An 81-year-old g3p3 woman presents to your office with a history of light vaginal spotting. she states this has occurred recently and in association with a thin yellow discharge. she has not experienced any vaginal bleeding since menopause at the age of 52 and denies ever having been on hormone replacement therapy. she has osteoporosis, well-controlled hypertension and diabetes. she is physically active and still drives to all her appointments. she is no longer sexually active since the death of her husband two years ago. on examination, she is noted to have severe atrophic changes affecting her vulva and vagina. a small pederson speculum allows for visualization of a normal multiparous cervix, and the bimanual examination is notable for a small, mobile uterus. rectovaginal exam confirms no suspicious adnexal masses or nodularity. which of the following is the most appropriate management for this patient? a. pelvic transvaginal ultrasound
b. office endometrial biopsy
c. reassurance and observation for further bleeding
d. vaginal estrogen therapy
e. clindamycin vaginal cream