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Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 54-year-old woman comes to the office complaining of increased urinary frequency and dysuria. She is accompanied by her husband. The patient reports that she goes to the bathroom 6-8 times a day. Additionally, she complains of pain at the end of her urinary stream. She denies fever, abdominal pain, vaginal discharge, or hematuria. Her husband adds, “we also don’t have sex as much as we used to.” The patient reports that even when she is “in the mood,” sex is “no longer pleasurable.” She admits feeling guilty about this. The patient’s last menstrual period was 15 months ago. Her medical history is significant for hyperlipidemia and coronary artery disease. She had a non-ST elevation myocardial infarction (NSTEMI) 3 months ago, and she has had multiple urinary tract infections (UTIs) in the past year. She smokes 1 pack of cigarettes a day and denies alcohol or illicit drug use. Body mass index is 32 kg/m^2. Pelvic examination reveals vaginal dryness and vulvar tissue thinning. A urinalysis is obtained as shown below:

Urinalysis
Glucose: Negative
WBC: 25/hpf
Bacterial: Many
Leukocyte esterase: Positive
Nitrites: Positive

The patient is prescribed a 5-day course of nitrofurantoin. Which of the following is the most appropriate additional management for the patient’s symptoms?
assistant
Topical estrogen