A 52-year-old obese patient is diagnosed with atypical adenomatous hyperplasia. What is the next step in her management?

In the context of atypical adenomatous hyperplasia (AAH), which is a precursor to endometrial carcinoma, the management approach often escalates depending on the patient's risk factors and symptomatology. In this case, the patient is 52 years old, obese, and has been diagnosed with AAH.

A total abdominal hysterectomy is considered the definitive treatment for AAH in women, especially those who are at higher risk of progression to endometrial cancer. This option allows for the complete removal of the uterus and cervix, reducing the risk of developing cancer. It is particularly indicated in women who are nearing menopause or are postmenopausal, like the patient in this scenario, because the chances of progression to malignancy are greater with atypical lesions in this demographic.

In contrast, other approaches like observation with follow-up biopsies or hormonal treatments may introduce risks and are generally more appropriate in younger women who desire fertility preservation or those with low-risk adenomatous hyperplasia without atypical features. However, given the patient’s age, obesity, and diagnosis of atypical hyperplasia, the most effective and definitive management is a total abdominal hysterectomy. This removes the potential for further malignant transformation and addresses any concerns regarding