<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 31-year-old female presents to her gynecologist with spotting between periods. She reports that her menses began at age 11, and she has never had spotting prior to the three months ago. Her medical history is significant for estrogen-receptor positive intraductal carcinoma of the breast, which was treated with tamoxifen. An endometrial biopsy is performed, which shows endometrial hyperplasia with atypia. She reports that she and her husband are currently trying to have children. What is the next best step?? A: Total abdominal hysterectomy with bilateral salpingoopherectomy, B: Partial, cervix-sparing hysterectomy, C: Start combination estrogen and progestin therapy, D: Start progestin-only therapy, E: Observation with annual endometrial biopsies,  <response>: This patient is a 31-year-old female with a history of estrogen receptor positive breast cancer treated with tamoxifen. She now presents with abnormal vaginal bleeding and an endometrial biopsy showing endometrial hyperplasia with atypia. Tamoxifen is known to increase the risk of endometrial hyperplasia and cancer. Endometrial hyperplasia with atypia confers a significant risk of concurrent or future endometrial cancer. However, this patient is trying to conceive. Of the options, a hysterectomy would definitively treat the endometrial hyperplasia but would affect her fertility. Estrogen therapy is contraindicated given her history of estrogen receptor positive breast cancer. Progestin therapy can be used to treat endometrial hyperplasia and preserve fertility. Annual endometrial biopsies would not definitively treat the endometrial hyperplasia.D: Start progestin-only therapy 