What we deliberately don't do

Cervical cancer develops over years. An annual smear therefore does not find more cancer – it finds more harmless changes that would have resolved on their own, and leads to follow-ups, colposcopies and procedures that helped no one.

With normal results, the recommended interval is three years (cytology) or five years (HPV testing from age 30). We test more often after abnormal results, after conisation, with immunosuppression, or on informed request.

The annual gynaecological check-up remains useful – but it consists of consultation, examination and ultrasound, not automatically of a smear.

A broad hormone panel «just to be safe» almost never answers the question you are asking. In perimenopause, FSH and oestradiol fluctuate from day to day: a normal value rules nothing out, an abnormal value proves nothing. The diagnosis comes from cycle, symptoms and time course.

We measure specific values when they have a consequence – TSH for cycle disorders, prolactin for nipple discharge, testosterone or AMH for a defined question, ferritin for exhaustion.

Treatment with body-identical hormones is also guided by symptoms, not by blood levels. We do not use saliva or urine hormone profiles.

Bacteria in the urine without symptoms are not a bladder infection. Outside pregnancy and urological procedures they are not treated: antibiotics do not prevent a later infection in this situation, but they cause side effects, thrush and resistance.

Even for an uncomplicated urinary tract infection, antibiotics are not the only route. A large share of episodes improve within 48 hours without antibiotics – with pain relief, fluids and a clear threshold for calling back.

In a pregnancy without risk factors, current SGGG guidance likewise no longer recommends routine screening. Bacteriuria is looked for and treated with previous preterm birth, previous late miscarriage, diabetes mellitus, immunosuppression, urinary tract disorders or previous pyelonephritis. A symptomatic infection in pregnancy is always treated.

Fibroids are benign muscle nodules of the uterus and are very common. A fibroid that causes no bleeding disorder, no pain and no pressure needs neither surgery nor hormones – only follow-up.

Neither size alone nor the number of fibroids is a reason to treat. What matters is your symptoms, the location of the fibroid and your family planning.

If surgery has been proposed and you are unsure, this is a classic case for a second opinion – without our own interest in the operation, because we do not operate on fibroids.

Most ovarian cysts are functional and disappear on their own within a few weeks. A simple, thin-walled cyst without suspicious features is monitored, not removed.

Every ovarian operation costs ovarian tissue and therefore reserve. For women who want children, that is a real argument against rushing into surgery.

We operate for persistent symptoms, for growth, for suspicious ultrasound features or for torsion – for a finding, not for a number.