RCPI Institute of Obstetricians & Gynaecologists Spring Conference puts spotlight on endometriosis
The diagnosis and management of endometriosis - a long-term condition affecting about one-in-ten women in Ireland – was the focus of RCPI Institute of Obstetricians & Gynaecologists Spring Conference, held at No. 6 Kildare Street on 6 March.
The important college meeting – the produce of several months’ planning by institute chair Dr Suzanne O’Sullivan – was opened by Minister for Health Jennifer Carroll MacNeill.
“Thank you to Dr Suzanne O’Sullivan for the partnership that’s bringing everyone together working to advance better care for women with endometriosis in Ireland,” the minister said.
At the conference, the minister announced funding has been ringfenced in 2026 for an additional 65 posts specifically for endometriosis services – representing a 180% increase in the dedicated endometriosis workforce. €2 million in research funding available for women’s health, including endometriosis projects, was also announced.
The conference brought together national and international experts in the field to discuss surgery and future trends in treatment.
The first session began with general practitioner Dr Ciara McCarthy (HSE GP Clinical Lead in Women’s Health) who explained how a new HSE National Framework for the Management of Endometriosis integrates a pathway for general practitioners to refer patients from primary care to gynaecology, ultrasound, and fertility hub. Dr McCarthy said that general practitioners are well-placed to develop a long-lasting trusting relationship with patients, and may introduce early on a possible diagnosis of endometriosis. A radiologist’s perspective was given by Dr Maeve O’Sullivan (Tallaght University Hospital), who explained the role of imaging in diagnosing endometriosis. Dr O’Sullivan said the first line of investigation is a transvaginal ultrasound. A Magnetic Resonance Imaging (MRI) scan is to be subsequently recommended if the ultrasound is inconclusive or negative.
An insight into how an Irish-based obstetrician-gynaecologist may subspecialise in treating endometriosis was given by Dr Laurentina Schaler (Rotunda Hospital), who secured a post-CSCST (Certificate of Satisfactory Completion of Specialist Training) fellowship to train in Germany for two years. “You’ll improve knowledge of instruments and technology. You’ll gain advancements in technology that you might bring home to your own unit. You’ll experience collaboration with multidisciplinary teams, with pain management, gastrointestinal unit, urology, and mental health,” she said. A colorectal surgeon’s perspective was given by Mr Cillian Clancy (Tallaght University Hospital), who discussed how the multidisciplinary team structure allows colorectal surgeons to be involved in pre-operative decision-making and planning. He spoke of the importance of discussing the fertility wishes of the patient, of false comparisons between endometriosis rectal resections and rectal cancer treatments, and how sharing MRI imaging with patients had a therapeutic effect on patients finally seeing their disease.
International expertise and perspectives were shared by obstetricians-gynaecologists who travelled from Portugal and Scotland. Dr Nuno Martins – an obstetrician-gynaecologist at Viseu Dão-Lafões hospital in Portugal, and Congress President of the European Board & College of Obstetrics and Gynaecology - spoke to the complexity of laparoscopic surgery for endometriosis, and how to manage risk and complications. Prof Andrew Horne - an academic gynaecologist with a focus on endometriosis pain at University of Edinburgh, and president of the World Endometriosis Society – looked at what the evidence suggested for future trends in endometriosis care.
The conference heard from the clinical leads of the countries two supra-regional endometriosis centres. Surgical approaches in endometriosis care were discussed by obstetrician-gynaecologist Dr Cathy Burke (Clinical Lead at the Cork Maternity University Hospital supra-regional endometriosis Centre). The modelling of endometriosis services within the new HSE Framework was explained by Dr Aoife O’Neill (Clinical Lead at the Tallaght University Hospital supra-regional endometriosis centre).
In a session focused on patient partnerships, Dr Cliona Murphy shared a recorded interview with Cllr Áine Smith, a Fianna Fáil councillor elected to Cavan County Council, who has endometriosis. Cllr Smith described how she spent her thirties dedicated to finding medical professionals to help her treat long-term pain she experienced after coming off birth control pills. She described receiving incorrect diagnoses from several health professionals before finally a fertility nurse suggested she consider endometriosis.
Eventually, an obstetrician-gynaecologist and surgeon confirmed stage four endometriosis. “It was quite a shock but it was such a relief. Finally, somebody knew what was wrong with me,” she said. Upon election in 2023, Cllr Smith’s first motion to Cavan County Council was to call on the Department of Health to invest more in endometriosis treatment.
There are other reasons to improve women-centred care. Prof Louise Kenny, internationally renowned researcher in women’s and childhood heatlh, and Pro Vice Chancellor of the University of Liverpool’s Faculty of Health & Life Sciences, quoted a survey by the Department of Health and Social Care UK stating 84% of female participants felt they weren’t listened to by their doctor. Annual litigation spend on obstetrics in England currently exceeds £1.14bn. Dr Minna Geissler (consultant obstetrician-gynaecologist, Cork University Maternity Hospital and South Infirmary Victoria Hospital) spoke of the impact of endometriosis on fertility and how best to protect fertility while treating endometriosis.
A final session dedicated to Endometriosis research in Ireland began with a presentation by Dr Mariarosaria Cuozzo (Department of Anatomy and Neuroscience, University Hospital Cork) about a new pilot multisystem biomarker exploring links between stress, pain, microbiome and inflammation in Endometriosis. An audit at Tallaght University Hospital by Dr Barbara Burke (HST Obstetrics & Gynaecology trainee) found that after Endometriosis surgery found that gonadotropin-releasing hormone (GnRH) agonist for supressing production of sex hormones was appropriately reserved for the most complex cases.
A joint study by Dr Mary Barrett (obstetrician-gynaecologist, Cork University Maternity Hospital) and Dr Bernard Kennedy (HST Obstetrics & Gynaecology trainee) reviewed all surgeries for presumed Endometriosis between 2014-2023 at the Cork site. The study found 78% of patients experiencing symptomatic improvement post-surgery for Endometriosis, but it also urged that symptomatic improvement isn’t related to pain cyclicity. The recurrence of Endometriosis symptoms post operatively is well documented, and repeat surgeries are often performed.
The conference concluded with Dr Radka Fahey (UCD National Institute for Bioprocessing Research & Training), who, with aid of Marie Skłodowska-Curie funding, uncovered evidence of glycome – the sugar complement of an organism – being used as a potential biomarker for endometriosis. Dr Fahey said next steps will involve validating and extending research in this area.
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