A 58-year-old woman presents to your office with heavy vaginal bleeding.

Comprehensive and Detailed Explanation:

Complex endometrial hyperplasia with atypia carries a high risk of progression to or concurrent endometrial carcinoma. Definitive management in postmenopausal women is total hysterectomy with bilateral salpingo-oophorectomy.

Toronto Notes 2023 – Gynecology, Abnormal Uterine Bleeding:

“Endometrial hyperplasia with atypia in postmenopausal women is best managed surgically due to the risk of malignancy.”

MCCQE1 Objectives – Gynecology > Postmenopausal Bleeding:

“Candidates should identify endometrial hyperplasia with atypia as an indication for hysterectomy in appropriate patients.”

Ablation (A) is contraindicated. Progesterone (B) is used for non-atypical hyperplasia. D&C (C) and hysteroscopy (D) are diagnostic but not definitive.

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