Weight-loss Drug for Fertility-Sparing Treatment of Atypical Hyperplasia and Low-grade Cancer of the Endometrium

Inclusion Criteria: * BMI ≥ 27 * Diagnosis of grade 1 or 2 endometrioid endometrial cancer or atypical hyperplasia made by either endometrial biopsy or dilation and curettage * For those with endometrial cancer, clinical FIGO 2009 stage 1A disease without evidence of metastatic disease beyond the uterus and no myometrial invasion by MRI or CT * ECOG status \<2 * Desire for fertility preservation * Ability to understand and willing to sign a written informed consent document Exclusion Criteria: * Evidence of myometrial invasion or extra-uterine disease on imaging * High grade or p53 mutated (p53mut) endometrial cancer * Estrogen receptor negative endometrial cancer (positivity defined as moderate/strong staining\>10%) * Mismatch repair deficient (MMRd) endometrial cancer * History of other malignancies except if curatively treated with no evidence of disease for \>5 years * Previous surgical treatment of obesity * Current use of weight loss medication (no use in last 2 months) * Medical co-morbidity with end-organ dysfunction * Contraindications to pIUD or tirzepatide. * Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns or compliance with clinical study procedures.