The power of choice

Dr. Jennifer Johnston's work began with a deeply personal experience.

A family physician in the Annapolis Valley and assistant professor in the Department of Family Medicine, Dr. Johnston (MD’10) is the founder of Elle, MD, a biotechnology company that is reimagining women's reproductive health.

After experiencing her own health challenges in 2021, she immersed herself in research on hormones and reproductive health. What she found was a lack of support for people seeking evidence-based hormone care, and a shortage of effective non-hormonal contraceptive options for those who could not or did not want to use hormones.

The mother of four was determined to find a solution. 

"Hormonal contraception works very well for many people and remains a great option, but for those who don't want hormones, the alternatives are limited," she says. "I thought, someone has developed new contraceptives before, so why can't I? It takes a certain amount of naïve optimism to begin something like this." 

That optimism and determination became the inspiration behind Elle, MD and a new once-monthly, non-hormonal vaginal ring contraceptive designed to work locally within the reproductive tract.  

From idea to clinical study

The development process has been rigorous. To date, the team has completed eight pre-clinical studies, including research examining the device's ability to prevent pregnancy in sheep, which are considered an appropriate model for vaginal ring research. Results from one study found that none of the animals using the ring became pregnant, while all of those in the control group did, providing an encouraging milestone for the technology. 

Dr. Johnston and her team have now submitted an Investigational Testing Authorization application to Health Canada and are preparing for their first human study at The Ottawa Hospital. Recent funding will support that work and help lay the groundwork for a second human trial that she hopes will begin next year. 

Several important steps remain. Following the initial human studies, the team will need to conduct larger pivotal trials and complete the Health Canada approval process. If development proceeds as hoped, Dr. Johnston estimates that the device could be available in Canada by 2029 or 2030 at the earliest.

The ring would initially be available by prescription, offering the most direct regulatory pathway and increasing the likelihood that it could be covered by Pharmacare. In the longer term, Dr. Johnston hopes evidence gathered through clinical trials and post-market use could support making it available over the counter.

“Ultimately, accessibility is the goal,” she says. “There are many people who don’t have a family physician or who face barriers to accessing care. If someone could safely order this product online or obtain it easily, that would make a meaningful difference.” 

Investing in women’s health innovation

Reaching this stage has required more than scientific expertise. With support and direction from the Nova Scotia Health Innovation Hub, Dr. Johnston was connected to opportunities, programming and funding to help bring her idea to life.

Support from National Research Council of Canada Industrial Research Assistance Program (NRC IRAP), Atlantic Canada Opportunities Agency (ACOA), and other funding sources has been critical in getting the project off the ground and continues to be important moving forward. Philanthropic support has also provided an important boost at key stages of development.

The company recently raised approximately $1.1 million in pre-seed financing and will soon be seeking approximately $3.5 million for its seed round. That funding would allow the team to complete its next phase of studies and prepare for a pivotal clinical trial. Dr. Johnston expects it will require a combination of private investment, grants and philanthropic partnerships. 

For Dr. Johnston, that investment is about more than advancing a single product. Historically, women were often underrepresented in research studies, leaving significant gaps in the evidence used to guide care. While progress has been made, she believes there is still a need for greater investment in women's health research and innovation, from contraception and reproductive health to conditions such as endometriosis, perimenopause, and menopause.

"There's tremendous potential in philanthropy," says Dr. Johnston. "Philanthropic funding can help to not only bring a technology to market but also ensure it reaches the people who could benefit from it most."

Global impact

"My dream is to see it freely available in sexual health clinics around the world so women have another practical, non-hormonal option they can access easily," she says. 

While continuing to care for patients in rural Nova Scotia, Dr. Johnston sees innovation as a way to extend the impact of her medical training far beyond her own practice.

"A family doctor helps people one at a time, which is incredibly meaningful, but with something like this, my hope is that it could eventually help women all over the world. That's an impact I could never achieve in my rural Nova Scotia practice alone."

At the centre of that vision is her belief that women should feel supported, heard and empowered to participate actively in decisions about their health.

“I want women to know that they have more agency over their health than they may realize,” she says. “I want women to feel informed, engaged and confident in making decisions about their care. That’s ultimately what this work is about.”