidence in her milk supply and/or a lack of information about lactation, infant nutritional needs, sleep patterns and hunger cues.  

LMS can also be related to the degree a mother receives sustained help with breastfeeding and the medicalization of breastfeeding which can result in a premature diagnosis of LMS and the early introduction of formula.

Increasing use of domperidone in Canada

Two Canadian studies have documented the rise in domperidone use to treat LMS. In BC, between 2002 and 2011, Smolina et al. found that domperidone use increased from 8 to 19 per cent for term births and from 17 to 32 per cent for preterm births. This research showed an increase in the median daily dose from 60 to 80 mg/day and a longer duration of use.  

A recent study in BC, Alberta, Saskatchewan, Manitoba and Ontario found domperidone use increased between 2004 and 2017 with some reduction in use after Health Canada’s 2012 domperidone advisor.

Off-label use of domperidone

Health Canada has only approved domperidone to treat digestive problems. When it is prescribed for LMS this is an-off-label, unapproved use. Off-label prescribing occurs when a drug that has been approved for specific use by Health Canada is prescribed for another use for which the drug has not been approved. Off-label prescribing can be beneficial especially when few treatments exist for a condition, but without data derived from the drug approval process it can be difficult to assess a drug’s benefits and harms. In addition, ADRs from off-label uses are not systematically collected or analyzed to identify safety problems. 

Domperidone has not been approved for any use in the United States and the distribution or importation of domperidone-containing products into the US violates the law. Domperidone has not been used to treat LMS anywhere in the world. 

Safety concerns of domperidone

Domperidone is a QT-prolonging drug which means that it can trigger ventricular arrhythmias. In the most serious cases, this can lead to Torsades de Pointes, an abnormal heart rhythm that can result in cardiac death.  

The cardiac risks of domperidone are dose-related. In a 2015 advisory, Health Canada recommended that domperidone be used at a maximum daily dose of 30 mg/day for a short duration. However, Canadian research indicates that domperidone is being prescribed above recommended guidelines, sometimes over 80 mg/day.

Taking other QT-prolonging drugs with domperidone increases cardiac risks. Many common prescription drugs are QT-prolonging. They include fluoroquinolone antibiotics (e.g., Cipro), antidepressants (e.g., escitalopram and citalopram, antifungals (e.g., miconazole), and some antipsychotics.

Using a QT-prolonging drug along with CYP3A4 Inhibitors, a type of enzyme, can trigger risks. Substances with CYP3A4 inhibitors include drugs like erythromycin and foods like grapefruit/ grapefruit juice. Other factors that increase the potential risks of domperidone include having a personal or family history of cardiac problems, liver disease, electrolyte problems, and low blood levels of potassium and magnesium. Female sex is an independent risk factor.

Domperidone is an antipsychotic (neuroleptic). Antipsychotics are psychiatric drugs usually approved to treat conditions like psychoses and schizophrenia. Even if someone is taking domperidone for LMS and not for a mental health condition, the potential for adverse drug reactions (ADRs) can be the same. ADRs may intensify if the drug is reduced or stopped rapidly, especially from high doses.

Recent case studies and reports to the Infant Risk Information Centre at Texas Technical University indicate that some people using domperidone for LMS are experiencing serious adverse reactions when they stop. ADRs effects from stopping domperidone could include fatigue, movement/muscle problems, weight gain, anxiety, agitation, palpitations, dry mouth/eyes, dizziness/ poor balance, gastrointestinal problems, insomnia, cognition problems, listlessness and depression and, in serious cases, psychoses or suicidal feelings.

To reduce antipsychotic withdrawal symptoms, domperidone should be tapered consistently and slowly in small increments with a period of 2-4 weeks between reductions or at a pace that is tolerable. A tapering plan should be discussed with a healthcare provider knowledgeable about antipsychotic withdrawal. 

The safety of domperidone absorbed by babies through breastmilk has not yet been clearly established.

Effectiveness of domperidone

Evidence of domperidone’s effectiveness from randomized control trials is of low quality with small study enrollment, short-term tracking, (1-2 weeks), a focus on low doses, a lack of meaningful outcome measures such as duration of breastfeeding and limited reporting of ADRs. In most cases, where domperidone resulted in an increase in milk volume, the increase was not significant. Higher dose levels were not associated with significant increases in milk volume. 

Behind the Science: Understanding Nanomedicine


Interviewee: Dr. Hagar Labouta, PhD | Authors/Editors: Arrthy Thayaparan & Negin Nia

Published: February 25th, 2022

With our blog series Behind the Science, we strive to share the stories and amazing work of a diverse range of scientists and academics in the Women’s Health field. The latest feature in our series is Dr. Hagar Labouta, assistant professor at the University of Manitoba’s College of Pharmacy and a renowned nanomedicine researcher. In this blog we speak with her to better understand exactly what nanomedicine is and to learn of her journey through academia as a Hijabi woman of colour. 

Can you please explain what your research is?

My research is in nanomedicine. So, we work with small things called nanoparticles, or small particles. Those tiny particles are very powerful, you can use them to target specific sites in the body that you are not able to do with conventional therapies. You can also decorate nanoparticles with some chemical groups or ligands on top. For instance, those attached ligands could target specific cancer cells. Therefore, there would be higher accumulation at the tumour side and lower accumulations elsewhere, and as a result the patient suffers less side effects from chemotherapies. 

Most of the applications of nanomedicine have been in cancer therapies, but there are lots of other applications that require nanotechnology-based solutions. The focus of my lab is using those technologies to develop safe and effective therapies for the treatment of maternal and fetal disease during pregnancy. More specifically, we design new nanoparticles to carry drugs that are essential for the mother or the baby and we carefully characterize them in the lab as well as evaluate them under conditions that simulate human pregnancy.

How did you get interested in pursuing this work?

My dad, Dr. Ibrahim Labouta, was a professor of pharmaceutical chemistry. I lost him recently to COVID-19 but he was my mentor throughout my entire life, who got me into science. Since I was a child, I wanted to be like him. He was my number one supporter to leave my home country after my master’s degree to pursue a career in Germany, where I got supported by my mentor during my PhD. I was really lucky to be mentored by great mentors, Drs. Labiba El-Khordagui, Marc Schneider, Claus-Michael Lehr and David Cramb, who pushed me into the direction of this research and significantly impacted my career.

In the beginning I was inspired by doing science, and drug delivery was a big thing. When I started my PhD in Germany, I was fascinated by nanomedicine and how powerful this field is. I think we’re now witnessing the glory of this field, millions and billions of people are now receiving the COVID-19 vaccines by Pfizer and Moderna that are based on mRNA lipid nanoparticles.

In 2019, I started at the University of Manitoba with lots and lots of ideas. I got in contact with the Children’s Hospital Research Institute of Manitoba (CHRIM), and I started collaborating with Dr. Richard Keijzer and his team to develop a delivery system for a specific microRNA to babies diagnosed with congenital diaphragmatic hernia before they are born. That was the first project I did related to fetal health. Now, the main focus of my lab is maternal and fetal health.

What got you into women’s health?

My father got me into science, and he was also very interested in women’s health. When I was working at the University of Alexandria in Egypt, he was working in the Women’s Health Centre and was responsible for several women’s health projects in Africa and the Middle East. So he invited me one day to give a talk there, and so it’s always been in the back of my mind that I wanted to do something related to women’s health. 

The motivation has always been there, especially when I started to go deeper into women’s and fetal health. I started to realise that most applications of nanomedicine are geared towards cancer, which is a really big thing and we have seen several products already in the market. But if you’re talking about helping or using those technologies for women’s health, it’s really an area that is understudied and there are lots of questions that haven’t been answered yet – which is why I want to use my expertise in this area to answer these pending questions.

As a Muslim Hijabi woman, how has it been for you going through the ranks of the scientific community?

Being Hijabi and a woman from a minority, it definitely has been a journey, and  I’m proud to be Hijabi. In general, people tend to respect you when they see how you respect your background and culture. I feel very fortunate to be a Muslim Woman from Egypt. I was also really lucky to work in labs where many were inclusive. But there were definitely some people who were discriminating. Nevertheless I just kept going, and currently I’m a faculty member and a Hijabi. I hope this inspires other people who are Hijabi, non-Hijabi, minorities, or females, who are looking to build their career in academia. I hope I can send them a message that this is possible, I hope their route is now easier than mine. Just to add to that, I want to also emphasise that having a family doesn’t mean you can’t be a professor. I have a loving husband and two kids who made me better in many different ways. Everything is possible; academia is not really limited to a specific population or stereotype of a scientist. 

Behind the Science: The Effects of Estrogen Signalling


Authors: Negin Nia and Arrthy Thayaparan (Blog Coordinators) || Interviewing: Dr. Troy A. Roepke, Associate Professor of Animal Science, Rutgers University

Published: January 28th, 2022

Our first Behind the Science for 2022 is a special feature with Dr. Troy A. Roepke. They are an Associate Professor of Animal Science at Rutgers University with a focused study on the effects of the steroidal hormone, estrogen. In our discussion, Dr. Roepke takes us through the motivations behind their work and their experience as a gay/genderqueer scientist.

Could you tell us a bit about your research?

There are two main areas that I study. The first is estrogen signaling, mostly in the brain, but sometimes in the periphery. I look at how estrogen controls reproduction, energy balance, stress, physiology, thermoregulation, mood, cognition, memory. The second is examining the impact or influence of endocrine disrupting compounds on those same physiological and behavioral parameters, especially compounds that interact with estrogen receptors. 

What got you interested in pursuing that research? 

I was trained as a marine biologist studying marine invertebrates. For my Ph.D. at the University of California-Davis, I studied the effects of endocrine disrupting compounds on sea urchin development and sea star reproduction. I found evidence for non-classical estrogen signaling in sea urchin embryos and got interested in that as a target for endocrine disruptors. 

As I was finishing my degree, I was trying to find a postdoc in a marine biology lab interested in the same thing. Also, I was limited in my search for a postdoc because I didn’t want to move to a state where there were no legal protections for my same-sex relationship. Sadly, I was not successful in obtaining such a postdoc due to this restriction in location. Nearing the end of my final year, a colleague of my Ph.D. advisor suggested I work with Dr. Martin Kelly at Oregon Health and Science University in Portland, Oregon, because he’s one of the first people to demonstrate non-classical estrogen signaling, although in the mammalian brain. I contacted Dr. Kelly and he was interested in training me. Thus, I switched from studying things that didn’t have brains to studying the brain and learning all I could about estrogen signaling in the brain. 

What sparked your interest in women’s health?

I study estrogen signalling, and that is very important to all sorts of women, and even some men and non-binary people. I think it is a simple leap that when your main expertise is studying estrogen signaling, you’re also going to be interested in women’s health. 

Also, I primarily study female rodent models. The lack of inclusion of female animal models in the field of neuroscience itself is very distressing. I’ve been a big proponent of studying sex differences and sex as a biological variable because we need to be inclusive and that lends itself to focusing on women’s health.

As someone who identifies as genderqueer, how have you found the science space?

In terms of, let’s say the non-science part of science, I do see a greater acceptance and awareness for LGBTQ+ scientists than 30 years ago when I started and cisgendered and heterosexual scientists are trying to be more aware. Especially, the younger generation of scientists are more aware about pronouns usage and more accepting about that. That’s given me a safer space to be open about my identity. But, it wasn’t always that case. I came out in the early 90s, and there was a reasonable amount of hostility about being queer – so things have improved but there’s always more room for improvement! 

But as for the science itself, many other scientists and I are push the idea that while it is important to study sex as a biological variable and study both male and female rodents, science needs to be very careful and inclusive in how we interpret those findings. We must reflect the real-world experience of all different types of people, who express different types of gender and don’t identify as cisgendered. We are working in small and big ways to make sure that happens.

What impact do you hope to have on today’s world and the future?

I hope that some of my work in terms of science would be impactful, especially with flame retardants and showing how these chemicals that interfere with estrogen signaling can impact physiology and behavior in all sexes. That would help regulatory agencies make the best decision possible, hopefully. In terms of estrogen signalling, I hope that it will help impact how we view the brain in terms of sex and gender. And demonstrating how hormone replacement therapy for postmenopausal people, trans people, or anybody who needs it can impact their health.

 

Learning to Forget: Making the Case for Sex-Specific Approaches to the Treatment of PTSD


Author: Dr. Luzia Troebinger, Post-Doctoral Fellow, University College London – Clinical Psychopharmacology Unit | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: April 8th, 2021

What’s your worst memory? If I offered you a pill that could erase it, would you take it? Or let’s rephrase the question: How bad would your worst memory have to be to take that pill? What if you couldn’t leave your house without reliving this memory? You might think this scenario is exaggerated, but for people suffering from post-traumatic stress disorder (PTSD), this might be a daily reality. For many people with PTSD, the impact on quality of life is so severe that they would not hesitate to take that pill. 

Research suggests that women are twice as likely to develop PTSD, even though rates of trauma exposure are higher in men.[1-3]  The reason for this disparity is complicated and dependent on environmental and biological factors.[4]  With regard to biological factors, the role of sex hormones in the context of stress and fear memory has become a primary target for research in this area.[5-7]

Studying fear memories in the laboratory can help improve our understanding of the mechanisms involved in PTSD. In the lab, a ‘fear memory’ is first established through a learnt association between a neutral and an adverse stimulus (e.g. a tone paired with an electric shock). This is similar to what happens in PTSD: a previously neutral stimulus becomes associated with the traumatic event. Extinction learning refers to the process of suppressing or reversing that learnt association. This is typically accomplished through repeated exposure to the neutral but not the adverse stimulus. Finally, extinction recall refers to how well this ‘extinction memory’ is remembered when confronted with the neutral stimulus later in time. 

Fear extinction plays an important role in exposure therapy, a type of behavioural treatment commonly prescribed in PTSD.[8-10] Briefly, this type of therapy involves repeated exposure to trauma-related memories in a safe context. Just as in the laboratory models, the idea is that repeated exposure will result in the ‘extinction’ of learnt associations between environmental stimuli and the traumatic event. Although this type of treatment is effective for many people, it has limitations. 

Try to think about your worst memory again.  Now imagine doing this over and over again. Not exactly pleasant, is it?

There is a host of factors that influence if exposure therapy will benefit an individual. One aspect that might be highly relevant for women is the level of sex hormones at the time of treatment.

Evidence from rodent studies suggests that low estrogen levels in females are associated with poor extinction recall. These findings also seem to translate to studies in human subjects, with extinction recall being worse during low-estrogen stages of the menstrual cycle.[5,11] Moreover, the suppression of the body’s natural estrogen through the administration of hormone-based contraceptives has also been found to impair extinction recall.[12] This is an issue because impaired extinction recall could render exposure therapy ineffective or even counter-productive. If patients go through the difficult process of recalling traumatic memories without an understanding that doing so is safe and effective, they may lose motivation to continue treatment.

What are the possible implications of this in a clinical context? Timing could be a crucial factor in prescribing exposure therapy in naturally cycling women. Also, women with chronically low estrogen levels may benefit from pairing exposure therapy with pharmacological interventions. For instance, a recent study in rodents has shown that a certain type of blood pressure drug could reverse the adverse effects of low estrogen on extinction recall, possibly by making up for low-estrogen-related deficits in the regulation of the physiological stress response.[13]

Another approach to dealing with intrusive, distressing trauma memories is to reduce their impact near the time they are formed. This could be achieved by using pharmacological treatments to prevent traumatic memories from being further strengthened. As with exposure therapy, the case can be made that such treatments should take sex into account.

Previous research suggests that high progesterone levels at the time of trauma exposure could contribute to a strengthening of the traumatic memory, resulting in the type of intrusive, ‘flashback’ memories associated with PTSD.[14] Another study found that women who had been exposed to sexual assault had differing levels of PTSD depending on if they received hormone-based emergency contraceptives and what hormone the contraceptive contained. [15] One of two types of emergency contraceptives was administered, with one containing both synthetic estrogen and progestin (Ogestrel), while the other drug contained a synthetic progestin-only (Plan B). Interestingly, the women who took Ogestrel reported fewer intrusive memories than those who took Plan B. This might point to a combined effect of estrogen and progesterone on the formation of trauma memories. In any case, these studies highlight the importance of considering sex in the development of pharmacological treatments intended for use in the immediate aftermath of a trauma.

Given this research, why are we not prescribing treatments – behavioural or pharmacological – in a sex-specific way?  

Treatments need to be well-studied before they can be used in clinical practice. Particularly in the case of pharmacological interventions, this process can be lengthy, costly and complex. The reality of research is that resources are limited, and drug studies are expensive. Testing for the influence of the menstrual cycle phase would increase the sample size required and would also put further demand on resources by necessitating the acquisition, storage, and analysis of biological samples for rigorous testing of hormone levels.  At this time, there is a need for more evidence regarding hormonal influences on PTSD treatments. With the emergence of funding opportunities dedicated to the field of women’s health, there is hope that this will change. What is clear from the evidence is that there are hormonal influences on the development of PTSD. By including sex differences, we are presented with an opportunity to drastically improve the treatment of mental health disorders.

About the author

Dr. Luzia Troebinger currently works as a postdoctoral research fellow in Professor Sunjeev Kamboj’s group at University College London’s Clinical Psychopharmacology Unit. Her research focuses on both behavioural and pharmacological approaches to the treatment of PTSD and is funded by the Sir Bobby Charlton Foundation.

Twitter: @UCL_SBCF

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Behind the Frontlines for World Health Day

Author: Alex Lukey, Women’s Health Blog Co-Coordinator | Editors: Arrthy Thayaparan, Women’s Health Blog Co-Coordinator

Published: April 7th, 2021

This past year will go down in history as the year the world halted at the hands of a global pandemic. But the sacrifice and dedication from our frontline workers, kept hopes up and fears at bay throughout these unprecedented times. For World Health Day, our blog co-coordinator Alex Lukey sat down with two nurses, Krista Koenig and Lauren Dyck, working on the frontlines of COVID-19 hospital floors to talk about the past year.

The Beginning

Alex: Take me back to this time last year. What were those first few months like for you?

Krista: The first few weeks were kind of chaos. Nobody was sleeping well. We were all on edge, trying to figure out what was going to happen.

Lauren: I remember thinking to myself, I’ve only been out of school for two years. How do I deal with this? Even the people supporting us didn’t know what to do, so it was very confusing and scary.

Lauren: Every time we discharged a patient, another one would come through the door. It’s kind of what it is like right now actually too. Last spring, we were never over capacity, but we are now. We’ve got a couple of variants on my unit, and now it’s younger people coming in. Really, really sick people, so it’s a lot to deal with for sure. We’re all so burnt out trying to deal with the workload and then trying to deal with the deaths on top of it too.

The Hardest Part

Krista: I’ve never had trouble sleeping before this. That’s kind of where it translated for me. I didn’t see my family. I was just so scared of bringing it to somebody that I loved. Even though my family all lives here in town, I couldn’t see them.

Lauren: The mental health aspect of not for myself but for the patients. A lot of them, when they come to the hospital and are that sick, they’re here for a good three weeks.

Both Lauren and Krista spoke about the difficulty of supporting patients near the end of their lives. While many of the sickest COVID-19 patients are cared for in the intensive care unit (ICU), many long-term care home residents do not go to the ICU. These older adults may choose to forgo life-saving measures such as intubation. So, while nurses in the ICU dealt with many deaths from COVID-19, the brunt of deaths from long-term care homes fell on the shoulders of nurses working on lower acuity COVID-19 units, such as Lauren and Krista.

Lauren: There’s a lot of struggling at the end because you can’t breathe.  At the beginning, we weren’t even allowed visitors for people who were dying, so we’d have to zoom with their families. We would have to help them say goodbye like that which is just horrible. Now we do visits for some people, but some families are scared to come in, which I understand. But you can’t fix that emotional part of it. It’s hard to feel like you can’t really do anything about it.

Krista: Family members haven’t been able to visit unless somebody is critically ill or near death. I think that’s been one of the most significant changes for me too. In my practice, it’s so much centered around family care and including everybody.

Who is Caring?

Despite personal protective equipment (PPE), nurses are at a high risk of contracting the virus on the job. A report published by BC Women’s Foundation found that 80% of people working in healthcare are women in BC. Further, the roles with the highest risk of exposure due to close physical contact are professions that have higher numbers of women, such as nurses and personal care aides.

Krista: We did have nurses end up testing positive on our floors.  We were nursing our own nurses.

COVID-19 also presented women starting families with a difficult decision. While there is much more research needed, there was almost no information on the risks of COVID-19 for pregnant women a year ago. This lack of data continues to be a cause of significant concern for women.

Krista: We have so many pregnant nurses that we were trying to protect. We have such a strong solid group that we just try to look out for each other. We tried to give the positive patients to younger healthy nurses.

Hope

Both Krista and Lauren spoke about how access to the vaccine is giving them hope for the future.

Krista: It’s a big moment for science and history for everyone. Unfortunately, there’s still so much fear and miscommunication in this information and media right now about vaccines, but for our group that was such a turning point.

Lauren: When I got vaccinated, it was a very emotional moment for me. I actually almost cried because I was thinking, we’re gonna get through this. It’s almost like a race right now with our numbers going up and trying to vaccinate as many people as possible.

 

 

Meet the Nurses

Krista Koenig

Cardiac Medical RN

Asthmatic Frontline Worker

Vaccinated

 

 

Lauren Dyck

Lauren grew up in Vernon, BC, and completed her nursing degree at UBCO in Kelowna in 2018. After graduating, she moved to Vancouver and has since been working at Richmond Hospital on a cardiac/covid-19 ward. She will be starting a new job in May on the cardiac unit at Vancouver General Hospital. She hopes to pursue travel/ER nursing in the future.

 

 

International Women’s Day: UBC Day on the Hill

Authors: Bonnie H. Lee, PhD student, WHRC Data Analyst and Dr. Liisa Galea, PhD, WHRC Lead | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: March 8th, 2021

The advancement in scientific knowledge is astounding to watch. The pace of science is expanding, and it is sometimes difficult to keep up with our changing world. One example of the fast pace of scientific research has been getting several vaccines for COVID-19 in such a short period of time. Who would have believed that we could have so many great options in less than a year? Why we are so far ahead in these discoveries is largely due to scientific research. Thankfully, many researchers have been studying things like bat coronaviruses and the efficacy of mRNA vaccines for many years. 

However, one thing we are woefully behind on here in Canada and across the world is women’s health research. We know that women suffer from poorer health than men due to missed diagnoses, minimized symptoms, a greater burden of certain diseases and because drugs are often tested in males and men. This has resulted in poorly targeted treatment for women, who generally have greater side effects from drug treatment. 

That is why here at the Women’s Health Research Cluster, we were thrilled to see that in late 2019, the Prime Minister’s Minister of Health Mandate Letter, included a call for increased support for women’s health research. Why? Because despite recent advances in sex-and gender-based (or sex-and-gender-based analysis, SGBA) research, women’s health research has historically been – and continues to be – underrepresented and underfunded across research disciplines. This is a critical issue that affects the health of 50% of the world population. Clearly, a lack of research jeopardizes the health and wellbeing of all women. 

The members of the Women’s Health Research Cluster (WHRC) have been working tirelessly to fill this gap. The WHRC is a growing network of multidisciplinary researchers and research partners, including clinicians, community partners, and trainees, who are engaged or interested in women’s health research. Our objectives are to spotlight and advocate for women’s health research and catalyze collaborations for women’s health research. Together, we are working to expand our knowledge of how different female-specific experiences – such as menstruation, hormonal contraceptives, pregnancy, and menopause – and gendered experiences influence women’s health and healthcare.

 

Bonnie Lee and Liisa Galea at UBC on the Hill event in 2019 (Photo: Bonnie Lee)

In March 2019, just before the pandemic hit us in full force, we were fortunate to have some of our WHRC members invited to attend the UBC ‘Day on the Hill’ in Ottawa. The goal of ‘Day on the Hill’ is to establish relationships with parliamentarians, showcase the university’s strengths, and begin to influence the ideas that may shape future policies.  As a world-renowned research university, one of UBC’s goals for this visit was to convey the value of investing in university education, research, and students. Together, Dr. Dermot P. Kelleher (Dean of the Faculty of Medicine and Vice-President of Health at UBC),  Dr. Liisa Galea (the lead of the WHRC), and Bonnie Lee (graduate student and Trainee Lead of the WHRC) represented UBC Health and met with several stakeholders, including members of parliament, Health Canada representatives, and the Deputy Minister of Health. Our health team spoke with these stakeholders about the goals of the Faculty of Medicine at UBC and Galea and Lee spoke about the cluster and their work in women’s health research. 

For Galea and Lee, it was an exciting time to advocate for the urgent need to prioritize women’s health research as distinct from and in addition to sex-and-gender based research. Lee highlighted that supporting research initiatives and graduate students with federal funding and work-integrated learning opportunities is imperative to improving the productivity and quality of research. Students in all academic endeavours are our future. They will become the future research leaders and we will need to count on their work to weather the next great global challenge.  

As noted, during each meeting, we advocated for the need for women’s health research and the important return on investment that training in research provides (both to the student and to the knowledge economy). We need to look no further than our current pandemic to understand the importance of inclusion of both sexes and all genders in research. COVID-19 is more likely to result in ICU visits and mortality in men compared to women, indicating a need to understand why this might be as this could lead to more effective treatments in men. Further, vaccine trials failed to include pregnant women, and this lack of inclusion has left many families in turmoil over the right course of action to take. Funding research, and in particular women’s health research, will significantly contribute to the health and wellbeing of all Canadians for years to come.

Kelleher, Galea, and Lee had insightful conversations with the following stakeholders: Stephen Lucas (Deputy Minister of Health), Kathryn Nowers (Director of Policy, Office of the Minister of Health), Don Davies (Member of Parliament for Vancouver Kingsway), Matt Jeneroux (Member of Parliament for Edmonton Riverbend), Jessica Halverson (Director of Research and Innovation for the Department of Women and Gender Equality), and Anna Romano (VP Health Promotion and Chronic Disease).  
 

Are All Women in Canada Really Free to Choose?


Author: Kennadie Chaudhary, AccessBC Campaign Coordinator | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: February 26th, 2021

Access to contraception, as a reproductive right, is a basic human right. However, many Canadians are unable to exercise this right for a variety of reasons. One of these reasons is the significant barrier of cost. People who can get pregnant are disproportionately affected by the often high costs of contraception. These costs can include between $75 and $380 for an intrauterine device (IUD), $20 per month for oral contraceptives, and up to $180 per year for a hormone injection. Lack of coverage for contraception means youth, people with low-income, and those from marginalized communities face a severe disadvantage when making choices about their bodies. Thus, acknowledging the factor of cost is essential to making universal access to contraception a reality. 

There are numerous benefits to accessible contraception, which are evident in studies in North America and around the world. In Canada, the cost of contraception is almost entirely the responsibility of the user, with few exceptions. This is in contrast to several countries which similarly have universal health care, but have chosen to subsidize prescription contraception, either in full or in part. Countries with universal healthcare that subsidize contraception include over 11 members of the European Union, the UK, Australia, and New Zealand. Countries with universal access to prescription contraception have recognized the social and public health benefits of doing so, and their programs are often revenue positive. A 2015 study in the Canadian Association Medical Journal​ estimated that the cost of delivering universal contraception across Canada would be $157 million. Yet, the savings for direct medical costs of unintended pregnancies alone would be approximately $320 million. 

A Colorado program offering free IUDs to young people saw a 54% reduction in teen pregnancies and a 64% decline in teen abortion rates over eight years. The program came to a cost of $28 million, saving the US government an estimated $70 million. In Canada, about 59,000 adolescent pregnancies per year are unintended. Studies such as the Colorado program show the immense impact that access to contraception can have. Unintended pregnancies are expensive and can significantly alter an individual’s life plans. Further, reducing unintended pregnancies and allowing women to properly space births by providing them with access to contraception prevents over 200,000 maternal deaths worldwide each year.

Access to contraception is not only an issue of health. Contraception is also an issue of gender equality. While condoms are often easily accessible at little or no cost and vasectomies are covered under provincial health insurance plans, people with uteruses face significant barriers to autonomous contraception due to cost and requiring a prescription. Advancing gender equality requires recognizing that the costs of prescription contraception should not disproportionately fall on women alone. Women’s right to decide if and when they want to get pregnant should not be based on what they can afford. The ability to make that decision freely will contribute to the status of women, their right to health, and their empowerment as decision-makers.

AccessBC is a province-wide campaign that advocates for universal no-cost prescription contraception in British Columbia. AccessBC is currently running a letter writing campaign to urge the BC Government to include this policy in the upcoming 2021 budget. You can learn more about AccessBC, the need for, and benefits of, making all prescription contraception universally available at no cost, at www.accessbc.org.

Photo by Reproductive Health Supplies Coalition on Unsplash