Hereditary factors play a particularly important role in their development and female hormones, specifically oestrogens, influence their growth significantly.

Although some women have no symptoms, uterine fibroids often cause:

• Excessive menstrual bleeding
• Longer menstrual periods
• Bloating and abdominal pain
• Weight gain
• Interference with fertility
• Complications during pregnancy and childbirth
• Pain during sex
• The need to urinate more frequently

For the diagnosis and monitoring of myomas, transvaginal ultrasound is indicated.

Myomas are usually benign, although on rare occasions they may be sarcomas which are malignant. Sarcomas originate in the tissues of muscles, fat, bones, and the fibrous tissue that forms tendons, they tend to grow much faster than fibroids.

There are several options for the treatment of myomas depending on the symptoms, size and location:

• If they do not cause any symptoms and they are not causing any harm, treatment is not necessary.
• Surgery is the most commonly used option:
  • Myomectomy, removal of fibroids preserving the uterus. It may be abdominal, hysteroscopic, or laparoscopic.
  • In more severe cases, hysterectomy may be necessary, removing part or all of the uterus.
• The use of ulipristal acetate (UPA) may also be indicated to help treat pain, improve patients’ quality of life, and reduce the volume of fibroids by up to 25%, avoiding surgery in certain cases. Ulipristal acetate is a progesterone modulator that controls bleeding and pain in most patients.

Endometriosis is a chronic disease that affects young women. Its incidence is high, 1 in 10, but it does not always occur with the same degree of severity, in fact, many women have it without knowing.

It is a benign condition that affects many women during their childbearing years, layers of endometrial cells are implanted outside the uterus, settling anywhere in the abdomen, ovaries, Fallopian tubes, vagina, supportive uterine ligaments and even in more uncommon places like the intestines or bladder.

The most common symptoms are:

• Severe menstrual pain
• Pain outside the menstrual period
• Pain during sex
• Fertility problems
• Painful defaecation

All these symptoms can seriously compromise the woman’s quality of life, with the effect on fertility often causing the greatest concern.

Vaginal ultrasound also enables diagnosis of so-called chocolate cysts on the ovaries. But, as we have said, small implants can also occur in the pelvis affecting the Fallopian tubes, peritoneum, and other abdominal organs such as the bladder, bowel loops, and rectum.

Treatment will always be individual with the aim of:

• Relieving pain and symptoms
• Restoring fertility
• Preventing recurrence
• Treating endometriosis lesions

Medical treatment is the primary choice. Until now, hormonal contraceptives have been used with good response and tolerance. Currently new treatments such as selective oestrogen and progesterone receptor inhibitors are opening new doors for the treatment of those women who want to preserve their fertility.

Surgery is reserved only for specific cases and times and, of course, should be performed by specialist surgeons. Surgical success includes prevention of recurrence, this relies on effective eradication leaving no residual disease.

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). Almost all sexually active people get it at some point in their lives with prevalence being higher in young people.

It is transmitted through unprotected sex due to contact between mucous membranes where the virus has become embedded.

Most of the time it is an infection which has no major health consequences, the immune system itself manages to fight it. However, HPV may be involved in pre-malignant lesions of the cervix, vagina, vulva, and anus. These are called dysplasias, which are diagnosed by annual cytology and, although not considered cancer, require follow-up and treatment. In women, HPV is a risk factor for cancers such as the cervix, vulva, vagina, and anus; in men, it is a risk factor cancer of the colon and penis.

HPV usually displays no symptoms, although in some cases genital warts (condylomas) develop.

Early detection is essential, therefore periodic gynaecological examinations are vital, as dysplasia is detected through cytology (smear).

Vaccines and the use of barrier contraceptive methods such as condoms also play a key role in preventing this disease.

Diagnosis of HPV is made through cytology, colposcopy, and, if deemed necessary, DNA testing.

Treatment depends on the age of the patient and the type and extent of the abnormality:

• You can choose to monitor the disease as in most cases the immune system eliminates the virus itself.
• The lesion may be removed to prevent progression to cervical cancer. Depending on the area affected, minimal or extensive surgery (conisation, hysterectomy, …) may be selected.
• If cancer is already present, care is transferred to the oncology unit, where the medical team will determine the most appropriate treatment for each case.

Menopause is a natural process that every woman will arrive at eventually. It is the cessation of ovarian function, menopause is considered to be established after 12 months without menstruation.

Some women have few or no symptoms during the menopause, but it’s common to have any of the following:

• Hot flashes
• Sleep problems
• Mood swings
• Anxiety or even depression
• Vaginal dryness
• Decreased libido
• Coagulation disorders

To alleviate these symptoms there are several effective and safe treatments that HC Marbella gynaecologists can recommend and prescribe according to the characteristics and circumstances of each patient.

To alleviate these symptoms there are several effective and safe treatments that HC Marbella gynaecologists can recommend and prescribe according to the characteristics and circumstances of each patient.

The CO2 laser can help greatly in combatting vaginal dryness.

Hormone replacement therapy may be necessary, but always prescribed and supervised by the gynaecologist and for a limited time. For patients with heart problems or a family history of breast cancer, caution should be exercised in choosing such therapy.