Endometrial intraepithelial neoplasia (hyperplasia) and carcinoma Quiz: Ace Your Exams
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A 30-year-old G0 woman presents to the gynecology office with heavy bleeding that has been occurring intermittently for the past 9 months. The bleeding is not cyclical and most recently occurred 2 weeks ago. That episode lasted 8 days but has ranged from 2 to 20 days, with the longest interval without bleeding being 3 weeks. The bleeding can be heavy at times, requiring a pad change every 1-2 hours. The patient reports irregular periods since menarche at age 9, typically occurring every 4-6 months. As a teenager, the patient was on birth control to help regulate cycles but stopped at age 20. There has been no follow-up with a doctor since then. Medical history is significant for obesity. An endometrial biopsy reveals crowding of the endometrial glands within the stroma and nuclear atypia. A hysteroscopy with directed biopsies shows no evidence of endometrial carcinoma. The patient desires future fertility. Which of the following is the best next step in management?
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