Background: Endometrium that lies within the uterus may develop hyperplasia, due to various causes, of which unopposed estrogen exposure is the most common one. Endometrial hyperplasia may well mask an underlying malignancy and should be followed upon by further procedures to rule out underlying malignancy. Materials and methods: This is a prospective observational study, from June 2017 to June 2019, at a tertiary care level teaching institution. Seventy patients who underwent hysterectomy following a diagnosis of endometrial hyperplasia with atypia were included. Results: 95.7% were in multiparous group, 67.14 % were in perimenopausal, 30% in postmenopausal and 2.85% in reproductive age groups, 52.8% presented with abnormal uterine bleeding, 34.28% with postmenopausal bleeding and 12.85% were asymptomatic, 35.41% had diabetes mellitus, 22.91% had hypertension and 30.20% had obesity as comorbid factors. Positive family history for malignancy was noted in 3.1%. MRI findings suggested endometrial carcinoma in 27.2%. In cases in which MRI suggested non malignancy, 82.4% turned out to be malignant in the final histopathology report. Of the 70 patients, 40% had endometrial carcinoma (not otherwise specified), 30% had adenocarcinoma, 10% had serous carcinoma, 5.7% had papillary serous carcinoma and carcinosarcoma in 1.4%. 12.9% were declared to be nonmalignant by final histopathology reports. Except for two patients, all others had grade 1 well differentiated carcinomas. Conclusion: This study demonstrates that endometrial carcinoma may be coexisting with endometrial hyperplasia with atypia, in majority of cases and available imaging modalities are not foolproof to rule out malignancy. Hence where appropriate hysterectomy may be suggested as the treatment option.