Mental Health Menu

Reproductive Life Stages Program (RLS)

Service updates for appointments at WCH

  • Due to the high volume of referrals and unusually long wait times, we have changed our exclusion criteria to ensure that we can meet the needs of patients who would not otherwise have access to perinatal mental health care. Pregnant and postpartum patients should be referred to the perinatal mental health program associated with their hospital of delivery.
  • We continue to provide mental health services during COVID-19.
  • If you have an upcoming in person appointment at Women’s College Hospital and you have a fever, cough, or new onset of shortness of breath, have travelled outside Canada in the last 14 days, tested positive for COVID-19, or been instructed to self-isolate by Public Health please do not come to the hospital, call the clinic directly for more information.
  • The hospital is open only to patients with appointments, please see our visitor restrictions information.
  • Most new and follow-up appointments are booked as virtual visits, using the telephone or over video.  Learn how to set-up a video visit.
  • Some current appointments may need to be rescheduled. You will receive a call from us with any changes to your appointment.
  • Note: We are still offering Child and Family psychiatric service by way of phone and video appointments. Please contact us at 416-323-6230 to book an appointment.

The Reproductive Life Stages program in the Department of Psychiatry provides assessment and short-term treatment for women experiencing new or recurrent mental health problems during the reproductive life stages (menstrual cycle, pregnancy, postpartum and the menopausal transition). Including:

  • Anxiety
  • Depression
  • Trauma related disorders
  • Mania
  • Psychosis 

Our interprofessional team works with a trauma-informed lens and we are actively engaged in establishing anti-oppressive practices. We welcome gender diverse individuals. 

As well, the program has two child psychiatrists on staff who provide care to children of mothers with mental health issues, and one addiction psychiatrist on staff who provides consultation to our program for women who have addictions in addition to their mental health difficulties.

The program is also committed to educating healthcare providers and to conducting research to further understand mental health as it relates to women at each reproductive life stage.

  • Our Services

    Menstrual Cycle 
    Psychiatrists in our program provide consultation with treatment recommendations for mental health conditions linked to the menstrual cycle.    

    Many individuals experience worsening of underlying mental health conditions premenstrually (premenstrual exacerbation).  Others may experience symptoms such as depressed mood, anxiety, irritability, and interpersonal sensitivity that are restricted to the time period leading up to menses (premenstrual dysphoric disorder). 

    Prior to an assessment, you will be asked to complete a set of questionnaires to track the relationship between your menstrual cycle and various symptoms for a period of at least two months.   

    Pregnancy Planning 
    Psychiatrists in our program provide consultation around pregnancy planning in the context of mental health conditions such as depression, anxiety, obsessive-compulsive disorder, trauma and stressor-related disorders (eg PTSD), bipolar disorder, and psychotic disorders.  Consultations may include a discussion of medication use in pregnancy and risks associated with the underlying condition. 

    Pregnancy and Postpartum 
    The program offers a combination of education, brief psychotherapy and medication to assess and treat mental health conditions in pregnancy and postpartum.  Individuals may be seen up to one year postpartum. 

    Conditions treated include depression, anxiety, obsessive-compulsive disorder, trauma and stressor-related disorders (eg PTSD), bipolar disorder, and psychotic disorders. 

    The majority of the therapy provided in our program is in a group format.  (Group therapy is currently being conducted virtually due to COVID-19 containment efforts.)   

    Additional Online Resources

    Menopausal Transition 
    Psychiatrists in our program provide assessment and treatment recommendations for mental health conditions linked to the menopausal transition.   

    The transition to menopause (perimenopause) may take 5-10 years and may be accompanied by vasomotor symptoms (hot flashes and night sweats), changes in sexual functioning, and cognitive changes as periods become more irregular.  Perimenopause is often associated with an exacerbation of underlying mental health conditions. 

    Additional Online Resources 

  • Your Care

    Intake and Booking Process 

    Pregnant and Postpartum Individuals
    Prior to your visit, your physician or midwife will request a consultation from us by faxing us a referral form. If your referral is appropriate for our program, we will call you to schedule a telephone pre-assessment with the RLS intake worker that will happen prior to your in-person visit with the RLS psychiatrist, and provide you with a consultation date with the RLS psychiatrist at the same time. If you have not heard from us within 1 week of your referral please call our program at 416-323-6230 to schedule your telephone intake. The RLS intake worker will ask you some questions about the reason for your referral, and any other information that will help us inform your assessment visit with the RLS psychiatrist. You will be asked to complete a short questionnaire over the phone so that we can better understand what symptoms you are having, and how severe these are. You must complete your intake telephone call prior to your visit with the RLS psychiatrist. If you have not done so, then your visit with the RLS psychiatrist will be cancelled. It may be rescheduled once the intake telephone call is complete. 

    Non-Postpartum Individuals
    If you are not pregnant or postpartum, an appointment date and time will be sent to your referring doctor’s office. You may be asked to complete a set of questionnaires which must be submitted to the RLS program prior to your consultation with the RLS psychiatrist. If the questionnaires are not completed by the due date provided to your referring doctor then your visit with the RLS psychiatrist will be cancelled. It may be rescheduled once the questionnaires are complete. 

    What to expect at your first visit

    When you arrive on the 7th floor, please proceed to check in at the information desk where you will be asked to fill out some important forms, including your current medications, and whether you would be willing to participate in research studies in our program if you are eligible. Please arrive 15 minutes early for your scheduled appointment to complete these forms.

    Your first visit to our program will be with one of the RLS program psychiatrists who will help determine a treatment plan to meet your needs. Women who are pregnant or postpartum may be referred for additional services in the RLS program, including psychological therapy with a mental health therapist.

    You are welcome to bring any children under the age of one in for your appointment. On-site child care is available through Stella's Playroom and should be booked in advance.

    Wait times

    At the present time, we are offering appointments for most referred patients within 8-12 weeks of the referral being received. If you are pregnant or postpartum, you may be given an expedited appointment based on your intake pre-assessment.

    Booking an appointment

    A referral by a doctor or midwife is required.

    Physicians and clinicians

    Download and complete the patient referral form from the Forms section in the sidebar. Once completed, please fax to 416-323-6356.

  • Our Team

    Intake & Triage 

    • Josephine D’Agostino, SSW

    Mental Health Therapists

    • Greer Slyfield Cook, MSW, RSW
    • Kaeli Macdonald, BFA, MSW, RSW
    • Marsha Gallinger MSW, RSW
    • Keisha Greene, RP, MC

    Psychiatrist Team

    • Lucy Barker (clinical associate)
    • Dr. Alicja Fishell
    • Dr. Renu Gupta
    • Dr. Aliza Israel (Child and Youth)
    • Dr. Jovana Martinovic
    • Dr. Cintia Padoin (Child and Youth)
    • Dr. Diane Meschino
    • Dr. Simone Vigod
    • Dr. Lori Wasserman, RLS Program Lead
    • Elise Wright 

    At any given time our team also includes social work and medical students, post-graduate medical trainees and fellows in psychiatry, obstetrics and gynecology, and family medicine, as well as clinical fellows from Canada and around the world.

  • Research and Trials

    The RLS program at Women’s College Hospital is actively involved in a variety of research initiatives at our institution and through partnerships with other hospitals. We aim to conduct research that improves the health of women with mental health issues and their families across the reproductive life cycle, inclxuding across the menstrual cycle, pregnancy, postpartum and in the menopausal transition.

    Current Studies Recruiting Participants

    We have several clinical research studies underway that are actively recruiting participants:

    • Reproductive Mental Health of Ontario Virtual Intervention Network (rMOVIN)

      Study funded by: Women’s College Hospital Foundation
      Principal Investigators: Dr. Simone Vigod, Dr. Ariel Dalfen

      Many people who experience depression or anxiety during pregnancy and postpartum have a hard time accessing the appropriate care. The online rMOVIN platform was created to help pregnant and postpartum people with depression and anxiety find suitable virtual treatment options. The platform includes many resources, access to a “care coordinator” to help people determine the best treatment option for them, link them to online mental health therapy interventions, and when needed arrange virtual e-consults to family doctors or direct patient video-consultation with the rMOVIN reproductive mental health psychiatrist. If you are pregnant or postpartum and experiencing symptoms of depression and/or anxiety, you may be eligible to participate in a study to determine if MOVIN can help to reduce your symptoms.
      For more information and to access the pre-screening questionnaire, please visit MOVIN at the Women's Research Institute

    • An Electronic Patient Decision Aid for Antidepressant Use in Pregnancy

      Study funded by: The Canadian Institutes for Health Research (CIHR)
      Principal Investigator(s): Dr. Simone Vigod

      Deciding to start or continue an antidepressant medication during pregnancy can be a difficult and complex decision. If you are pregnant or planning a pregnancy, deciding whether you should start or continue an antidepressant medication for the treatment of depression, and are conflicted about what to do, you may be eligible to participate in a study examining whether or not an interactive website is a helpful tool for women who are making this decision.
      For more information and to access the pre-screening questionnaire, please visit the PDA Study page.

    • Technology-enabled (Electronic) Measurement Based Care (eMBC) for Perinatal Depression and Anxiety: A Pilot Randomized Controlled Trial 

      Study funded by: Women’s College Hospital Academic and Medical Services Group (WCHAMSG) Alternate Funding Program (AFP) Physician Innovation Fund
      Principal Investigators: Dr. Renu Gupta and Dr. Simone Vigod

      Tracking symptoms of depression and anxiety during pregnancy and postpartum through self-report scales in the electronic hospital chart has the potential to tailor decisions about antidepressant medication to individual patients. Talk to your psychiatrist if you are interested in learning more about this study.

    • Decisional Conflict of Lithium Use in Breastfeeding in Women with Bipolar Disorder

      PI: Dr. Simone Vigod

      The postpartum period is a time of high risk for the onset and recurrence of bipolar disorder. The onset of symptoms is often rapid and may occur in late pregnancy or within the first few days to weeks after delivery. There is a higher postpartum relapse rate in women with bipolar disorder who were medication free during pregnancy than those who were maintained on medication.

      Lithium is a gold standard pharmacological treatment for bipolar disorder because it is effective in both the acute and maintenance phases of manic and depressive episodes. There is also growing evidence of its effectiveness for the prevention and treatment of postpartum psychosis. For some women, lithium may be the only effective treatment or maintenance medication. However, the use of lithium in the postpartum presents a major dilemma for women with BD as it pertains to the issue of breastfeeding because lithium is excreted into breastmilk.

      There are significant benefits of breastfeeding, so the risk of breastfeeding must be balanced against the risk of exposing the baby to lithium. The purpose of this study is to examine the decision-making around lithium use and breastfeeding among women with bipolar disorder.

      You may be eligible to participate if you are pregnant or planning to become pregnant. For more information, contact Maria Michalowska at 416-351-3732 ext. 2302 or maria.michalowska@wchospital.ca

    • Using virtual care to reduce barriers to mental health care in postpartum women and full-time workers

      Content HereStudy funded by: MOHLTC AFP Innovation Fund
      Principal Investigator(s): Dr. Jennifer Hensel
      We are currently recruiting for a study where women can take advantage of personal computer videoconferencing as part of the therapy offered in the RLS program.

    Completed Studies

    Below are results from some of our recently completed studies:

    Other Ongoing Research Studies

    In addition to the clinical research studies described above, our staff are engaged in high-quality research activities of relevance to women during their reproductive life cycle. Some examples:

    Schizophrenia Understood in the Perinatal Period: Psychiatric Outcomes and Reproductive Trajectories (SUPPORT) III
    Principal Investigator: Dr. Simone Vigod

    PACT Canada: Predictive Analytic Models of PPD Risk
    Principal Investigator: Dr. Simone Vigod

  • Patient Resources

    There are many resources available for both patients and their healthcare providers. The following are leading websites that will provide the answers to many of the questions you may have about mental health during reproductive life stages:

    Patient Handouts

    Educational Videos
    Postpartum Mental Health - video provided by Women's Health Education Made Simple

    Designed by Aileen Lin, the following series of videos provide information about mental health in pregnancy and the postpartum period.

    1. How can you tell if you are struggling with your mental health in pregnancy and postpartum? 
    2. Why am I struggling with my mental health in pregnancy and postpartum? Coming Soon.
    3. What kind of help is available if I am struggling with my mental health in pregnancy and postpartum? Coming soon

    Pregnancy and Postpartum Community Resources
    City of Toronto: Healthy Babies Healthy Children
    Provides support services, including home visiting for pregnant and postpartum women in their communities (also available from local public health departments outside Toronto)

    Postpartum Support International
    Open Forum: weekly telephone support via 800 bridgeline. 
    "Chat with an expert” Call schedule and access codes are available here, or call 1-800-944-4773 for more information

     

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