Background:Idiopathic hypogonadotropic hypogonadism (IHH) is a rare endocrine disorder characterized by deficient gonadotropin-releasing hormone (GnRH) secretion or action, resulting in delayed puberty and infertility. Its clinical distinction from functional hypothalamic amenorrhea can be challenging because of overlapping features. Pulsatile GnRH therapy offers a physiological approach to fertility induction in affected women; although pregnancies following this treatment have been reported previously, detailed longitudinal documentation from diagnosis through pregnancy and delivery in women with IHH remains valuable for clinical education. Case Presentation:We present a 27-year-old nulligravid woman with clinical and biochemical features consistent with normosmic IHH who presented with primary amenorrhea and absent secondary sexual characteristics since adolescence. Evaluation revealed markedly suppressed gonadotropins (FSH 0.41 IU/L, LH 0.10 IU/L) with undetectable estradiol, normal pituitary magnetic resonance imaging, and a 46,XX karyotype. Normosmia distinguished this case from Kallmann syndrome. Following six months of hormone replacement therapy with regular withdrawal bleeding, the patient initiated pulsatile subcutaneous GnRH therapy (10 μg every 90 minutes) for fertility induction. Natural conception following pulsatile GnRH therapy occurred within two months of treatment initiation. The pregnancy progressed uneventfully with appropriate β-hCG doubling and normal ultrasonographic development. GnRH pump therapy was maintained until 12 weeks of gestation to support early pregnancy. The patient subsequently delivered a healthy term infant. Conclusion:This case illustrates that pulsatile GnRH therapy can be an effective and physiological approach for achieving pregnancy in women with IHH. Although based on a single case, the favorable outcome achieved within a short treatment duration supports considering this modality as one of the treatment options for fertility induction in appropriately selected patients. In the absence of genetic confirmation and given the overlap with functional hypothalamic amenorrhea, the diagnosis is best regarded as consistent with, rather than definitive for, congenital IHH.

Objective: To investigate whether short-term postoperative estrogen-related therapy is associated with recurrence of intrauterine adhesions (IUA), endometrial polyps (EPs), and pregnancy outcomes in women with concomitant IUA and EPs. Methods: This single-center retrospective cohort study included women (18-45 years) diagnosed with both IUA and EPs who underwent concurrent hysteroscopic transcervical resection of adhesions (TCRA) and polypectomy from January 2019 to June 2024. Patients were grouped by postoperative regimen: (1) estradiol-dydrogesterone sequential therapy (Femoston; estradiol 2 mg/dydrogesterone 10 mg; 2-3 months), (2) combined oral contraceptive (Yaz; ethinylestradiol 0.02 mg/drospirenone 3 mg; 3 months), or (3) no hormonal therapy. Recurrence was confirmed by transvaginal ultrasound and/or hysteroscopy. Results: A total of 166 women were included (sequential therapy, n=47; COC, n=32; no hormone, n=87). Baseline polyp multiplicity differed among groups (P=0.003), with a higher proportion of multiple EPs in the COC group. Postoperative IUD/balloon placement also differed among groups (P=0.012). Overall recurrence rates were 6.6% for IUA and 4.8% for EPs. No statistically significant differences were observed among groups in postoperative menstrual changes, recurrence rates, time to recurrence, or pregnancy outcomes (all P>0.05). Follow-up duration did not differ significantly among groups. Conclusion: In this retrospective cohort, no statistically significant differences were observed among short-term sequential estrogen-progestin therapy, COC use, and no hormonal therapy with respect to IUA recurrence, EP recurrence, or pregnancy outcomes. Shortterm estradiol-dydrogesterone therapy was not associated with increased EP recurrence in women with IUA and a single EP. These findings are observational and should be confirmed in prospective studies.

Objective: To compare the efficacy and safety of levornidazole and levornidazole disodium phosphate in women with pelvic inflammatory disease. Methods: Women from 12 hospitals in China received a 14-day treatment course comprising 7 days of intravenous therapy followed by 7 days of oral sequential therapy: intravenous levornidazole 0.5 g twice daily (Group A, n =49), levornidazole disodium phosphate 1.0 g once daily (Group B, n =49), or levornidazole disodium phosphate 0.5 g twice daily (Group C, n =46), followed by oral levofloxacin plus ornidazole for 7 days. Results: Of the 144 patients in the full analysis set (FAS), 131 (91.00%) were included in the per-protocol set and 38 (29.00%) were microbiologically valid. In the FAS, clinical cure rates at day 14 were 77.55%, 83.67%, and 82.61% for Groups A, B, and C, respectively ( P =0.745). Bacteriological clearance rates were 76.47%, 93.75%, and 100.00%, respectively ( P =0.248). Drug-related adverse events occurred less frequently in Group B than in Group A (38.78% vs . 61.22%; P =0.025). Conclusions: Daily administration of levornidazole disodium phosphate achieved clinical and bacteriological efficacy comparable to twice-daily levornidazole in women with pelvic inflammatory disease and was associated with significantly fewer drug-related adverse events.

GRAPHICAL ABSTRACT: ABSTRACT:To explore the relationship between endometrium, quality of transferred embryo, and their effects on the live birth outcome of IVF/ICSI-ET using different downregulation protocols, we conducted a retrospective cohort study in an academic reproductive medical center. A total of 13,585 participant's first fresh embryo transfer cycles, comprising 10,951 cycles using the GnRH-agonist regimen and 2,634 cycles using the GnRH-antagonist regimen, were included in this study. We found that the first fresh embryo transfer cycles using the GnRH-agonist downregulation regimen achieved a significantly improved live birth rate (41.9%) compared with the fresh cycles using the GnRH-antagonist regimen (30.4%). This was accompanied by a significantly thicker endometrium on the day of hCG administration. In the general population, increased endometrial thickness in the agonist group demonstrated a protective effect on the live birth. The cutoff value of endometrial thickness for live birth increased with the addition of poor-quality embryos in the double cleavage-stage embryo transfer cycles and the single blastocyst transfer cycles. Different choices of downregulation strategy affect the endometrium and the treatment outcome of IVF/ICSI-ET. LAY SUMMARY:The union of an embryo and the uterine lining is much like that of a seed and soil. The process of nurturing life resembles a seed taking root, sprouting, and bearing fruit. Different seeds require different conditions and soils. In assisted reproductive technology, the downregulation protocol used can affect the state of the uterine lining. Embryos of varying quality also have different chances of successful implantation. Just as fertile soil supports a seed's growth, an endometrium of suitable thickness favors embryo implantation. When seed quality is less than ideal, a richer soil may improve its chance to take root. Similarly, when the available embryos are of lower quality, a thicker endometrial lining is associated with a higher live birth rate.

Objective To compare the efficacy of oral and transdermal estrogens in improving the quality of life in perimenopausal and recently postmenopausal women.Methods 257 women aged 40-55 years, within three years after their final menstrual period were randomized to receive transdermal oestrogel (t-E2) (n = 128) or oral estradiol valerate (o- E2V) (n = 129; both with micronized progesterone 200 mg for 14 days each month). Menopausal symptoms were recorded at screening and at 4, 12, and 24 weeks post-randomization. Menopausal symptoms were evaluated using the Menopause-Specific Quality of Life (MENQOL) questionnaire.Results Significant improvements of MENQOL scores were observed in both groups compared with baseline. The decrease of MENQOL scores after treatment showed almost no difference between the two groups (p > 0.05) except the VMS domain which indicated a better result in oral estrogen group after 24 weeks.Conclusions This study showed that both transdermal and oral estrogens were highly effective in relieving the overall menopausal symptoms for recently-menopausal women, with little difference in treatment efficacy between the two routes.

Menopausal hormone therapy (MHT) is a widely employed approach for managing menopausal syndrome, entailing the administration of exogenous estrogen to alleviate diverse symptoms and mitigate associated diseases in perimenopausal women. However, recent studies have reported an increased risk of breast cancer associated with estrogen and progestin therapy, although there are notable variations among these studies. Therefore, it is imperative to identify individuals at high risk for breast cancer following MHT. This study conducted a comparative analysis of genes between breast cancer patients who received MHT and those who did not, identifying SNP loci closely associated with the risk of developing breast cancer in postmenopausal women undergoing MHT. A predictive model for assessing the risk of breast cancer in postmenopausal women undergoing MHT was established to facilitate personalized treatment recommendations and alleviate menopausal symptoms. Based on the sequencing data of perimenopausal patients with breast cancer (treated MHT) and unaffected breast cancer (treated MHT), effective SNP sites were obtained in the whole genome, and differential SNP sites associated with breast cancer and hormone therapy were initially screened based on association analysis. Finally, a group of 128 SNP sites for risk prediction of breast cancer in perimenopausal women after hormone therapy was determined. The score of Breast cancer (treated MHT) Cohort was significantly different from the other two groups (Breast cancer (untreated MHT) Cohort, and Unaffected breast cancer (treated MHT) Cohort) (P=0.0032 and P=1.8E-06), which showed that patients with a high risk of breast cancer undergoing MHT could be distinguished based on the above 128 MHT-SNPs. In addition, the efficient of four algorithms was evaluated and the RF method had the highest AUC value 0.813, indicating its superior predictive capability in assessing MHT-related breast cancer risk. The 128 MHT-SNPs presented in this study can be utilized for precise determination of the suitability of MHT for women during perimenopause. And the validated model risk prediction tool effectively forecasts the risk of breast cancer following MHT, thereby offering personalized diagnostic and therapeutic recommendations to clinical practitioners.

The prevention of postoperative adhesions remains a critical clinical challenge in gynecological surgery, as these pathological formations may lead to intestinal obstruction, chronic pelvic pain, and reproductive complications. Regarding the clinical application of anti-adhesion barriers, current products including but not limited to Interceed and chitosan-based dressings have demonstrated suboptimal efficacy in practice. We developed a triple-layer patch comprising: (1) a tissue-adhesive inner layer of polyacrylic acid-gelatin composite, (2) a mechanically dissipative intermediate layer of polyglycine, and (3) an anti-adhesive external layer of polyzwitterionic polymer. In this study, we investigated the antiadhesion effect of the triple-layer patch by using a uterine operation model in rats and reported that the triple-layer patch can inhibit the production of tumor necrosis factor-α and transforming growth factor beta 1, upregulate tissue-type plasminogen activator, and downregulate plasminogen activator inhibitor to inhibit inflammation and fibrosis. These findings substantiate that the triple-layer patch may have broad applicability to prevent postoperative adhesions through inhibition of inflammatory responses and fibrotic processes, demonstrating promising translational potential in gynecological surgery.

Background:In previous studies, the authors have attempted to define normal measurements of external female genitalia, but results showed significant variability, and the populations studied were highly heterogeneous. In this study, the authors provide standard vulvar dimensions and, to their knowledge, represent the largest homogeneous cohort investigated on this topic to date. Objectives:The aim of the authors of this study is to obtain a precise understanding of vulvar anatomy in the southern Chinese population and provide accurate data for aesthetic gynecologic surgery. Methods:This cross-sectional prospective study was conducted by the Gynecology Department of Sun Yat-Sen Memorial Hospital from January 2017 to December 2018. The study included women, all of whom were from southern China. Data on various vulvar measurements were collected for 9 parameters, including clitoral prepuce length, clitoral glans length and width, clitoris-to-urethra distance, urethra-to-vagina distance, vagina-to-perineum distance, perineal body length, and labia majora length and width. Additionally, baseline characteristics were recorded. Results:A total of 1154 women completed the study. The mean age was 36 years (standard deviation [SD] 10), and the mean BMI was 22 (SD 3). The mean (±SD) clitoral glans length and width were 6.59 (±2.86) mm and 5.34 (±2.56) mm, respectively. The mean length from the vagina to the perineum was 6.81 (±3.43) mm, and the mean perineal body length was 21.70 (±4.88) mm. Statistical analysis indicated that women who underwent vaginal delivery had a wider vulva. Compared with women who had vaginal delivery, those who had a cesarean section tended to have smaller vulvar parameters. Additionally, multiparous women had a larger vulva than women who had only undergone a single vaginal delivery. Conclusions:In this study, the authors provide a comprehensive baseline database of vulvar measurements in the Han ethnic population in China, which could be used to establish standards for aesthetic gynecologic surgery. Level of Evidence 4 Therapeutic:

Background In this multicenter, double-blind, randomized, parallel-group study, the efficacy and safety of levornidazole and levornidazole disodium phosphate for the treatment of women with pelvic inflammatory disease (PID) were compared. Methods The women from 12 hospitals in China received a 14-day course of intravenous levornidazole at 0.5 g twice a day (Group A, n = 49) or intravenous levornidazole disodium phosphate at 1.0 g once a day (Group B, n = 49) or 0.5 g twice a day (Group C, n = 46). Results Overall, of the 144 patients in the full analysis set (FAS), 91.00% (n = 131) were included in the per-protocol set; further, 38 of these cases (29.00%) were microbiologically valid. In the FAS population, the 14-day clinical cure rates were 77.55% for Group A, 83.67% for Group B, and 82.61% for Group C (P = 0.7446). The 14-day bacteriological clearance rates in the FAS population were 76.47% for Group A, 93.75% for Group B, and 100.00% for Group C (P = 0.2476). Drug-related adverse events occurred less frequently in Group B (38.78%) than in Group A (61.22%; P = 0.025). Conclusions These results indicate that daily administration of levornidazole disodium phosphate as a concentration-dependent antibacterial agent antibacterial agent for 14 days was as clinically and bacteriologically efficacious for women with PID as levornidazole twice daily for 14 days. Moreover, the former was associated with significantly fewer drug-related adverse events. Trial registration: ChiCTR2300073123 registered on 03/07/2023 (https://www.chictr.org.cn/showproj.html?proj=196700).

BACKGROUND:Cisplatin is integral to ovarian cancer treatment, yet resistance to this drug often results in adverse patient outcomes. The association of circular RNA (circRNA) with cisplatin resistance in ovarian cancer has been observed, but the mechanisms governing this relationship require further elucidation. METHODS:High-throughput sequencing was utilized to profile circRNA expression in cisplatin-resistant ovarian cancer cells. Gain-and-loss-of-function experiments assessed the impact on cisplatin sensitivity, both in vitro and in vivo. Fluorescence in situ hybridization was conducted to determine the cellular distribution of circRNAs, and RNA pulldown and immunoprecipitation experiments were performed to identify associated binding proteins. RESULTS:The study revealed that circ_ARHGEF28 is overexpressed in certain cisplatin-resistant ovarian cancer tissues and cell lines, and is associated with reduced progression-free survival in patients. It was observed that circ_ARHGEF28 contributes to cisplatin resistance in ovarian cancer models, both in vitro and in vivo. Importantly, circ_ARHGEF28 was found to interact directly with MST1/2, inhibiting the SARAH coiled-coil binding domains and consequently deactivating the Hippo pathway. CONCLUSION:This investigation identifies circ_ARHGEF28 as a novel circRNA that contributes to cisplatin resistance in ovarian cancer by suppressing the Hippo pathway. Therapeutic strategies targeting circ_ARHGEF28 may offer a potential avenue to mitigate cisplatin resistance in ovarian cancer treatment.

To clarify the incidence of excessive distension absorption in hysteroscopic surgery using 5

Conservative surgery for adenomyosis has been shown to be effective. However, risk factors for postoperative recurrence have yet to be clarified. In this study, we aimed to determine the recurrence rate after conservative surgery for adenomyosis and identify the risk factors for recurrence. This retrospective study was conducted in a tertiary hospital. Patients who underwent conservative surgery for adenomyosis between January 2013 and April 2023 were identified. Eligible patients were assigned to either the recurrent or non-recurrent group. Continuous and categorical variables were compared between the two groups using the Mann–Whitney U test or chi-squared test. Risk factors for recurrence were identified by Cox proportional risk analysis. Data for 133 eligible patients who underwent conservative surgery for adenomyosis were analyzed. The mean follow-up duration was 52 months. The recurrence rate after conservative surgery was 39.1

To investigate pregnancy outcomes following hysteroscopic adhesiolysis (HA) in patients with recurrent pregnancy loss (RPL) or infertility. Retrospective cohort study. University-affiliated hospital. According to the inclusion and exclusion criteria of this study, finally, a total of 461 subjects were included. HA performed using either an electrosurgical instrument or hysteroscopic scissors. Pregnancy outcomes post-HA. A total of 461 patients were included in the study, with follow-up periods ranging from 1 to 6 years. The mean age was 29.48 ± 3.25 years. Hysteroscopic scissors demonstrated greater efficiency in restoring the uterine cavity compared to electrosurgical instruments (88.1

OBJECTIVE:To clarify the incidence of excessive distension absorption in hysteroscopic surgery using 5% mannitol solution, evaluate the associated risks, and help to establish a safe fluid deficit threshold for such complication. DESIGN:Retrospective descriptive study. SETTING:Academic medical center. PATIENTS:Ten thousand six hundred ninety-three patients underwent inpatient hysteroscopic surgery with 5% mannitol perfusion using a monopolar electrosurgical instrument from Jan. 2015 to Sep. 2020. INTERVENTION(S):None. This study has been approved by the Ethics Committee of Sun Yat-sen Memorial Hospital. MEASUREMENTS AND MAIN RESULTS:A fluid deficit of more than 1000 mL was defined as the diagnostic criteria for excessive distension absorption. The overall incidence of excessive distension absorption in this study was 0.46% (49/10693). The incidence was 2.57% (16/623) for transcervical resection of fibroid (TCRF), 2.36% (9/381) for retained products of conception (RPOC) removal, 1.20% (6/501) for hysteroscopic uterine septum resection (HSR), 0.48% (4/828) for transcervical resection of the endometrium (TCRE), and 0.53% (14/2621) for transcervical resections of adhesion (TCRA). Excessive distension absorption could occur within seven minutes in HSR. Among the patients diagnosed with excessive distension absorption, 30.77% (12/39) exhibited signs or symptoms related to circulation overload with a fluid deficit under 2500 mL, and 10.26% (4/39) developed pulmonary edema. CONCLUSION:Excessive distension absorption could happen in all kinds hysteroscopic surgical treatment including RPOC removal and TCRA which were rarely reported. The overall incidence of excessive distension absorption could be low. But it would be five times higher in certain procedures such as TCRF, RPOC removal and TCRA. Resection using a needle electrode in HSR and TCRA may contribute to the short time development of excessive distension absorption. 30.77% of the patients could not tolerate the fluid deficit of less than 2500 mL which was set as a threshold for isotonic distending media and presented with circulation overload related signs or symptoms.

To compare the ovarian reserve of different hemostatic methods after laparoscopic endometrioma stripping (LES) and explore which factors may affect ovarian reserve. Patients who underwent LES from January 2019 to December 2021 were retrospectively included. Anti-Müllerian hormone (AMH) levels were measured before, and 3 months after surgery to determine changes of serum AMH in each patient. A multivariate linear regression analysis was performed to identify significant factors that were associated with the rate of decline of serum AMH levels at month 3 after surgery. A total of 67 patients who underwent LES were included. Of these patients, 20 with gauze packing, 24 with bipolar dessication (BD), and 23 with suture to achieve hemostasis. The 3 groups were similar in terms of demographics, cyst diameter, and basal AMH levels, except basal hemoglobin levels. At 3 months after surgery, the decline rate of AMH levels was significantly greater in the suture and BD group compared with the gauze packing group [48.2% (interquartile range, IQR, 28.1–67.1) and 31.1% (IQR,14.6–49.1) vs. 15.1% (IQR,1.1–24.5), P = 0.001]. On multivariate regression models, significant predictors of the decline rate of serum AMH levels at 3 months after surgery were hemostatic methods (p < 0.001), basal AMH levels (p = 0.033), and lesion bilaterality (p = 0.017). Compared to BD or suturing hemostasis, gauze packing hemostasis led to less damage on ovarian reserve at 3 months after LES. Besides, hemostatic methods, bilateral endometriomas and basal ovarian reserve were independently correlated with the impairment of ovarian reserve after surgery.

Objective:To investigate the safety and efficacy of Xiangshao granules for treating emotional disorders in perimenopausal women.Methods:This study was conducted in 11 centers across the country from December 2013 to June 2016.300 perimenopausal womenwith emotional symptoms were recruited.This randomized, double-blind, placebo parallel control study was conducted for 8 weeks.The patients were randomly assigned to the study group（1 bag of Xiangshao granules, 3 times a day, 150 cases）and the placebo group（1 bag of Xiangshao granules analogues, 3 times a day, 150 cases）.The Hamilton 17 depression scale（HAMD）,Hamilton 14-item anxiety scale（HAMA）and Greene scale were used to evaluate the depression and anxiety of patients and the changes of menopausal symptoms.Results:276 subjects（92.0%）completed at least 4 weeks of follow-up, including 136 in the study group and 140 in the placebo group.After 8 weeks of treatment, the HAMD and HAMA scores of the study group and the placebo group decreased significantly（P＜0.001）,and the scores in the study group were significantly lower than those in the placebo group（P＜0.05）.Compared with baseline, HAMD and HAMA score reduction rates in the study group were higher than those in the placebo group（P＜0.05）.The total effective rate of depressive symptoms in the study group and placebo group was 67.6% and 53.6%,respectively.The difference between groups was significant（P＜0.05）.The overall response rate of anxiety symptoms in the study group was also better than that in the placebo group（61.0% vs.44.3%,P＜0.01）.After 8 weeks of treatment, the reduction rate and total response rate of Greene scale score were better in the study group than in the placebo group（P＜0.05）.There was no significant difference between the two groups in estradiol and follicle stimulating hormone levels and the incidence of adverse events（P＞0.05）.Conclusions:Xiangshao granule is effective in improving emotional disorder during perimenopause, with good safety and no serious adverse reactions.

中山大学本科生临床见习带教安排教师全脱产带教的优良教学传统,给带教教师更多时间和精力准备带教工作并设计带教方法,可以有效地提高见习教学质量.针对本科生妇产科临床见习阶段,结合学生学情及自身特点,总结教学工作准备内容及流程,根据见习教学大纲要求,设置理论知识与临床技能实践相结合的教学内容,采取以问题为导向,角色扮演、多重反馈、翻转课堂及微讲课等教学模式,优化教学效果.

目的:探究延长早期妊娠药物流产保守治疗的价值.方法:回顾性分析一家三甲医院对7周前早孕行药物流产后120天内的药流结局(完全及不全药流)和超声情况:子宫内膜厚度(ET)、妊娠残留物(RPC)、整合的RPC值(V-RPC)及能量多普勒彩色评分(PDCS).结果:共纳入完全组90例、不全组55例患者,完全组62.3%诊断时间超过30天,不全组仅14.6%.不全组ET、RPC及V-RPC均大于完全组,PDCS3-4比例高于完全组,但基本未达统计学差异(P>0.05).结论:药流后30天内超声参数并非预测药流结局的决定性因素,对早孕药流患者进行超过30天的长期保守治疗是有益的.

遗传性平滑肌瘤病及肾细胞癌( hereditary leiomyomatosis and renal cell carcinoma,HLRCC)综合征临床罕见,是位于1q43区域的延胡索酸水化酶( fumarate hydratase,FH)基因胚系变异导致的常染色显性遗传且不完全性外显的肿瘤易感综合征,主要表现为皮肤平滑肌瘤、子宫平滑肌瘤、肾细胞癌,常呈家族聚集性[1].HLRCC综合征的发病率尚不清楚,目前全球范围内约有200个家庭患有该种疾病[2].2022年7月中山大学孙逸仙纪念医院收治1个HLRCC综合征家系,并结合相关文献进行讨论.

Background We aimed to explore the clinical and metabolic characteristics in polycystic ovary syndrome (PCOS) patients with different endometrial lesions. Methods 234 PCOS patients who underwent hysteroscopy and endometrial biopsy were categorized into four groups: (1) normal endometrium (control group, n = 98), (2) endometrial polyp (EP group, n = 92), (3) endometrial hyperplasia (EH group, n = 33), (4) endometrial cancer (EC group, n = 11). Serum sex hormone levels, 75 g oral glucose tolerance test, insulin release test, fasting plasma lipid, complete blood count and coagulation parameters were measured and analyzed. Results Body mass index and triglyceride level of the EH group were higher while average menstrual cycle length was longer in comparison with the control and EP group. Sex hormone-binding globulin (SHBG) and high density lipoprotein were lower in the EH group than that in the control group. 36% of the patients in the EH group suggested obesity, higher than the other three groups. Using multivariant regression analysis, patients with free androgen index > 5 had higher risk of EH (OR 5.70; 95% CI 1.05–31.01), while metformin appeared to be a protective factor for EH (OR 0.12; 95% CI 0.02–0.80). Metformin and hormones (oral contraceptives or progestogen) were shown to be protective factors for EP (OR 0.09; 95% CI 0.02–0.42; OR 0.10; 95% CI 0.02–0.56). Hormones therapy appeared to be a protective factor for EC (OR 0.05; 95% CI 0.01–0.39). Conclusion Obesity, prolonged menstrual cycle, decreased SHBG, and dyslipidemia are risk factors for EH in patients with PCOS. Oral contraceptives, progestogen and metformin are recommended for prevention and treatment of endometrial lesions in PCOS patients.