Welcome to our latest e-newsletter!Our Winter newsletter includes information from Oxford Women's Health gynaecologist Michael East on upcoming guidelines for treating endometriosis, and also a story on research into biomarkers for the disease. Anna Fenton shares some of the latest information on osteoporosis. We're also very excited to be celebrating our five year anniversary partnering with Genea. Inflammatory biomarkers may help unlock endometriosis mysteries A new study by Oxford Women’s Health gynaecologist Michael East is helping unlock the medical mysteries of endometriosis. Over the next three years Mike will work with biomedical scientist Dr Teagan Hoskins on studying whether inflammatory biomarkers decrease following surgical treatment of endometriosis. The study, which began earlier this year, will recruit about 100 patients. Previous studies have shown that inflammatory biomarkers are higher in the peritoneal fluid and blood of people with endometriosis, Mike says. What no one has shown is whether removing endometriosis decreases the levels of inflammatory biomarkers. “These biomarkers are not specific to one area of inflammation but if you’ve had a diagnosis of endometriosis and you can get a correlation between biomarkers and activity then it may be a useful clinical tool.” Samples of blood and peritoneal fluid will be taken at the start of surgery in patients who may need to return to the operating table at a later date, such as in the case of patients whose ovaries have been temporarily relocated to allow healing to take place. This will allow for a second round of tests for the inflammatory biomarkers, Mike says.
Mr Michael East He is hopeful that his work will be the start of ongoing research. “This will give us more information in addition to what we know about increased inflammatory biomarkers. You don’t know where it may lead, but once you start doing this sort of research it often develops a life of its own. Hopefully there will be other studies and the research will mushroom over time.” Better to treat osteoporosis than ignore it With safe and effective treatments now available for osteoporosis, people with the condition should make sure it is treated so that they can stay strong and well, according to Oxford Women’s Health endocrinologist Anna Fenton. “Often people try and turn a blind eye to it, even when they know they have reduced bone density, because they feel it is a natural part of ageing or nothing can be done to change it,” she says. As an endocrinologist, Anna diagnoses and treats hormone problems and the conditions that can arise from them. She has served on the board of Osteoporosis New Zealand and is currently the clinical leader for the Canterbury District Health Board Bone Density Service. Osteoporosis can result in chronic pain; loss of height, functionality and self-esteem; a rounded back (Dorsal kyphosis); anxiety; and depression. “It’s so important that individuals, their whānau, and medical practitioners care about the impact of osteoporosis. Fifty-six percent of women and 29 percent of men will suffer a fracture after the age of 60 because of it,” Anna says. “Of those with hip fractures, 20 per cent will die within a year from fracture-related complications.” Access to bone density testing means it is possible for medical practitioners to readily identify those at risk, and to individualise treatment. “There have been wonderful advances in tests for bone density, the understanding of oestrogen and testosterone depletion, and medical treatments. This means we can develop an individual approach to treatment. For some people drug intake can be minimised, with minimal or no side effects, but with significant benefits in reducing the risk of fracture,” Anna says. Dr Anna Fenton “Getting tested or treated can make such a difference to your ability to function, but more than that, to live life well.” Anna also encourages people to reduce their risk of osteoporosis by stopping excessive coffee or alcohol intake; not smoking; including calcium and Vitamin D in their diet; regular exercise with some weight-bearing included; and reducing hazards or installing stability and mobility aids around the home. Laser survey findings Since introducing the MonaLisa Touch treatment in early 2018, Oxford Women’s Health has surveyed patients throughout their treatments. We wanted to share patient observations collected during more than 200 treatments. Most obvious is a dramatic improvement in sexual function. Patients reported improved lubrication, a significant reduction in pain during intercourse, particularly around the entrance to the vagina, and an increase in ‘normal’ sensation. The majority of patients reported that the sexual issues that had previously concerned them, and prompted them to seek the treatment, were now either no longer a problem or only a slight problem.
There were few findings in relation to prolapse as although the Australasian Pelvic Floor Questionnaire did ask about prolapse symptoms, patient selection was not targeted for women with prolapse. While the MonaLisa Touch treatment does not claim to resolve urinary issues, patients reported an improvement in urinary symptoms. These included a reduction in urinary frequency, less urgency, and improvement in flow and stress incontinence. Our new survey will start shortly and we will report on our findings in six months. Endometriosis sufferers to benefit from new guidelines A more collaborative approach to treating difficult cases of endometriosis will be one benefit of upcoming Ministry of Health treatment guidelines, according to Oxford Women’s Health gynaecologist Michael East. As a representative of Endometriosis New Zealand, Mike has worked with others from across the health sector over the last three years to develop the guidelines. He says the guidelines will include an emphasis on progestin only therapy, a reduction in surgeries, and cooperation on difficult cases by multidisciplinary medical teams spanning the public and private health sectors. Mike says there is evidence that progestins on their own are more effective at suppressing the symptoms and progression of endometriosis than the combined oestrogen and progestogen oral contraceptive pill. Some studies suggest the oral contraceptive pill, which is frequently prescribed at a primary care level, may increase the progression of endometriosis. “The combined oestrogen and progestogen oral contraceptive pill doesn’t help as many people as you might think. The guidelines recommend that medical intervention with progestin should start early when symptoms present, which is often in the teens.” Mike says the guidelines will be in line with the World Endometriosis Society which recommends that laparoscopies should only be done if intended to be therapeutic, rather than for diagnosis.
The idea is that many young women may never even need surgery because you can usually make a reasonable working diagnosis from history alone. All the [international] guidelines agree that you don’t need a laparoscopy to have a working diagnosis because of the high correlation between menstrual distress —pain that is so bad you take time off work and school—and the presence of endometriosis.” He says the guidelines are designed to encourage multidisciplinary teams across the public and private health sectors to work together, and where possible, limit the number of surgeries. “Multidisciplinary teams will mean people in geographical regions will put their heads together on more difficult cases. This might include general practitioners, physiotherapists, dietitians, educators, clinical psychologists, pain specialists and gynaecologists.” Genea Oxford Fertility: Celebrating five years In February 2014, Oxford Women’s Health launched an exciting joint venture with international fertility experts Genea. This year, we’re celebrating five years of this hugely successful partnership. Subfertility is far more common than most people think. Fortunately, there are now many treatments available, and in many cases, these treatments result in a successful pregnancy. We’re proud of the many successes we have achieved over the past five years and look forward to continuing our work into the future. Based in the Forte Health building, the Genea Oxford Fertility clinic complements the services offered by Oxford Women’s Health. Together we have been able to provide a comprehensive range of treatments for women’s health, fertility and childbirth. While Genea Oxford Fertility has only been established for five years, we have become the clinic of choice for a large number of South Islanders seeking to start or grow their families. The focus of the Genea Oxford Fertility team is on making your fertility treatment as comfortable, simple and stress-free as possible. We know that the longer people wait to seek help, the more it can adversely affect their chances of conceiving. The best time to seek help is when you are worried – if you’ve had no luck conceiving and it’s starting to bother you, get in touch with Genea Oxford Fertility today. A free phone consultation with a fertility nurse is available through calling 0800 377 894. You can also make an appointment with one of our fertility specialists through this number. For more information on the services Genea Oxford Fertility has to offer, visit geneaoxford.co.nz Remembering Lois Tonkin We were deeply saddened by the recent death of our colleague Dr Lois Tonkin. Lois provided counselling services at Genea Oxford Fertility and was a well loved and hardworking member of our team. In addition to her work at Genea Oxford Fertility, she was a lecturer in the School of Health Sciences at the University of Canterbury and published a number of works on grief and loss. Her latest book; Motherhood Missed: Stories from Women who are Childless by Circumstance was a particularly valuable contribution to our understanding of childlessness and to the continuing work and research in this area. Dr Lois Tonkin |