Holistic Approach to Minimally Invasive Gynaecology and Fertility Treatment
Neil Johnson, Gynaecologist and Fertility Specialist.
Endometriosis.
My strong interest in endometriosis – a challenging condition that can profoundly impact women’s lives – has led me into rewarding involvements with Endometriosis New Zealand (ENZ) and the World Endometriosis Society (WES). I was privileged to convene the WES consensus on management of endometriosis (http://humrep.oxfordjournals.org/content/28/6/1552.full.pdf+html), a distillation of a vast literature of evidence (http://humrep.oxfordjournals.org/content/28/6/1552/suppl/DC1). This was a unique consensus, focused around a meeting in Montpellier, France, at the last World Congress on Endometriosis in 2011, as different perspectives were presented in one forum: clinicians, surgeons, scientists, as well as women with endometriosis. Non-consensus also emerged, in which previously accepted treatments were challenged. A philosophical shift to consideration of endometriosis and pelvic pain as a continuum of disease, thus avoiding exclusion of women lacking laparoscopic confirmation, was highlighted. That women with endometriosis may require individualised care over a long-term period, where priorities change owing to the type and severity of symptoms, impact of these symptoms, current or future fertility wish and lifestyle factors, was emphasised. New concepts in treatments emerged: supplements accepted to be evidence-based effective treatments such as vitamins (B1 and B6), minerals/salts (magnesium) and fish oils; the concept of long term prevention with agents such as Mirena, OCPs, GnRH-analogues, even combined treatment with more than one of these agents; Lipiodol fertility treatment, the theme of my MD thesis, was acknowledged for the first time by an international group; principles of networks expertise for women with intractable disease and the invaluable roles of endometriosis organisations such as ENZ (http://www.nzendo.co.nz/) were highlighted. For the future, most promise lies with GnRH antagonists (such as Elagolix, for which we have a multi-centre trial underway), selective progesterone-receptor modulators and aromatase inhibitors.