Uterine disorders Quiz: Ace Your Exams

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A 55-year-old woman, gravida 1 para 1, presents to the office with complaints of abnormal vaginal bleeding for the past two days. The patient states that she soaked 4 sanitary pads yesterday. Menarche was at age 14, and her menstrual periods had been irregular for the last few years before menopause, which she underwent at the age of 51. Past medical history is significant for generalized anxiety disorder managed by paroxetine for the last 15 years. Family history is significant for diabetes mellitus in her father and hypertension in her paternal grandmother. Vitals are within normal limits. BMI is 33.5 kg/m2. Pelvic examination shows blood clots in the vagina. The remainder of the examination is unremarkable. Endometrial biopsy is shown below:    


Reproduced from: Wikimedia Commons  

Which of the following risk factors in this patient’s history is the most significant in the development of this patient’s condition?  

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