Soru

A 58-year-old woman presents to the clinic with a 3-week history of continuous, thin, watery vaginal discharge that occasionally leaves pink stains on her undergarments. She reached menopause at age 51. Her medical history is notable for estrogen receptor-positive breast cancer diagnosed 4 years ago, which was treated with a lumpectomy and radiation therapy. She has been taking anastrozole for the past 3 years. Since starting the medication, she reports significant vaginal dryness and dyspareunia. Her vital signs are within normal limits. Speculum examination reveals pale, thin, and dry vaginal mucosa with a loss of rugation. There are no lacerations in the vaginal vault, but a small amount of dark red fluid is noted pooling at the external cervical os. Bimanual examination demonstrates a small, mobile, non-tender uterus without adnexal masses. Which of the following is the most appropriate next step in the management of this patient?