367) A 62 year old woman presents to your office with complaints of vaginal spotting for the past three months. Occasionally, she also had vaginal bleeding. She is concerned with this new development because she has not has not had a menstrual period for the past ten years. She has never taken hormone replacement therapy. She also reports burning and irritation upon sexual intercourse. She denies any fever or dysuria. She has no other past medical problems and otherwise, feels healthy. On pelvic examination, vaginal epithelium is smooth, dry and shiny with complete loss of rugae. There are no obvious masses or polyps. Vaginal pH is 6.5 . Urinalysis is normal and is negative for nitrite or leucoesterase. Which of the following is the most appropriate next step in management?
A) Endometrial biopsy
B) Vaginal Estrogen Cream
C) Vaginal Lubricant Cream
D) Oral Estradiol
E) Check serum estradiol levels
