###Human: How to treat endometrial hyperplasia with atypia? ###Assistant: Hi. Please say whether you had any menopausal or perimenopausal symptoms. Please mention whether you had irregular bleeding or scanty periods or whether there is a stoppage of periods. You have placed Mirena before four years. You can also have side effects. The side effects should be subsided. Hormonal effects can also cause heavy bleeding or unscheduled irregular bleeding. Mirena is advised in endometrial hyperplasia with atypia. It usually gives scanty cycles, and there is a reduction in menstrual flow in some patients. In some patients, there is an increase in endometrial size after a long time due to a hormonal effect. In this age, it is better to have a total abdominal hysterectomy and bilateral salpingo-oophorectomy (removal of ovaries due to a risk of ovarian cancer). Please mention the history regarding obesity, family history of cancer, diabetes, and hypertension. All the factors should be followed when you are planning to have a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Please give a detailed history. For symptomatic relief, I suggest you take cyclic Norethisterone 10 mg from 4th day to 25th day for three cycles. You can take it for six cycles. You can have this for heavy periods and during unscheduled bleeding. For pain, you can take tablet Ponstan 500 (Mefenamic acid) for eight hours from the second day to the fifth day. If the bleeding is heavy, you can also take tablet Tranexamic acid 500 mg for eight hours along with Ponstan from the second day to the fifth day. Both these tablets can be stopped if you are asymptomatic. Check your complete blood count and thyroid function test also. Please decide for having surgery soon as you cannot take hormones for more than six months. Have a healthy diet and iron supplements. Have a walk daily and maintain a healthy BMI (body mass index).