Hi, I understand your concern. Tamoxifene does increase the risk of endometrial carcinoma, a cancer of the uterus. But it is difficult to predict the individual risk. However, since you had atypical hyperplasia, this drug has been advised as a safeguard to protect against further development of breast cancer. Monitoring of tamoxifene therapy by regular gynec examination and endometrial sampling may be done to identify any early changes in the uterine lining and than stop therapy if needed. Even though these are not full proof methods to rule out endometrial cancer, but they are the standard of therapy. Also, if at all you need a hysterectomy, it may be possible to preserve the ovaries and protect against menopausal symptoms. Also having a hysterectomy does not mean loss of active sexual life as many women continue to be sexually active after hysterectomy. An intact uterus is not always needed for active sex life. There is a psychological aspect too. Hope you find this useful. Thanks for using HCM. Dr Madhuri Bagde