As the world marks International Women’s Day, the University of Alberta celebrates the scientists who are working to improve women’s health. More than 140 researchers are working on women, children’s and perinatal medicine through the Women and Children's Health Research Institute (WCHRI) at the U of A, supported by the Alberta Women’s Health Foundation and the Stollery Children’s Foundation. Thanks to this partnership between the university, the health-care system and philanthropists with vision, research-focused clinicians are making life better for women here and around the world. Here are just three examples.
Jane Schulz: Overcoming the stigma of pelvic floor disorders
One in four women will experience a pelvic floor disorder in their lifetime, according to Jane Schulz, professor, urogynecologist and interim chair of the Department of Obstetrics and Gynecology. Symptoms can include urinary and bowel incontinence, pelvic organ prolapse, frequent bladder infections and pelvic pain—and the causes range from genetics to pregnancy, childbirth, loss of estrogen during menopause and various medical conditions.
Schulz and her team treat 11,000 women a year in their multidisciplinary pelvic floor clinic at the Lois Hole Hospital for Women. Patients can see a variety of medical specialists, nurse practitioners, physiotherapists, a dietitian, pharmacists and other health-care professionals all in one place—a model of care that has been copied in other centres nationally and internationally. The medical team carries out research and immediately integrates what they learn into clinical care, thanks to the on-site research centre within the hospital.
Half of the women affected by pelvic floor disorders do not seek care because they don’t have time due to work or family care commitments, or they don’t realize treatment is available, Schulz said. There is a stigma associated with talking about pelvic floor disorders, to the point that Schulz has had to use an actor rather than an actual patient in videos to illustrate her work.
“People don’t like to say, ‘Hey, I pee my pants.’”
Schulz’s most recent research shows the issue is even worse for new Canadians. “Women from marginalized or minority populations simply suffer in silence,” she said.
In response to this research, Schulz and her team have developed educational classes, online pelvic floor disorder videos and information pamphlets in eight languages, and are teaching volunteer trainers from minority communities to do outreach to immigrant women.
“Many women think surgery is the only treatment option, but we offer dietary and fluid management, physiotherapy, medication and pessaries (prosthetic devices to support internal organs),” she explained. “With pelvic floor physiotherapy, we find up to 70 per cent of women will get better.”
Schulz believes the new Women's Health Collective Canada will provide opportunities to do research in multiple centres, meaning patient recruitment can happen more quickly and results will be stronger. She is particularly concerned to learn how COVID-19 has affected women’s access to care, how delaying care because of COVID will affect women’s health, and how COVID-19 affects pregnancy outcomes.
Nese Yuksel: Conquering menopause symptoms
Nese Yuksel, professor in the Faculty of Pharmacy and Pharmaceutical Sciences, is working to overcome stigma in another area of women’s health: menopause. Symptoms can include irregular periods, hot flashes, night sweats, sleep disturbances, mood changes, weight gain and vaginal dryness. Yuksel’s research questions are inspired by the women she sees at the Lois Hole Hospital for Women’s menopause clinic, an interdisciplinary clinic involving medical specialists, pharmacists, a dietitian and nurses.
“Though many women have symptoms during perimenopause or menopause, not all are severe,” she said. “However, some women really do suffer—yet these symptoms are sometimes swept aside and not addressed.”
“More research is needed to understand the best approaches to support women suffering from menopause symptoms.”
Yuksel and her research team helped develop the SheEmpowers tool for women going through early surgical menopause to support them in making decisions about hormone replacement therapy.
“Surgical menopause can be severe because it’s so abrupt, and if the woman is younger than 45 years of age, she faces an increased risk of long-term health issues such as osteoporosis and cardiovascular disease,” she said, noting that hormone therapy can help prevent these issues.
“We did focus groups and asked women what their needs were first,” Yuksel said. “Many talked about falling through the cracks, and needing more information to make these decisions.”
Yuksel is now working with a graduate student to assess how women in menopause are using cannabis to help with symptoms.
Helen Steed: Using robotics for less invasive gynecological cancer surgery
Edmonton is home to the only robot in Canada dedicated to women’s health. Helen Steed, associate professor and director of the Division of Gynecological Oncology, uses the da Vinci robot to remove the uterus and/or fallopian tubes, ovaries and lymph nodes of patients with early stage endometrial and cervical cancers.
“For patients there is less pain, less risk of infection, less bleeding, and many can go home the same day,” said Steed. “Their recovery takes three weeks compared with six to eight [following conventional surgery].”
“As a surgeon, the 3-D vision and seven degrees of motion the robot provides allow more precise and controlled movements than traditional laparoscopy,” Steed said.
Recently the Lois Hole Hospital Women’s Society purchased an extension to the robot called Firefly, which uses fluorescent dye and near-infrared imaging to guide Steed to the precise sentinel lymph node into which a tumour drains. Side-effects such as lymphedema (swelling) are reduced by removing only the nodes where the cancer has spread. The status of the sentinel lymph node also determines whether further treatment such as chemotherapy or radiation will be needed to lower the chances of cancer recurring.
The next step for Steed, her partner Sophia Pin and their division’s research team will be to create a database of the 1,500 cases that have been treated using the robot, with the goal of tracking measures like patient outcomes and cost savings to the health-care system thanks to same-day discharges from the hospital. Steed hopes the new Canada-wide research collaboration will lead to further data sharing and increased advocacy for minimally invasive surgery in women’s oncology.