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This case report presents the therapeutic effects of herbal medicine modified Sihogyeji-tang monotherapy for suspected nonatypical endometrial hyperplasia (EH), documented through transabdominal ultrasonography monitoring and clinical symptom assessment. A 38-year-old woman presented with hypomenorrhea and ovulation-related pain, headache, body aches, and nausea since April 2023. The patient was clinically assessed as having nonatypical EH based on the ultrasound findings and clinical symptoms. She was treated with modified Sihogyeji-tang twice daily from 3 June 2023 to 29 December 2023. Treatment outcomes were evaluated using regular transabdominal ultrasonography measurements of endometrial thickness and changes in menstrual patterns, including cycle length and blood volume. Menstrual symptoms showed notable improvements: severe ovulation pain decreased from NRS 7–8 to 0, menstrual volume increased from 2 to 3 medium pads to 4 to 5 large pads per day during peak flow, and menstrual duration normalized from 4 to 6 days. Symptoms associated with ovulation and menstruation, headache, chills, and nausea resolved. At the 3-month follow-up visit after 7 months of herbal medicine treatment, endometrial thickness measured during the secretory phase had normalized to 1.40 cm (normal range: 0.7–1.4 cm). The coexisting uterine myoma remained stable throughout the treatment and follow-up. No adverse events were reported during the entire course of treatment. This case demonstrated that modified Sihogyeji-tang alone may effectively improve suspected nonatypical EH and its associated symptoms. Improvement was objectively assessed using ultrasound measurements and was sustained over a 9-month follow-up. Full article