<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 45-year-old woman visits your office with concerns about recent changes in her menstrual cycle. She noticed that her menses last longer and are heavier, to the point of needing almost twice the number of sanitary pads than 6 months ago. She denies any abdominal or pelvic discomfort. She started menstruating at 9 years of age. She had a negative Pap smear and HPV test 5 years ago. The physical examination is unremarkable with no masses on abdominal palpation and the pelvic examination is negative for vaginal lesions or tenderness. The bimanual examination reveals a mobile, non-tender, retroverted uterus with no masses in the adnexa. A transvaginal ultrasound performed 4 days after her last menses revealed an endometrial thickness of 4 mm. Which of the following is the most likely cause of this patients condition?? A: Uterine leiomyoma, B: Endometrial carcinoma, C: Uterine adenomyosis, D: Endometrial polyp, E: Endometrial hyperplasia,  <response>: This is a question about abnormal uterine bleeding in a 45-year-old woman. The key findings are heavier and longer menstrual periods over the past 6 months. The physical exam, pelvic exam, and transvaginal ultrasound were unremarkable. The differential diagnosis includes uterine leiomyoma, endometrial carcinoma, uterine adenomyosis, endometrial polyp, and endometrial hyperplasia. Based on the patients age and history, the most likely cause is endometrial hyperplasia. Endometrial hyperplasia is a benign overgrowth of the endometrium that can lead to abnormal uterine bleeding. It is common in perimenopausal women as estrogen levels fluctuate. The normal endometrial thickness on ultrasound makes cancer unlikely. Adenomyosis and polyps typically cause pain and are often visible on ultrasound. Leiomyomas may cause heavy bleeding, but are usually palpable on exam. E: Endometrial hyperplasia 