How many visits should I plan for assessment and follow-up?
How many visits should I plan for assessment and follow-up? Most people with genitourinary syndrome of menopause (GSM) need 1 detailed assessment, a review at 6–12 weeks to gauge real-life change, and another at 3–6 months to fine-tune maintenance. If you add device-based care or injectables, expect 2–3 treatment sessions spaced 4–8 weeks apart with a review afterwards. Timings adapt to your goals and any red flags. Educational only. Results vary. Not a cure.
Detailed Medical Explanation
How many visits should I plan for assessment and follow-up? A practical plan spaces visits to capture changes you can actually feel—less urine sting, fewer “paper-cut” micro-tears at the entrance, easier initial penetration, and calmer walking or cycling. Because genitourinary syndrome of menopause (GSM) mixes biology (low oestrogen → thinner epithelium, higher pH, reduced Lactobacillus) and mechanics (friction → dyspareunia, fissures), you’ll usually see us enough to address both.
Visit 1 – Assessment (60–90 minutes). We map symptoms (dryness/GSM/atrophy; burning; dyspareunia; urinary urgency/frequency), screen for mimics (BV, thrush, UTI, contact dermatitis, lichen sclerosus), check red flags (e.g., new post-menopausal bleeding), and examine gently if appropriate. You leave with a personalised foundation plan: a scheduled vaginal moisturiser (many prefer hyaluronic-acid gels), the right lubricant (water-based = versatile/condom-friendly; silicone-based = longest glide for a tender vestibule; oil-based = rich feel but may degrade latex condoms/toys), and precise placement so creams reach the vestibule/posterior fourchette. If acceptable, we introduce local vaginal oestrogen or vaginal DHEA with technique coaching.
Visit 2 – Early review at 6–12 weeks (30–45 minutes). Biology takes weeks to shift, so this is the first fair check-point. We look for fewer micro-tears, easier speculum tolerance, better lubrication, and calmer pH-related symptoms. If foundations helped but gaps remain, we may adjust dose/format or add vestibule-specific steps (e.g., a fingertip of cream externally). For an at-a-glance pathway, see how treatment steps are sequenced.
Visit 3 – Consolidation at 3–6 months (20–30 minutes). We aim for the lowest effective maintenance: keep the moisturiser schedule and the single best-fit lubricant; continue local therapy if it’s making a difference; and strip out anything that irritates (perfumed washes/liners, tight synthetic kit, chlorine left on the skin). If symptoms remain intrusive after well-run foundations and local therapy, we may discuss selective adjuncts (radiofrequency/laser; injectables such as platelet-rich plasma or polynucleotides) with realistic timelines and goals.
If procedures are added. Device-based care or injectables are usually delivered as a short series: 2–3 sessions spaced 4–8 weeks apart, then a review 6–12 weeks later to assess day-to-day outcomes. These are adjuncts, not replacements for foundations or local biology support. We’ll signpost inclusions and spacing up-front—see treatment prices for how sessions and follow-ups are bundled.
After that—maintenance and safety-net. Many people move to 6–12-monthly check-ins. Bring a simple diary (sting with urine contact, where tears occur, whether silicone-based lubricant outperforms water-based, any triggers like saddle pressure). If “paper-cut” splits or insertional burn creep back, we first re-check placement and friction control before considering a single maintenance procedure.
Why this cadence? GSM improvements arrive in phases: immediate friction relief from lubricants; 2–6 week epithelial change from local oestrogen/DHEA; and, for selected people, gradual comfort gains after device/injectable sessions. Reviews are timed to those arcs so we can adjust with evidence, not guesswork. If red flags appear—malodorous green/grey discharge, intense itch with thick white discharge, fever, visible blood in urine, or new post-menopausal bleeding—we pause and prioritise diagnosis before any escalation.
Personal factors that may add visits. Recent pelvic/perineal surgery (we’ll wait for surgeon clearance), active BV/thrush/UTI, anticoagulant use (for injectables planning), severe sensitivities/dermatoses, or pelvic floor guarding (where pelvic health physiotherapy and graded dilators are higher-yield than procedures) may add targeted appointments. Equally, if foundations solve your main limiter, you might only need the assessment plus one review.
Bottom line. Plan for one thorough assessment, a 6–12 week review, and a 3–6 month fine-tune; layer extra visits only if you add procedures or need closer support. The goal is comfort with the simplest, safest routine that works for you.
Clinical Context
Who may need fewer visits? People whose main limiter is vestibular sting and micro-tears who respond to a scheduled moisturiser, a generous silicone-based lubricant for the longest glide, and accurate placement of local oestrogen/DHEA. Many reach stable comfort after the assessment plus one 6–12 week review.
Who may need closer follow-up? Anyone with suspected infection (BV/thrush/UTI), contact dermatitis, or dermatoses (e.g., lichen sclerosus); those on anticoagulants considering injectables; or people with pronounced pelvic floor guarding after painful sex—physio/dilator coaching can be pivotal.
Next steps you can action now. Keep cleansing gentle (lukewarm water; bland emollient as a soap substitute), schedule moisturiser 2–4 nights weekly, match lubricant to your needs (water-based for condoms/versatility; silicone-based for tender vestibule; avoid oil with latex), and diary triggers and wins. Arrive at reviews ready to decide on the lowest effective maintenance.
Evidence-Based Approaches
Patient-friendly basics: The NHS provides plain-English guidance on causes, self-care and when to seek help for vaginal dryness, including moisturiser/lubricant principles.
Guideline framing (UK): The NICE Menopause Guideline (NG23) recommends offering information on vaginal moisturisers and lubricants and considering low-dose local vaginal oestrogen when symptoms affect quality of life; these timelines underpin 6–12 week and 3–6 month reviews.
Product and prescribing detail: UK dosing/cautions for vaginal oestrogens and prasterone (DHEA) are set out in the British National Formulary (BNF), supporting long-term, lowest-effective maintenance once settled.
Effectiveness benchmarks: Systematic reviews in the Cochrane Library show that local vaginal oestrogens improve dryness, soreness, dyspareunia and vaginal pH versus placebo—useful for setting expectations at 6–12 week reviews.
Pathophysiology & nuance: Peer-reviewed overviews indexed on PubMed describe GSM mechanisms (thinner epithelium, raised pH, fewer lactobacilli), explaining why phased reviews align with biological and mechanical change.