A 49-Year-Old Woman Visits the Clinic Because Her Hot Flashes

A 49-year-old woman visits the clinic because her hot flashes and nocturnal sweats have been worse over the last year. The patient's menstrual cycles have been inconsistent for the previous two years, with her most recent cycle occurring a year ago. She has no chronic medical issues and has never had surgery. The BMI is 23 kg/m2². Vital indicators are typical. The neck is flexible and free of thyromegaly. The remainder of the exam is routine. The sufferer declares, "This is terrible. I become hot and sweaty at work meetings and have to leave to cool down. I'm curious whether hormones may assist." Which of the following is the best way to deal with this patient?

A) "Although menopause can be uncomfortable, it is a natural process; let's try making some simple lifestyle changes first."
B) "Hot flashes and sweating are very normal in menopause; for most women, they subside on their own in 1-2 years without treatment."
C) "I can see these symptoms have been affecting your day-to-day life; hormonal therapy can be an effective option, although there are some risks."
D) "I don't recommend taking hormonal therapy because your symptoms are not that severe; the risks would likely outweigh the benefits."
E) "Menopause can be very stressful; perhaps talking about how to cope with the emotional effects would be helpful."