A 54-year old woman complains of hot flashes and night sweats. Her last menstrual period was 2 years ago. She also has migraine headaches and a family history of breast cancer her maternal aunt. What is the appropriate treatment for her?

This 54-year old woman has vasomotor instability and needs hormonal replacement. Because she has two contraindications to estrogen therapy (migraine headaches and a family history of breast cancer), medroxyprogesterone acetate is the best treatment of choice. Even though it is less effective than estrogen, it still can offer symptomatic relief. There is no indication for an endometrial biopsy in this patient. A hysterectomy is the treatment for a woman with early stages of endometrial cancer.