<prompt> What is the ideal treatment for a 55-years-female with Simple hyperplasia of the endometrium with Atypia?Simple hysterectomyMedroxy progesterone acetate MPALevonorgesterol LNGIUCD  <response>: Management of Atypical Endometrial Hyperplasia:Hysterectomy is the best treatment for women at any age with atypical endometrial hyperplasia because the risk of concurrent subclinical invasive disease is high.Williams Gynae 1st ed p 691In presence of atypia, response to progesterone therapy is poor and the relapse rate is high. Nearly one-third of them will progress to cancer and one-fourth may already have associated undiagnosed cancer. In women approaching or post menopause, hysterectomy is a safer choice in those with complex or atypical hyperplasia. Jeffcoate 7th ed p 425So Remember: Best management of atypical hyperplasia is hysterectomy.Also, Know Management of Endometrial Hyperplasia:Management depends on the patients age and the presence or absence of cytological atypia.Non-atypical hyperplasia:Premenopausal women: Progesterone therapy-options: - Medroxyprogesterone acetate for 21 days a month daily for 3 months.Progesterone-containing IUCD.Postmenopausal womenSimple hyperplasia without atypia - Generally followed without therapy.Complex hyperplasia without atypia - Cyclicalcontinuous progesterone therapy.These patients should be followed annually by endometrial biopsy.Atypical hyperplasia:The ideal treatment is a hysterectomyPremenopausal women willing to preserve fertility - High dose progesterone therapy after full information of risk of undiagnosed cancer or progression to cancer. In these cases periodic TVS and endometrial biopsy is necessary. 