Jane, a healthy 48 year old woman, presents to you complaining of severe hot flashes, emotional lability, mild depression, insomnia and irregular vaginal bleeding. Her physical examination is normal. Her last pap smear was 3 months ago and was normal. She has a normal lipid panel, exercises 3 times per week and takes calcium 1000 mg/day and vitamin D 800 IU daily. She had a mammogram that was normal 6 months ago. Her mother was diagnosed with breast cancer at age 72. She requests treatment for her symptoms.