Rebecca Mallick | President, British Society for Gynaecological Endoscopy (BSGE); Consultant Gynaecologist, University Hospitals Sussex NHS Foundation Trust; Lead Surgeon, Sussex Endometriosis Centre, Princess Royal Hospital, Haywards Heath, UK
Citation: EMJ. 2026; https://doi.org/10.33590/emj/79863S5Y
You recently became President of the British Society for Gynaecological Endoscopy (BSGE). Where would you most like to see tangible change during your presidency?
For me, a real passion is improving care for women with fibroids. They cause so many symptoms that affect quality of life and fertility, but their impact is often not fully appreciated.
Over the next 2 years, I want to improve diagnosis, strengthen training for trainees and clinicians, and ensure women have access to the full range of appropriate, evidence-based treatment options, whether that is laparoscopic myomectomy, hysteroscopic surgery, uterine artery embolisation, radiofrequency ablation, or newer medical treatments. It is about providing holistic, individualised care and ensuring women have access to the right treatment for them.
Ultimately, I would like to establish fibroid centres of excellence across the UK, so women can access that same high standard of care regardless of where they live. It is a huge project, and I know it will take longer than 2 years, but we have done it for endometriosis. I am confident we can do it for fibroids too.
The burden is not just heavy bleeding and anaemia. There are pressure symptoms, bladder and bowel symptoms, fatigue, and lethargy. Women take time off work and younger patients miss school, affecting their education. There is a significant wider societal and economic impact, which makes improving fibroid care such an important piece of work.
What can fibroid services learn from the development of specialist endometriosis care?
The Endometriosis Centre Project started in 2007, before I began my obstetrics and gynaecology training. Clinicians were doing good work across the UK, but there were no consistent standards defining what treatment should look like.
It started with a few clinicians coming together to define good care: how we diagnose the condition, what surgery should entail, what medical treatment should be offered, and what outcomes we should measure. It was about creating networks, working in multidisciplinary teams (MDT), and sharing good practice. We must do the same for fibroids.
We have now established a fibroid subcommittee within the BSGE and started work on our National Fibroid Network. We plan to launch it formally towards the end of the year, with our first national conference next year. We want to bring together all the stakeholders, including patients, to improve care. Our ambitions include national standards, multidisciplinary care pathways, better access to the full range of treatments, and, ultimately, fibroid centres of excellence across the UK.
There are centres internationally delivering exceptional fibroid care, particularly in specific treatment areas, but we are not aware of an equivalent comprehensive national network bringing all these elements together. It is an ambitious project, but hopefully what we develop in the UK can provide a model for others too.
What needs to change to reduce gynaecology waiting lists and help women access care sooner?
It is really difficult, and the reasons are multifactorial. The Royal College of Obstetricians and Gynaecologists (RCOG) is doing some excellent work in this area, but we need government-led action and women’s health to be a priority in the UK.
There are so many competing demands. There are cancer services and targets, but we also need to recognise the huge burden of conditions such as endometriosis, fibroids, and adenomyosis, and their impact on women’s wellbeing and the economy.
We need a multipronged approach: funding, training more clinicians, better diagnostics, and prioritising women’s health within elective hubs. The BSGE continues to work closely with the RCOG to advocate for these improvements and ensure that women’s health receives the attention and investment it deserves.
Could more care be delivered in the community?
Absolutely and we need people thinking outside the box. We have seen some excellent examples of women’s health hubs across the country, but funding and implementation have been variable.
The Getting It Right First Time programme is looking at models to move more care into the community, and we are working with them. Not everything needs to be consultant-led. There is so much that GPs with a special interest, specialist nurses, and sonographers can deliver with the right training, support, and clear referral pathways.
Women could be seen sooner, have a management plan started, and move into secondary care when needed. They should not have to wait 6–12 months for advice and a scan when those first steps could happen earlier.
We need to move away from the idea that all gynaecological care must start in a hospital setting. There are better ways of working, and we should be embracing them. Ultimately, it is about getting women seen by the right person, in the right setting, at the right time.
From your experience leading the Sussex Endometriosis Centre, Haywards Heath, UK, where are the biggest gaps in the endometriosis pathway?
The BSGE sets standards for what good endometriosis care should look like. Our role is to help trusts deliver that locally, but we are working at a time of significant financial constraints.
Diagnosis is a key issue. We need to upskill clinicians in diagnostic methods, including scanning, and improve access to advanced gynaecological ultrasound. We also need the infrastructure to support earlier diagnosis. If someone is diagnosed sooner, that’s excellent, but what happens afterwards? We need those next steps in place.
One area we have been exploring is developing a more structured network of endometriosis care, similar to the model used in cancer services, where specialist centres work alongside local units.
At the moment, women with severe disease attending specialist centres can access MDT input, holistic management, pain services, urology, and colorectal expertise. Many other women do not have access to those services, while specialist centres are overwhelmed.
We could have centres managing severe disease linked to units with an endometriosis nurse, a clinician with a special interest in diagnosis and treatment, and access to pain management.
That could improve care for all women, while helping specialist centres look after those with the most complex disease. It is about making sure patients reach the right centre, see the right person at the right time, and are offered all the different aspects of care.
How has your threshold for recommending endometriosis surgery changed, particularly for women concerned about fertility?
This has probably been the biggest evolution in my practice, and I think many endometriosis specialists would say the same.
As trainees, the first thing we are taught is how to operate. However, particularly when we are looking at fertility, surgery is often not the right answer and can cause harm. Surgery on the ovaries can affect anti-Müllerian hormone levels and ovarian reserve.
It all comes down to counselling and informed consent. What is the patient’s objective? Is it fertility, pain relief, or both? Are they planning a pregnancy now or in the future? Looking at that whole picture, alongside the patient’s symptoms, helps us develop a plan together.
Surgery is not without risk, and that extends beyond fertility. We need to have detailed discussions about the risks, benefits, and likely outcomes, and then make a decision together.
From a pure fertility perspective, I very rarely offer surgery unless it is going to improve fertility outcomes. That is why MDTs and collaboration with fertility specialists are so important.
Recent guidance has been helpful in focusing those conversations on optimising fertility and informed decision-making. It should not simply be: “There is a 4 cm endometrioma; go ahead and remove it.” That might help pain, but the patient may not have pain, and in doing that we could significantly reduce ovarian reserve and impair their chances of pregnancy. It is all about informed consent, correct counselling, and shared decision-making.
How should fertility preservation feature in discussions before endometriosis surgery?
It is such an important conversation; endometriosis surgery can significantly improve wellbeing and quality of life, but it can also affect fertility and ovarian reserve.
Asking someone to choose between fertility and pain relief is incredibly difficult. People want quality of life, and they want to have children.
In an ideal world, with limitless resources, we would take an MDT approach and be able to refer all our patients to fertility specialists to discuss their options around fertility preservation.
I am also a trustee of the Endometriosis Foundation, which does a lot of work around fertility and campaigns for fertility preservation. There is already work happening, but improving access would require national guidance and ring-fenced funding.
What do future gynaecological surgeons need to be taught differently from previous generations?
I still think of myself as quite a young consultant, but training has changed considerably even since I trained. It used to be very firm-based. You joined a team, worked with a consultant day in, day out, and learned how to scan and operate. It was a fantastic model, particularly for building relationships and mentorship, but it does not always fit with current shift patterns, less-than-full-time working, and the demands of modern training.
We need to recognise that trainees have fewer opportunities for hands-on surgical experience, and training needs to evolve to reflect this. At the same time, we must make sure trainees are supported, have access to good mentorship, and do not burn out. That is incredibly important to me.
I am a huge fan of simulation, and I could talk about it for hours. When it is embedded in training, trainees can progress much more quickly once they enter the operating theatre. It does not replace operating experience, but it can help bridge the gap. Simulation, AI, and augmented reality can help develop surgical skills and hand–eye coordination.
It is also about more than operating: human factors, civility in theatre, and learning how to deal with complications all matter.
The BSGE provides practical and virtual training opportunities up and down the UK, and many deaneries also do this fantastically well. However, I would love to see simulation embedded formally within the curriculum, ensuring all trainees have access to high-quality training opportunities, regardless of where they work.
Which developments at this year’s European Society for Gynaecological Endoscopy (ESGE) Congress do you think will most influence gynaecological surgery?
The biggest change is robotics. Even compared with congresses 3–4 years ago, you can really see the difference.
Robotic surgery absolutely has a place in gynaecology. When patients are selected correctly, particularly in complex gynaecology and gynaecological oncology, it can offer important benefits: precision, better visualisation, avoiding large abdominal incisions, and improved ergonomics for surgeons.
Alongside that come questions about teaching and training. How do we train our trainees, support consultants, and ensure equitable access to robotics across the UK?
This is something I have been particularly keen to champion as BSGE President, and we have recently launched our national robotic training pathway for trainees. However, access to robotic surgery for non-cancer gynaecology remains a big issue. We need to ensure women have access to these technologies where there is evidence that they can improve care.
I am not saying we should use a robot for every case. We need appropriate patient selection, a cost–benefit assessment, and proper training. When I speak to colleagues, they describe improved visualisation and precision in complex endometriosis surgery. We need to collect those data, publish them, and present the outcomes.
I am hugely supportive of embracing new technologies, but innovation needs to be evidence-led and ultimately improve patient care. We need to support clinicians and trusts in developing these skills and accessing the necessary equipment. As always, it comes back to investment, training, and ensuring women’s health receives the priority it deserves.
