A 60-Year-Old Woman With Endometrial Intraepithelial Neoplasia: A Case of Persistent Postmenopausal Bleeding

Endometrial intraepithelial neoplasia (EIN) is a premalignant lesion of the endometrium that may progress to endometrioid adenocarcinoma. This case is unique because EIN occurred in a 60-year-old woman who was 10 years postmenopausal, lacked risk factors, and had symptoms despite prior treatment for a presumed benign endometrial polyp. The patient presented with several months of pelvic pain and postmenopausal spotting. Laboratory studies were largely normal. Transvaginal ultrasound revealed a slightly thickened 7-mm endometrium and multiple intramural fibroids, suggesting benign pathology. Due to continued bleeding, an endometrial biopsy was performed and demonstrated atypical hyperplasia consistent with EIN. Given the patient's postmenopausal status and the high risk of progression to carcinoma, definitive treatment with hysterectomy was recommended. This case highlights the importance of continued evaluation of persistent postmenopausal bleeding, even when initial findings suggest benign disease. Early biopsy and clinical vigilance are essential to prevent progression to endometrial cancer.