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Initial Assessment: Physical exam: BMI 29, BP 132/82 mmHg, no signs of acute illness Labs: TSH within normal limits, fasting glucose 98 mg/dL, total cholesterol 208 mg/dL, FSH elevated, estradiol low Menopause Rating Scale: Severe vasomotor and psychological symptoms Clinical Decision-Making: Given Marias significant vasomotor symptoms and the absence of contraindications, her provider considers hormone replacement therapy for symptom relief and improved quality of life

Subjects were evaluated every 4 weeks

no significant changes Annual mammogram scheduled Complications and Risk Management: At her 1-year visit, Maria mentions occasional mild breast tenderness but no new symptoms