How would you approach hormone replacement therapy for perimenopause in a patient with increased risk factors for VTE (hereditary thrombophilia without personal thrombosis, family history of thrombophilia or thrombosis, etc.)?  

Like many medical choices, this decision involves weighing trade-offs—specifically, the risk of venous thromboembolism (VTE) versus the burden of severe menopausal symptoms. If we focus only on VTE risk (and set aside the trade-offs related to menopausal symptoms and the controversial issue of...