For millions of women, midlife brings more than hot flashes and sleepless nights.
It brings brain fog, anxiety, high blood pressure — and an increased risk of stroke and dementia later in life.
Science has suggested for years that both conditions are largely preventable during this stage, however, care often focuses on treating them after they happen, when the impact on the brain can be irreversible.
UHN’s Jay and Sari Sonshine Centre is working to change that with the launch of the new Women in Midlife (WIM) Brain Health and Stroke Prevention program. The program provides integrated, preventative neurological care, driven by lifestyle medicine, for women aged 35 to 65 who are experiencing severe menopause symptoms and are at a high vascular risk for — or have already had — a stroke.
The goal is to optimize brain health and reduce the risk of stroke and cognitive decline.
“What we're addressing is a fundamental disconnect between what the science tells us and what women actually receive in clinical care during midlife,” says Dr. Aleksandra Pikula, a stroke neurologist at UHN’s Toronto Western Hospital and director of the Sonshine Centre.
Midlife is when the menopause transition begins. Dr. Pikula says it’s also when hormonal, metabolic, cardiovascular and neurological changes in the body come together and create the perfect trajectory for vascular and brain issues to take hold in the future.
Strokes and dementia are up to 80 per cent and 45 per cent preventable, respectively. Women have a 20 per cent higher lifetime risk of experiencing a stroke than men and are also more likely to die from it. Sixty per cent of stroke deaths are amongst women.
“For a decade, clinical guidelines have called for aggressive screening and prevention during this window, because that’s when the risks are most modifiable,” says Dr. Pikula. “But the reality is there is no dedicated care model that exists that delivers care in this way.”
A different type of clinical experience
More than 20 years of research led by Dr. Pikula has helped identify stroke and dementia risk in women as a sex-specific issue rooted in the menopause transition. She and her team are the first in the world to translate that knowledge into a functional program that integrates all three areas of medicine in one place.
Co-created by an advisory panel of women with lived experience in stroke, the program has a deliberate focus on lifestyle-based approaches to care, such as nutrition, physical activity and sleep, instead of solely pharmaceutical interventions.
WIM is led by clinical nurse specialists, Hamdi Mohamed and Stiffra Armamento, under Dr. Pikula’s leadership.
“We want them to feel equipped to manage these symptoms in a way that goes beyond a typical clinic visit — and that’s what makes this program unique,” says Mohamed.
At a patient’s first appointment, the team investigates their specific concerns and risk factors using validated tools to assess menopause symptom severity, Brain Care Scores, cognitive function screening, and depression and anxiety assessments.
Mohamed says the tests help the WIM team provide personalized care by understanding the patient’s needs.
“We’re hoping to help women feel heard, understood and in control of their own journey,” she says.
The program also offers Shared Medical Appointments (SMAs), a community-based care model. Led by specialized clinicians, patients with similar experiences gather virtually to learn about their conditions and relevant educational materials together, providing an opportunity for meaningful social connection.
Promising early results with patients
So far, 24 patients have enrolled in the pilot. Twenty-one have completed their initial appointments and are continuing to the SMA program.
“All 21 patients have expressed a high level of satisfaction, particularly with the increased amount of time that they are spending with a clinician and the additional resources that we are providing and reviewing with these women,” says Armamento.
Shannon Langlois was one of them. After surviving a stroke at 42, the teacher and mother of two struggled to return to normal life. Her attention span was limited, multitasking was difficult and anxiety was heightened.
“It was the cognitive demand on my brain,” says Shannon, now 46. “That was really weighing on me. I couldn’t quite explain it to my doctors.”
Through the program, Shannon was able to better understand her symptoms. Dr. Pikula helped her piece together the specific aspects of her health that were impacting her cognition — cortisol levels, trouble sleeping, and increased stress and anxiety.
“For the first time I finally felt like someone understood what I was going through,” says Shannon.
She has since learned to manage her symptoms through lifestyle changes, in addition to her current medical regimen.
“If I didn’t have the program, I would probably still be fumbling my way through it and feeling really lost,” she says.
“It put me back in the driver’s seat.”
Shifting the future of women’s brain health
Dr. Pikula hopes this initiative will be a turning point in medicine that encourages a shift towards proactively preventing neurological disorders. She also hopes the program will be a model for other institutions to do the same.
“What this program really is trying to do is move toward truly preventive care,” says Dr. Pikula.
“If we get this right, it has the potential to change not just outcomes for individual patients, but scale the system and hopefully improve community health.”
The program will be formally accepting referrals this month from neurology (general or subspeciality), the Toronto Western Family Health Team and women’s health specialists, including obstetricians and menopause specialists.
