Perimenopause, menopause, and primary ovarian insufficiency Quiz: Ace Your Exams

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A 53-year-old woman comes to the clinic for evaluation for over 1-year of worsening hot flashes and amenorrhea. She reports that the hot flashes during the day and night have significantly impacted her quality of life and disrupted her life. She has frequently had to call out of work due to feeling exhausted after not sleeping at night. During the day she has had to miss meetings at work because of her hot flashes. Her medical history is significant for a total hysterectomy performed 5 years ago for benign fibroids. She has no personal or family history of cardiovascular disease, venous thromboembolism, or breast cancer. Her only medication is a daily multivitamin. She is open to taking any type of medication that will help. Vital signs are within normal limits. BMI is 24 kg/m2. Physical examination is unremarkable. Which of the following is the best next step in management?  

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