A 54-year-old G2P2 presents to your office for a health maintenance examination. Her last menstrual period was eight months ago. She complains of severe vasomotor symptoms, vaginal dryness, and dyspareunia, and she desires treatment for her symptoms. She has otherwise been in good health and has no significant past medical or surgical history. Her family history is significant for a mother who has severe osteoporosis at the age of 75 and a grandmother who died of breast cancer at the age of 79. She does not report any smoking, alcohol or drug use. On physical exam her BP=130/78, Pulse=84, BMI=26. The remainder of her exam is within normal limits except for severe vaginal atrophy noted on the pelvic examination. The best recommendation for this patient would include which of the following? A. Lowest effective dose of combination hormone replacement therapy for the shortest duration possible
B. Long term hormone replacement therapy to treat her vasomotor symptoms and prevention of osteoporosis
C. Testosterone cream
D. Progesterone cream
E. Biosphophonates