A 34-year-old nulliparous woman with oligomenorrhoea and a BMI of 34 kg/m2 has an endometrial biopsy reported as hyperplasia without atypia. She declines surgery. What is the most appropriate first-line management?

• A Levonorgestrel-releasing intrauterine system with surveillance biopsies ✓
• B Total hysterectomy with bilateral salpingo-oophorectomy
• C Combined oral contraceptive pill for six months then repeat biopsy
• D Observation alone with annual ultrasound scans

Explanation

Hyperplasia without atypia carries a low progression risk of around 1 to 3 percent and frequently regresses spontaneously. The levonorgestrel-releasing intrauterine system achieves higher regression rates than oral progestogens and is recommended first line, with endometrial surveillance at least every six months until two consecutive negative biopsies. Observation alone risks persistence, and hysterectomy is reserved for relapse or non-compliance with surveillance.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.