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A 68 year old woman on HRT returns for the fourth time in the last six months because of unscheduled vaginal bleeding. Her mother recently died from breast cancer. Several adjustments to her HRT had been tried unsuccessfully. Her uterus is normal size and except for the bleeding the remainder of her physical and pelvic exam are normal. A recent endometrial biopsy failed to reveal any hyperplasia or neoplasia. A hysteroscopic assessment of her uterine cavity was normal. Her Pap smear and mammogram are normal. She wants to stop taking all hormonal medications and asks you about her risk of osteoporosis.
What do you counsel her?
A) To have a hysterectomy and take estrogens without a progestin.
B) To stop taking HRT and do nothing else.
C) Discontinue HRT and start bisphosphonates or calcitonin.
D) Obtain a BMD measurement and assess the need for therapy.
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