A 49-Year-Old Woman Comes to the Office Due to Worsening

A 49-year-old woman comes to the office due to worsening hot flashes and night sweats over the past year.  The patient's menstrual periods have been irregular for the past 2 years, and her last menstrual cycle was a year ago.  She has no chronic medical conditions and has had no surgeries.  BMI is 23 kg/m².  Vital signs are normal.  The neck is supple and without thyromegaly.  The remainder of the examination is normal.  The patient says, "This is awful.  I turn red and sweat in the middle of work meetings and then have to leave to cool down.  I'm wondering if hormones could help."  Which of the following is the most appropriate response to 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."