For generations, women’s health has been shaped by missed opportunities in medicine—from clinical trials that overlooked female patients to care systems that treated symptoms in isolation rather than as part of a woman’s whole health story.
At Sinai Health, that narrative is changing. Across programs and specialties, clinicians and researchers are building a more integrated model of care—one that recognizes how menopause, cardiovascular health, autoimmune disease and mental health intersect across a woman’s lifetime.
The goal is ambitious but clear: to ensure that women are centred as a focus of research, prevention and care across their lifespan.
Reframing menopause care: from symptom relief to symptom prevention
At the Weston and O’Born Centre for Mature Women’s Health, gynaecologist and Clinical Lead Dr. Marie Christakis is helping transform how menopause care is delivered. Menopause often intersects with other health issues—including cardiovascular disease, mental health and neurological changes—yet patients frequently navigate separate appointments, resulting in fragmented care.
“Our goal is to create a more integrated clinical space where menopausal women can be seen by multiple subspecialists and receive a comprehensive plan for their health,” says Dr. Christakis.
With donor support, Sinai Health is developing new clinical pathways that allow women to enter care through virtual education tools before their first visits, helping them identify priorities and better understand their symptoms. This approach reflects a growing recognition that menopause is not simply a collection of isolated symptoms, but a key opportunity for preventive care.
“I had been through trauma with my first pregnancy and birth, so this time I felt like I was constantly walking on edge.”
Dr. Christakis’s research also explores the relationship between menopause and cognition—an area that has historically received little attention. Her current research examines how menopausal hormone therapy affects cognitive symptoms such as forgetfulness and distractibility, which many women report during the menopausal transition.
“Cognitive symptoms have often been minimized, even though they can affect a woman’s ability to work, maintain relationships and care for herself,” she explains. “By understanding what changes are normal and which may signal increased risk, we can begin thinking about prevention rather than reacting later.”
Uncovering the hidden differences in women’s cardiovascular health
This life-course approach is echoed in research led by Dr. John Floras, a cardiologist and Clinician-Scientist at Mount Sinai Hospital, who studies how cardiovascular disturbances manifest differently in women.
Cardiovascular disease and stroke remain the leading causes of premature death in women, yet many clinical studies have historically focused on male patients. Sinai Health’s unique research infrastructure—including the Harold and Esther Mecklinger and the Posluns Family Cardiac Catheterization Research Laboratory, Canada’s only cardiac catheterization lab dedicated to research—allows scientists to investigate these differences at a physiological level.
Recent work led by Dr. Floras has uncovered important differences in how women with heart failure respond to exercise. His team found that during exercise, women have a stronger sympathetic nerve response and lower oxygen uptake by muscles. This sympathetic nerve response causes blood vessels to constrict, decreasing blood flow to the muscles and making physical exertion more challenging.
“What we found is that women with heart failure show a much stronger relationship between nerve discharge and therefore noradrenaline release by these nerves and their ability to exercise,” says Dr. Floras. “That helps explain why so many experience fatigue and shortness of breath during everyday activities.”
These insights are helping researchers explore new treatment strategies, from personalized rehabilitation approaches to non-invasive nerve stimulation techniques that may improve exercise tolerance.
Researchers are also studying how cardiovascular health changes across a woman’s lifetime. By analyzing decades of patient data, Dr. Floras's team has identified distinct patterns in women’s nervous system activity before and after menopause—findings that could reshape how clinicians assess cardiovascular risk in women.
When autoimmune disease affects the whole body
Meanwhile, in rheumatology, Dr. Bindee Kuriya is tackling another area where women’s health gaps persist. Rheumatoid arthritis, a chronic inflammatory disease that can cause severe joint damage, affects women disproportionately, making up about 75 per cent of patients seen in her clinic.
But the disease rarely exists in isolation.
“Arthritis is more than just a joint disease. It’s a whole-body disease,” says Dr. Kuriya. “Inflammation can damage blood vessels, increase cardiovascular risk and affect mental health. Yet these associated conditions often go under-screened because the arthritis takes centre stage.”
As one of the leads of the Ontario Best Practices Research Initiative – one of the largest real-world registries of rheumatoid arthritis patients—Dr. Kuriya is using this data to examine how comorbid conditions such as heart disease, depression and hypertension interact with inflammatory disease. The registry, which includes thousands of patients across Ontario, provides critical insights into how treatments perform outside of controlled clinical trials.
These findings are helping to reshape how physicians approach care, emphasizing collaboration between rheumatologists, cardiologists and primary care providers to ensure patients receive comprehensive screening and preventive treatment.
The work also highlights another crucial factor often overlooked in medical research: sex and gender differences.
“Many of our risk models for heart disease were developed based on men. They don’t account for factors such as menopause, stress or hormonal changes that influence women’s health.”
A new model for women’s health
Clinician researchers such as Drs. Christakis, Floras and Kuriya demonstrate the power of Sinai Health’s integrated approach to women’s health. By connecting research, clinical care and data science across specialties, Sinai Health leadership is creating a model that reflects the complex realities of women’s lives—particularly during pivotal transitions such as midlife.
For patients, this approach means care that reflects the whole person rather than a single diagnosis. For researchers, it opens the door to discoveries that can improve outcomes for women in Canada and around the world.
And for Sinai Health’s philanthropic community, it demonstrates the impact of supporting a vision that looks beyond today’s treatments to tomorrow’s breakthroughs.
As Dr. Christakis puts it, the future of women’s health lies in integration: “We need to see women as whole people,” she says. “When we bring our expertise together and study women’s health across the lifespan, we can begin to close the gaps that have existed for far too long.”
