Canadian Women's Health Today

A Pragmatic Approach to the Prevention of Preterm Birth

2024-04-03T21:05:40+00:00

Preterm birth (PTB) -delivery before 37 weeks of gestation- occurs in ~8% of Canadian pregnancies, a rate that has remained stable for >20 years. Prematurity remains the leading cause of neonatal mortality- especially at the extreme of viability: 22–26 weeks gestation. Children born prematurely have increased rates of cerebral palsy, global neurodevelopmental impairment, learning disabilities, deafness, vision impairment and behavioural diagnoses. Hospital length of stay and re-admission rates in the first year of life are higher in babies born preterm. The family impact is immeasurable in the domains of mental health diagnoses, financial health, and disordered social interactions. Prematurity has a longitudinal impact on reproductive and public health with an increased risk of occurrence in subsequent pregnancies.

2024 Updates to Cervical Cancer Screening in Canada

2024-04-03T21:05:30+00:00

The landscape of cervical cancer screening in Canada is about to undergo a major shift from cytology-based screening to testing directly for the presence of high-risk strains of the human papilloma virus (HPV), the persistence of which is known to be a prerequisite for the development of almost all cases of cervical cancer. In 2018, the World Health Organization declared a call to action for the worldwide elimination of cervical cancer by 2040. Subsequently the Canadian Partnership Against Cancer (CPAC) released an action plan outlining the necessary steps for Canada to reach this goal. One of the 3 major priorities identified in the action plan is the transition to primary HPV testing. This transition from screening to testing represents a major shift in infrastructure and also a shift in mindset for clinicians, policymakers, and the public. To help guide this transition, CPAC has collaborated with the Gynecologic Oncology Society of Canada (GOC) and the Society of Canadian Colposcopists (SCC) to release two open-access, evidence‑based guidelines in June 2023. These guidelines address how to manage a positive HPV screening test, and colposcopy in the context of primary HPV‑screening. This paper will outline the evolution of cervical cancer screening in Canada along with the rationale behind the transition to HPV testing. Also included is a discussion on the broad recommendations from the 2023 CPAC/GOC/SCC guidelines, as well as recommendations for age and interval of screening and special populations. Readers of this article in e-journal format can access the Canadian Guideline on the Management of a Positive Human Papillomavirus Test and Guidance for Specific Populations here. Readers may also access the 2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia here.

Management of Polycystic Ovarian Syndrome: Looking Beyond the Ovaries

2024-04-03T21:05:21+00:00

There is something remiss in the name polycystic ovarian syndrome (PCOS). It bears the word ovary; however, the ovary is an innocent bystander of a more sinister pathology. The name belies the nature of a disease that is a complex metabolic and reproductive syndrome with sequelae extending beyond ovarian dysfunction.

PCOS is a chronic, life-long illness that affects approximately 1.4 million Canadians. Its inception is thought to begin in utero. Factors such as elevated levels of maternal anti‑Müllerian hormone (AMH), endocrine disruptors, growth restriction, and maternal androgen excess generate epigenetic changes that have a life-long, transgenerational impact on the fetus.

New Options in Contraception

2024-04-03T21:05:12+00:00

In the last few years, more contraceptive options have been introduced into Canada, expanding choice for our patients. Patients and clinicians have experienced changes in how health care is accessed and delivered. For patients, this includes an increased use of the internet and social media as sources of information. Also included are changes to insurance coverage for contraception, such as provincial coverage for some (British Columbia, Quebec and Manitoba), and private insurance offered through school or an employer. In 2015 the cost of universal coverage of contraception in Canada was $157 million, while the cost to provide health care for unintended pregnancies was $320 million, providing a strong economic argument for this change. For clinicians, the pandemic provided an opportunity for many to switch to increase the use of virtual care options, and toward efficiencies in practice.

Understanding Female Sexual Dysfunction

2024-04-03T21:05:03+00:00

Sexuality is an integral part of our human existence. It is more than a source of pleasure—it is a source of fulfillment, emotional connection, intimacy and empowerment. Unfortunately, for many women worldwide, a satisfying and fulfilling sex life is thwarted by sexual dysfunction. Female sexual dysfunction (FSD) is an all too common and often very distressing condition that encompasses a wide range of difficulties, and affects women of all ages and backgrounds. This condition is characterized by a persistent or recurrent inability to achieve sexual satisfaction, causing the woman distress. This is a complex issue as the causes can be quite varied and sometimes elusive. The contributing factors we evaluate include physical (hormones, chronic illnesses, medication side effects), psychological (anxiety, depression, stress, relationship issues) and social (cultural or religious beliefs). Women who experience FSD are often distressed, experiencing relationship strain as a result, and their overall quality of life is impacted. This is a topic that is still shrouded in shame and stigma, leaving many women unable to discuss or uncomfortable discussing their difficulties even with healthcare professionals. We need to empower women with knowledge, encourage them to discuss their sexuality, and provide help and support. As health professionals, we need to play our part in the destigmatization and normalization of sexual wellness.