Endometrial intraepithelial neoplasia (hyperplasia) and carcinoma Quiz: Ace Your Exams

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A 53-year-old woman presents to the gynecology office with daily light vaginal bleeding for the past month. The patient’s last menstrual period was 3 years ago. Past medical history is significant for menarche at age 14, polycystic ovary syndrome (PCOS), uterine fibroids, and heterozygous factor V Leiden mutation. The patient does not take any medications. Vital signs are within normal limits. A chaperoned pelvic examination reveals a normal-sized uterus, normal adnexa, and a small amount of blood at the cervical os. An endometrial biopsy shows crowded endometrial glands with solid components, marked nuclear atypia, and significant glandular irregularities. Which of the following risk factors most significantly contributes to this patient’s likely diagnosis?

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