Menopause and HRT

A 52-year-old Indian woman presents with hot flushes, night sweats, and vaginal dryness for the past 18 months. Her last menstrual period was 14 months ago. She has no contraindications to hormone replacement therapy (HRT). Her bone mineral density (BMD) T-score is −1.8 at the lumbar spine. She is concerned about fracture risk and asks about HRT. Which of the following statements about HRT in this patient is most accurate?

A 58-year-old Indian woman who has been on combined estrogen–progestin HRT for 4 years (started at age 54 for moderate hot flushes and night sweats) now presents with a 2-month history of unilateral breast pain and a palpable 1.5 cm firm nodule in the upper outer quadrant of the left breast. Mammography shows a suspicious lesion with microcalcifications. She is anxious about her HRT use. What is the most appropriate next step in her management?

Which of the following hormonal changes is characteristic of the menopausal transition?