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Collect baseline and follow-up (e.g., 1, 3, 6, 12 months) vaginal symptom PROMs, vaginal pH, microbiome sequencing, HbA1c, hydration markers, sex hormones (oestradiol/estrone/SHBG), and weight trajectory

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Before starting vitamin B12 injections, we encourage an open discussion about your medical history, current medications, lifestyle, and overall health status with your healthcare provider

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Surgical Management First : For patients with symptomatic gallstones who are appropriate surgical candidates, laparoscopic cholecystectomy followed by weight loss therapy represents a logical sequence