Frequently asked questions: The questions I am asked most in clinic

Yes. The transvaginal route gives the most precise image, but it is not the only one: the scan can also be done abdominally when that suits you better. Tell me before we start and we will decide together.

It can show signs of endometriosis or adenomyosis, and it is one piece of the diagnosis, but not the only one: the diagnosis rests on your history, the examination and an expert ultrasound, and sometimes an MRI. If your symptoms point that way and the scan is inconclusive, there are other tests that add information.

Yes: the scan checks the position of the IUD, as well as assessing the uterus, the endometrium and the ovaries. As it is done during the same visit, that question is answered without booking you in again.

No. It is the test done when your smear or HPV test suggests looking at the cervix more closely, and that is exactly what it is for: examining it under magnification to see whether any area needs attention, so the decision rests on findings rather than guesswork.

Not always. A biopsy is taken only if magnification shows an area that should be looked at more closely; in that case I take it during the same visit, so you do not have to come back another day.

The result is what allows us to decide the next step: whether monitoring and regular checks are enough, or whether the lesion needs treating. I explain what was seen and the options available before anything is decided.

That the virus is there at this moment. Most women catch HPV at some point in their lives and almost all clear it on their own; what really matters is whether the infection persists over time and which type of virus it is.

Because not all types of HPV behave the same way. Typing identifies the high-risk genotypes and, together with the smear, that is what sets how often you should be checked.

A balanced vaginal ecosystem is part of your body's defence against the virus, so looking after your microbiota is part of the plan rather than an extra. When needed, I assess it with vaginal microbiome testing.

They answer different questions and are often done together. Microbiome testing is a genetic analysis that measures the balance of the ecosystem: lactobacilli, bacteria linked to vaginosis, Candida overgrowth and the main sexually transmitted infections. A culture identifies the microorganism and, with susceptibility testing, shows which treatment will work.

Not in every case. The endometrial test uses a small sample from inside the uterus and looks above all for chronic endometritis, so it makes sense when infections keep coming back, when symptoms have no clear explanation or when you are finding it hard to get pregnant.

Yes: the test shows whether there is Candida overgrowth and, with a culture and antifungal susceptibility testing, which species it is and which antifungal it responds to. It is the first step when thrush keeps coming back, not least because there are conditions that look very similar and are not Candida at all.

Because, as well as sexually transmitted infections, I look for low-grade infections: the ones that cause few obvious symptoms and therefore go unnoticed. They are identified with a swab from the cervix or vagina, or a urine sample.

Chronic inflammation or infection of the cervix and genital tract can be the source of inflammatory mediators that make every cycle worse. Finding it means we can treat the origin rather than only the symptoms, and that is why cultures are central to the way I investigate PMS.

To choose a targeted treatment instead of a generic one: it shows which antibiotic the bacteria found will respond to. Antifungal susceptibility testing does the same for fungi.

Not on its own. It measures inflammatory markers in the blood and adds one more clue when your symptoms point towards endometriosis, but it does not confirm the diagnosis or decide anything by itself: I read it alongside the rest of your history.

Yes, it happens: endometriosis takes far too long to diagnose and is not always visible on a first scan. When the ultrasound is inconclusive, the cytokine profile adds information, as do the examination, your history and, sometimes, an MRI.

No, it is added to it. Endometriosis is, above all, an inflammatory disease, and measuring inflammation offers a different view from imaging; neither of them replaces the examination.

No. It is a highly reliable screening test, but not a diagnostic one: what it gives is an estimate of risk. If the result is abnormal, it is confirmed with an invasive test before any decision is made, and I explain calmly what each step means.

Because it is done with a blood sample from the mother, without touching the uterus. From week 10 of pregnancy the mother's blood carries fragments of DNA from the placenta, and it is that DNA that is analysed.

No. It estimates the risk of the main chromosomal conditions — trisomies 21, 18 and 13, among others — not of any illness. It is a specific screening test, not a complete genetic study.

It may make sense: a family or personal history of thrombosis is one of the situations in which I consider this test. It is not a test for everyone, so we look together at whether it adds useful information in your case.

Because the result may influence which hormonal treatment is right for you. It is one of the specific situations in which the test adds information before the choice is made, not after.

In some pregnancy losses thrombophilia testing adds information, but it is not the explanation for every case, nor the only test I consider. It is read as part of your whole history.

No. A large part of the population carries the HLA-DQ2 or HLA-DQ8 genes and most never develop the disease. If the result is positive and there is a suspicion, the diagnosis is completed with blood antibody tests and, when needed, with a gastroenterologist.

It rules things out. Almost everyone with coeliac disease carries one of those two genes, so if you do not, coeliac disease is very unlikely and we can go on looking for the cause elsewhere.

It is useful to know when there is unexplained anaemia or iron deficiency, recurrent miscarriage, difficulty getting pregnant or digestive symptoms. Those are common reasons for coming to a gynaecology clinic, and it is a door worth checking.

Not on its own. It measures the balance between oxidative damage and your antioxidant capacity, which is context rather than a diagnosis: it helps guide the plan.

It helps fine-tune diet, lifestyle and supplements within the integrative approach. And since it can be repeated later, it also shows whether the plan is working instead of leaving us to guess.

Because oxidative stress goes hand in hand with many chronic inflammatory processes, such as endometriosis, premenstrual syndrome or some fertility problems. Measuring it gives an idea of that part of the picture, which is precisely the part addressed through diet and lifestyle.

He may well do. Some low-grade infections cause almost no symptoms, and if only one of you is treated, reinfection returns before long.

Cultures and tests for sexually transmitted infections and, in men, an assessment for possible prostatitis.

By knowing exactly what is there: microbiome testing and a culture with antibiotic or antifungal susceptibility testing, which identify the microorganism and the treatment it responds to. If it still comes back, that is when testing your partner makes sense.

No. It is done in my office: a very cold probe is applied to the cervix for a few minutes, to destroy the abnormal tissue and let healthy tissue grow back.

A watery discharge for a few days is the usual thing. If you notice something you were not expecting, it is better to ask than to be left wondering.

No. It is indicated for specific lesions, and they have to be properly assessed with colposcopy first. We find out what is there, and only then decide whether cryotherapy is the right answer.

They are two different things: the treatment removes the lesions, and the papillomavirus is another matter. That is why, as well as removing them, we review where you stand with HPV and what you can do to reduce the chance of them coming back.

It depends on their size and where they are. In my office I use local techniques such as cryotherapy or laser, and in other cases topical treatments; I explain which one applies to you before we start.

No. Genital warts are caused by the human papillomavirus, and molluscum contagiosum by another skin virus. They can look alike, and it is worth telling them apart before treating.

Because it is not the first option for everyone. For menopausal dryness and atrophy we start with the basics — moisturisers and lubricants, and local oestrogen when indicated — and the laser is considered when that has not been enough or is not suitable for you.

It is usually more uncomfortable than painful. It is done in my office over a few sessions; how many depends on your case, and we agree that at the assessment.

For mild or moderate stress incontinence the laser can be added to the treatment, but it does not replace it: the foundation is still pelvic floor work, properly learnt. And if your case needs a different solution, I will tell you clearly.

No. It is a complement, with a local antimicrobial and anti-inflammatory action: it is part of a wider plan and never replaces a treatment your case needs. What I do aim for with it, in some situations, is to be able to reduce the use of antibiotics or antifungals.

Recurrent infections are one of the situations in which I use it, but it is not the starting point. First we need to know what is there: microbiome testing and cultures with susceptibility testing show which microorganism you have and which treatment it responds to.

For chronic inflammation of the cervix or the endometrium, always as part of the plan and after looking into where it comes from.

What I treat with it is discomfort. Over the years, or after the menopause, the outer labia and the vaginal entrance lose volume and moisture, which can cause discomfort and friction during sex; the aim of the injection is to restore that moisture and comfort. Whether it is right for you is assessed case by case.

No. Hyaluronic acid is a substance your body already makes, and the injected one is gradually reabsorbed: its effects are temporary.

It is injected under local anaesthetic, in my office.

They work in different places. The laser stimulates the vaginal lining to produce collagen and improves its blood supply; hyaluronic acid is injected into the outer labia and the vaginal entrance to restore volume and moisture. They are sometimes considered for the same thing, such as menopausal dryness, and which one suits you is decided after examining you.

A deep warmth, produced in a controlled way: the device has temperature control. It is applied with a vaginal or rectal probe, or externally, depending on what suits your case.

No. I almost always use it alongside physiotherapy: TECAR therapy relaxes the muscles, improves circulation and stimulates tissue repair, and pelvic floor work is what consolidates that.

Vaginismus is one of the situations in which I use TECAR therapy, and the device can also be applied externally. The plan adapts to what you can tolerate; nothing is forced.

Often it is that the right muscles are not being activated, and that is genuinely hard to feel on your own. Electrical stimulation with biofeedback exists precisely for that: it teaches you to activate them, and concentrates the work into a few sessions.

No. The foundation is pelvic floor exercises, properly learnt; for mild or moderate stress incontinence the vaginal laser can be added, but as reinforcement, not instead.

Then I will tell you clearly. Not every kind of incontinence is resolved in the consulting room, and knowing when a different solution is needed is part of the assessment too.

No. I use it as a complementary therapy, within a comprehensive plan, above all for chronic pelvic pain, overactive bladder and symptoms that get worse with stress.

It is applied to the skin with a non-invasive device that delivers brief electromagnetic impulses, similar to the nervous system's own signals. It is painless and done in my office.

No. It means the autonomic nervous system is involved — the one that silently regulates pain, the bladder and your response to stress. When one of its two sides dominates for months, the body feels it as pain, urgency, tension or tiredness, and that does not make the symptoms imaginary.

No. It is low-intensity LED or laser light: no heat, no cutting and no burning. It is painless and needs no recovery time.

In what they do and in how they feel. The diode laser stimulates the vaginal lining to produce collagen and improve its blood supply, and is usually more uncomfortable than painful; biophotostimulation uses low-intensity light, without heat, to stimulate cell activity and local circulation.

It is a complementary therapy whose uses in gynaecology are still being studied, and I would rather say so plainly. That is why I combine it with the rest of your treatment, within a comprehensive plan, and never instead of what your case needs.

It is a complementary therapy with still limited scientific backing, and I prefer to say that clearly. It does not replace a diagnosis or a treatment your case needs: it adds to your plan rather than replacing it.

Through electrodes on your hands and feet, the MORA device picks up your body's electromagnetic oscillations and returns them to you filtered and modulated. It does not apply external currents, and the session is calm and painless.

I do not use it as a diagnostic test. I use it as support within the plan when we already know that inflammation, food intolerances, recurrent candidiasis or stress play a part; the diagnosis is made with the tests that belong to each of those.

The pattern is what points the way: the symptoms appear in the days before your period and ease once it starts. That is why keeping a symptom diary over two or three cycles, and taking the self-assessment test before your appointment, helps so much. The test is not a diagnosis: it measures how this affects you and gives us a starting point to compare against later.

Because low-grade infection and inflammation cause almost no local symptoms: you feel them in how you are each cycle, not as discharge or itching. Examining the cervix carefully and taking cultures is what makes it possible to find that source of inflammation, if it is there.

Treatments that simply suppress hormones are often not enough, and that is exactly the starting point of Dr. Lolas's approach: look for the source of inflammation and treat it, as well as looking after diet, the microbiota, rest and stress. What we find in your case is what shapes the treatment.

There is no single timescale: the treatment, its intensity and its length depend on what we find. We review together how your symptoms evolve over the following cycles and adjust the plan as we go.

That is not the first step. The diagnosis rests on your history, the examination and an expert ultrasound, and sometimes an MRI. Surgery, with an expert team, is one of the treatment options when it is needed, not the way to start looking.

It is possible: endometriosis takes far too long to diagnose and is not always visible on a first scan. A period so painful that it forces you to stop deserves to be looked into further, with the examination, an expert ultrasound and, when they add something, the cytokine profile or an MRI.

Not necessarily. Hormonal treatment is one piece and is considered when appropriate; the others are pain and inflammation control, diet, physiotherapy and, if needed, surgery. The order depends on your symptoms and on where you are in your life.

It is worth saying so from the start, because it changes the order of the decisions. Endometriosis can make pregnancy harder, and it is one of the things I review in the preconception consultation, along with genital tract infections, fibroids, polyps and uterine malformations.

No. The image is only one part: the diagnosis is made using the international criteria and after ruling out other causes that produce similar symptoms. Ovaries with many follicles are not enough on their own.

PCOS is not only gynaecological: insulin resistance is part of the picture, just like irregular periods, acne or excess hair. That is why care starts with diet, exercise and sleep rather than with a drug.

Yes. PCOS can make ovulation harder, so your pregnancy plans are one of the first things I ask about: whatever is added afterwards — supplements or medication — depends on your symptoms and on whether you are trying now or later.

Not necessarily. Most fibroids cause no symptoms and often they only need monitoring. The options range from monitoring to surgery, and they are chosen according to the symptoms you have, not the finding itself.

That needs confirming. Before assuming the fibroid is responsible, I rule out another condition alongside it, such as adenomyosis or polyps: if the wrong thing is treated, the symptoms stay.

Yes. Beyond the fibroid itself, I check related factors such as iron or vitamin D deficiency, which matter especially when there are heavy periods and anaemia.

That is not a question that can be answered in general, only in your case: hormone therapy is considered when it is indicated and safe for you, taking your history and your background into account. In some situations it is also wise to carry out thrombophilia testing first.

That is not the first step. We start with moisturisers and lubricants and with local oestrogen, and when they are needed there are the techniques I use in my practice: laser, hyaluronic acid or radiofrequency.

Yes, and it should not be taken as inevitable. The foundation is pelvic floor training, with electrical stimulation and biofeedback to learn to activate the right muscles, and for mild or moderate stress incontinence the vaginal laser can be added.

Not having found it yet does not mean it is not there. Behind pelvic pain that lasts for months there may be endometriosis, chronic inflammation of the cervix or endometrium, myofascial pain of the pelvic floor, nerve entrapment, interstitial cystitis or digestive problems, and often several causes at once.

A record of the pain: when it appears, how long it lasts, what makes it worse and how it changes across your cycle. It sounds like a small thing and it is one of the most useful in guiding the investigation.

Possibly, and that is not a bad sign: treatment for chronic pelvic pain is multidisciplinary and adapts to what we find. Pelvic floor physiotherapy, for instance, is a usual part of the plan.

Before repeating treatment, two things need confirming: that it really is Candida, and which species. Microbiome testing and a culture with antifungal susceptibility testing show that and which antifungal it responds to. And it is worth remembering that some conditions look very like thrush and are not.

Because the plan is not only the antifungal: it includes changes in hygiene and diet, care of your gut and vaginal microbiota, and support in managing stress. That is not an extra; it is part of the treatment.

When genital infections keep coming back, testing your partner stops the cycle of reinfection, and in men a possible prostatitis is assessed as well. If that fits your situation, we will consider it.

Sexuality is body and emotion at the same time, so that question rarely has a single answer. Behind pain, dryness or low desire there may be recurrent infections, vulvodynia, vaginismus, inflammation of the cervix, pelvic floor pain, endometriosis, lichen or the menopause. A careful gynaecological examination is what makes it possible to find the physical cause, if there is one.

That is extremely common, and it is why the consultation is a space to talk without rushing. As a sexologist, I also support you with the emotional and relationship side: what is not talked about cannot be solved.

First, look for where the pain comes from, with a careful examination. Depending on what we find, the plan may include treating the cause and techniques such as pelvic floor radiofrequency, laser or hyaluronic acid, almost always alongside pelvic floor physiotherapy.

Before you start trying. Folic acid is taken from before conception, and there are things worth having checked beforehand: your thyroid, your vaccinations, your diet and your exposure to toxins and endocrine disruptors.

It is not a full infertility work-up. I do look for what may be making pregnancy harder — genital tract infections, fibroids, polyps, endometriosis or uterine malformations — and if your case needs a different level of investigation, I will tell you clearly.

They are substances present in everyday life — in pesticides, plastics and other products — that can interfere with the hormonal system. In the consultation we look at how to reduce your exposure with realistic changes, the kind that can be kept up.

No. It is the foundation the rest rests on: diet, rest, movement and stress management are part of every plan I make, alongside the treatment your case needs, not instead of it.

Supplements are specific and for what your body needs; there is no single list for everyone. When it helps, blood tests and oxidative stress testing guide them and, later on, show whether the plan is working.

Many chronic conditions share the same ingredients: low-grade inflammation, oxidative stress and nutritional deficiencies. Those can be worked on through diet and lifestyle, and that is why they are part of every plan.