The incidence of diminished ovarian reserve (DOR) has been increasing annually among younger patients, making it a challenging issue in the field of reproductive health worldwide. Traditional Chinese medicine (TCM) has demonstrated certain therapeutic effects and advantages in addressing the decline of ovarian reserve function, particularly in improving the quantity and quality of oocytes. However, there remains a lack of systematic promotion for the integrated use of TCM and Western medicine in the diagnosis and treatment of DOR. According to the standardized management methods from the China Association of Chinese Medicine, our project team aimed to address the issues of menstrual disorders, sex hormone imbalances, and fertility decline associated with reduced ovarian reserve function. By combining ancient and modern literature with insights from experienced TCM practitioners, we developed an integrated diagnosis and treatment plan. This was achieved through expert interviews and questionnaires, employing methods that integrate TCM with Western approaches, including internal and external treatments as well as long-term adjustments. Our goal is to provide standardized guidance to clinicians for informed decision-making in DOR treatment.

Background and Objectives Oligomenorrhea and hypomenorrhea were common conditions in outpatient visit which affected child-bearing aged women, and the conventional progesterone treatment has been related to several side effect and contradiction, and this study aimed to evaluate the effectiveness and safety of traditional Chinese medicine (TCM), progesterone capsules, and their combination in treating oligomenorrhea and hypomenorrhea via both clinical and metabolomic approach. Methods A prospective, randomized, multi-center trial has been conducted, and a total of 239 oligomenorrhea and hypomenorrhea were randomly assigned to receive TCM, progesterone capsules (PG), or the combined Chinese and Western medicine (COM) and treated from 3 months, respectively. Scores were recorded at 1 st and 3 rd month of treatment, while the seral samples for sex hormone and safety parameters were taken before and after management, with adverse events recorded. A post-hoc metabolomic research was further conducted, in which a total of 84 patients' blood sample collected before and after 3-month treatment were screened via liquid chromatography-tandem mass spectrometry (LC-MS) and the results were analyzed with machine learning models to identify the differential metabolites, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway database and Interactive pathways explore (iPath) database were applied to unveil the potential pathway involved in the treatment. Results A total of 220 participants completed the trial treatment, with dropout rate of 11.6%. The Traditional Chinese Medicine Syndrome Scale (TCMSS) scores of each group were significantly lower than those before treatment after 1 month of treatment and after 3 months of treatment. After 3 months of treatment, the COM group had the highest total effective rate (61.54%). The pictorial blood loss assessment chart (PBAC) scores in the TCM group were significantly higher than those before treatment after 1 month of treatment and 3 months after treatment, whereas no difference before and after treatment was observed within PG group. In COM group, the score after 3 months of treatment was significantly higher than that before treatment. In the post-hoc study with metabolomic approach with KEGG pathway enrichment and topological analyses, glycerophospholipid (GPL) metabolism were found significantly altered in all 3 groups. while TCM could potentially improve the clinical symptom via tryptophan metabolism. Conclusion From the perspective of TCMSS scores, the effect of COM group is more significant. In terms of PBAC scores, sex hormone level, endometrium and the improvement of ovarian function in patients with low ovarian function, the TCM group had a better response. In a comprehensive evaluation, the regimen of TCM alone or COM can significantly improve menstrual flow and treat oligomenorrhea and hypomenorrhea patients. With KEGG pathway enrichment and topological analyses, GPL metabolism were found significantly altered in all 3 groups, and TCM could potentially improve the clinical symptom via tryptophan metabolism. Whereas unique pathways influenced under combo treatment suggested a synergetic effect of combination TCM with western medicine in management of oligomenorrhea and hypomenorrhea.

BackgroundPrimary dysmenorrhea (PD) is one of the most common reasons that affect the life quality of women during childbearing age. This research aims to explore the efficacy and curative effect characteristics of oral contraceptives and low-power visible-light-activated photodynamic therapy (PDT). Besides investigating the possible mechanism of PDT, we expected to find a treatment model with better efficacy and fewer side effects.MethodIt was a multicenter, randomized, parallel-controlled study. Eligible participants were randomly assigned to three groups: placebo group, oral contraceptive (Marvelon) group, and the PDT group. They were treated continuously for three menstrual cycles and followed up for two cycles after treatment. The scores of the visual analog scale (VAS) and the concentration of pain-related small molecules in blood before and after treatment were recorded in each group, which can evaluate the therapeutic characteristics of different treatments.ResultBoth Marvelon and PDT were effective. The effect of Marvelon appears quickly which can significantly relieve symptoms at the beginning, while PDT shows a relatively slow role. There was no significant difference in the final efficacy two cycles after treatment. The therapeutic effect was achieved by reducing the concentrations of prostaglandin 2 (PGE2) and endothelin (ET) in the blood.ConclusionMarvelon and PDT are effective methods for the treatment of PD. The long-term efficacy of the two is similar, while the therapeutic characteristics and the side effects are different. Patients can choose the suitable way according to their individual needs.

ETHNOPHARMACOLOGICAL RELEVANCE:Ding-kun-dan (DKD), as one of well-known traditional Chinese medicine (TCM), is considered as an effective prescription to regulate menstruation, benefit Qi and nourish the blood. Previous studies had showed that DKD could improve sex hormone levels, insulin resistance, metabolism abnormalities and regulate immunity in animal models with polycystic ovary syndrome or endometriosis, however, little study conducted to reveal its clinical efficacy in Primary Dysmenorrhea (PD). AIM OF THE STUDY:To compare the effect of Ding-kun-dan (DKD) with Marvelon on relief of symptoms and change of serum pain-related factors in patients with primary dysmenorrhea. MATERIALS AND METHOD:136 patients with primary dysmenorrhea were randomly assigned to the DKD group (n = 73, take one tablet per day from 5th day of the menstrual cycle for 10 days every 28 days) and the Marvelon group (n = 63, take one tablet per day from 5th day of the menstrual cycle for 21 days every 28 days), the therapeutic effects were analyzed through evaluating the change of VAS scores, CMSS scores and the level of PGF2a, PGE2, PGF2a/PGE2 and NO during the 12 weeks intervention. RESULTS:Both DKD and Marvelon could effectively relief pain and other associated symptoms at each visit (Baseline, 4th week, 8th week and 12th week). Although Marvelon was significantly superior to DKD in reducing VAS scores, the total CMSS, CMSS severity and duration scores at each posttreatment follow-up (P < 0.01), VAS scores in the DKD group decreased significantly over time while scores in the COC group only dropped rapidly after the first two months of treatment. Efficacy gap between two interventions continuously narrowed over time and the efficacy of DKD became non-inferior at the 12th week compared to that of Marvelon (the difference between groups, - 0.78%; 95% confidence interval (CI), -13.67%-12.75%; non-inferiority margin, 15%). DKD group had better efficacy on mild pain compared to that of the COC group with no statistical difference (75% VS 61.9%, P > 0.05). DKD and Marvelon could effectively reduce PGF2a, PGE2 and higher PGF2a/PGE2 in patients with PD. There was no statistical difference in the level of PGF2a, PGE2, PGF2a/PGE2 and NO between DKD and Marvelon group at each follow-up. No serious adverse effect was observed. CONCLUSION:Ding-kun-dan is another available, effective and safe method for patients with primary dysmenorrhea to choose, especially for those who are suffered from mild pain and/or contraindicated to hormonal agents.

Background : Primary dysmenorrhea (PD) afflicts many childbearing-age women, with a high prevalence ranging from 17% to 90%. The Dingkun pill (DKP), a traditional Chinese medicine formula, has been prescribed for managing menstrual disorders empirically in clinical practice for a long time, but there are very few high-quality studies supporting this practice. Therefore, this trial aimed to assess the efficacy and safety of DKP in patients with PD. Methods : Our study was a multicenter, prospective, randomized, double-blind, placebo-controlled study. DKP or placebo was prescribed to participants from the 5th to 14th day of each menstrual cycle for 12 weeks. Changes in pain intensity were measured by a visual analog scale (VAS) and were compared between groups using repeated measures analysis. The pain mediators and sex hormones were also assessed before and after the treatment, and their intergroup changes from the baseline were analysed by student t -test. The hemodynamic indices and safety profile of DKP were also investigated. Results : A total of 156 women were recruited and randomly allocated to receive either DKP or placebo, of whom 142 (73 in DKP and 69 in sham control) completed the study. A more distinctive reduction in VAS scores was observed in the DKP group, compared with placebo (–2.68 ± 0.21 vs . –1.29 ± 0.14, p < 0.001). Compared to placebo, DKP treatment resulted in a pronounced suppression of serum PGF2 α , oxytocin and vasopressin, along with a significant increase in beta-endorphin level ( p < 0.001). Moreover, uterine artery flow measured by ultrasonography indicated increased blood perfusion after DKP treatment ( p < 0.01), while no change was detected in the placebo group. Additionally, except for an inhibited serum follicular stimulating hormone (FSH) ( p = 0.037), no statistical difference in hormonal status and safety indicators was detected before and after the treatment. Conclusions : DKP treatment attenuated pain severity in patients with primary dysmenorrhea, and no harmful side effect was observed during 12 weeks of treatment. Clinical Trial Registration : ClinicalTrials.gov, NCT03953716. Registered 17 May 2019. https://clinicaltrials.gov/ct2/show/NCT03953716.

Chronic pelvic pain (CPP) has been challenging for physicians to manage due to the ambiguous diagnostic criteria and unclear pathogenesis. The poor treatment of pelvic inflammatory disease (PID) can give rise to a range of sequela, including CPP, hydrosalpinx, and infertility. Fuke Qianjin tablet, a traditional Chinese medicine regimen, has been prescribed for acute or chronic pelvic inflammatory diseases and endo-metritis solely or in combination with conventional therapy; however, high-quality research is required to assess its potency further. This multi-centered, double-blinded, randomized, placebo-controlled clinical study was designed to evaluate the efficacy and safety of Fuke Qianjin tablet in managing PID-related CPP. A total of 241 patients with CPP were recruited and randomly assigned to either treatment (n = 112) or placebo group (n = 129). Fuke Qianjin tablets and identical sugar pills were administrated orally to patients for 60 days, while the VAS and life quality scales and safety measures were observed during the 60-day management and one-month post-treatment. There was a significant (p < 0.05) reduction of VAS in patients administrating Fuke Qianjin tablets, whereas a non-statistical (p > 0.05) difference was observed in placebo control before and after treatment. No drug-related toxicity event was found during 2 months of treatment. Fuke Qianjin tablets are efficient and safe in alleviating chronic pelvic pain in PID.

Traditional Chinese medicine has been used for a long time to treat a variety of gynecological diseases. Among various traditional Chinese medicine, Dingkun Pill (DK) has been used for the treatment of female gynecological diseases. However, DK therapeutic effect on PCOS and the target tissue for its potential effect need to be explored. This study aims to explore the therapeutic effect of DK for PCOS in mice from three aspects: metabolism, endocrine and fertility, and determine whether the brown adipose tissue is the target organ to alleviate the PCOS phenotype. PCOS mouse model was constructed by subcutaneous injection of DHEA. The estrous cycle, ovulation, and pregnancy outcome was examined in mice. The level of hormone including the LH, FSH, estrogen and testosterone in the serum were measured by ELISA. Both the glucose sensitivity and insulin sensitivity were determined in mice with different treatment. The histomorphology and lipid contents in the brown adipose tissue were analyzed. RNA-Seq was conducted for the brown adipose tissue and different expression of critical metabolism marker genes was confirmed by real-time PCR. The data showed that the fertility in PCOS mice with DK treatment was significantly increased, and the metabolic disorder was partially restored. Both the whiten of brown adipose tissue and reduced UCP1 expression induced by DHEA was rescued by the DK. The RNA-Seq data further demonstrated both the DHEA induced downregulation of lipolysis genes and oxidative phosphorylation genes were at least partially rescued by DK in the brown adipose tissue. DK has therapeutic effect on PCOS in DHEA treated mice and the brown adipose tissue is at least one critical target organ to alleviate the PCOS. This is achieved by not only regulating the lipid mobilization of brown adipose, but also restoring its thermogenic function.

OBJECTIVE:To evaluate the effectiveness and safety of Zhenqi Buxue Oral Liquid (ZQ), progesterone capsules, and their combination in treating oligomenorrhea and hypomenorrhea with qi-blood and Kidney (Shen) essence deficiency.METHODS:This was a prospective, randomized, multi-center controlled trial between June 2022 to December 2022. Ninety-six oligomenorrhea and hypomenorrhea patients with qi-blood and Shen essence deficiency were randomly assigned to receive ZQ (ZQ group, 29 cases), progesterone capsules (PG group, 32 cases), or the combined Chinese and Western medicine (COM group, 31 cases) at a ratio of 1:1:1. Patients in the ZQ or PG group took daily 10 mL twice a day of ZQ or 200 mg once a day of progesterone capsules for 10 consecutive days on day 15 of the menstrual cycle respectively, and patients in the COM group received the same ZQ combined with progesterone capsules. The treatment course lasted for 3 months and follow-up was performed at 1 and 3 months after the end of treatment. Primary endpoint was the menstrual Traditional Chinese Medicine Syndrome Scale (TCMSS) scores. Secondary endpoints included pictorial blood loss assessment chart (PBAC) scores, clinical efficacy rate, 36-item Short Form Health Survey (SF-36) scores, sex hormones and thickness of endometrium. Adverse events (AEs) were recorded.RESULTS:TCMSS scores after 1- and 3-month treatment in all groups were significantly lower than those at baseline (P<0.05). Only TCMSS scores after 3-month treatment in the ZQ and COM groups continuously decreased compared with those after 1-month treatment in the same group (P<0.01). TCMSS scores after 3-month treatment in the ZQ and COM groups were significantly lower than those in the PG group (P<0.05, P<0.01). Compared with baseline, PBAC scores in the ZQ and COM groups after 3 months of treatment were also significantly higher (both P<0.01). The total effective rates of TCM syndrome of 3-month treatment were significantly improved in all groups compared with that after 1 month of treatment (P<0.05). The total effective rate of the COM group was the highest in the 3rd month of treatment and significantly higher than that of PG group alone (P<0.05). Compared with baseline, only the SF-36 scores of COM group were significantly improved after 3 months of treatment (P<0.05). No serious adverse reactions were observed after treatment.CONCLUSIONS:The combination of ZQ and PG, or ZQ only had better effects on reducing TCMSS scores compared with PG, and COM showed the higher total effective rate compared with monotherapy. Besides, COM could effectively improve menstrual blood loss and quality of life. ZQ combined with PG may be an effective and safe option for oligomenorrhea and hypomenorrhea patients with qi-blood and Shen essence deficiency.

Background: Uterine malformations can be divided into the dysmorphic uterus (U1); septate uterus (U2); bicorporeal uterus (U3); hemi-uterus (U4) and hypoplastic uterus (U5) with clinical significance ranging from mild to severe. This study aims to investigate whether different types of uterine malformations in infertile patients who have undergone hysteroscopic and laparoscopic surgery are associated with different pregnancy outcomes. Methods: This is a retrospective study of patients with uterine malformations and infertility admitted to the Department of Gynecology of Peking Union Medical College Hospital between January 2003 and December 2020. Patients were followed through 31 October 2021. Those lost to follow-up or who had not tried to become pregnant were excluded. Fertility outcomes included pregnancy rate, live birth rate and miscarriage rate. Fertility outcomes among patients experiencing different uterine anomalies were compared using one-way analysis of variance (ANOVA). Results: A total of 161 patients were included, of whom 62 (38.5%) had no other infertility-related factors except a uterine malformation. The rate of concomitant endometriosis (36.0%) was significantly higher than among the non-specific infertile population (p < 0.05). One hundred seventeen patients achieved a total of 151 pregnancies postoperatively. The total pregnancy rate was 77.5%, and the live birth rate was 73.4%. The pregnancy and miscarriage rates in patients with uterine septum with a single cervix were 76.0% and 15.5%, respectively; 75.0% and 37.5% among patients with unicornuate uterus with a single cervix; 88.9% and 9.5% among patients with uterine septum with a double cervix; 100% and 25% among patients with uterus duplex with double cervix; and 50% and 25% among patients with bicornuate uterus with a single cervix. Patients were grouped into either the septum group or the unicornuate uterus group dependent on the ability to enlarge the uterine cavity by surgery. The pregnancy rates for the two groups were 78.1% and 80.6%, respectively, with no significant difference noted (p = 0.599), although there was a significant difference in the miscarriage rate (14.4% vs. 33.3%) (p = 0.002). Conclusion: This retrospective analysis can help to illustrate differences in pregnancy outcomes of different types of uterine malformations although it lacked a proper control group. The non-obstructive uterine malformation may not be a dominant cause of infertility, and the volume of the uterine cavity may be a key factor leading to first-trimester miscarriage, rather than an important causative factor for infertility.

Background. Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women of reproductive age, whose clinical characteristics are hyperandrogenism (HA), ovulatory dysfunction, and polycystic ovary, often accompanied by insulin resistance (IR) and metabolic abnormalities. Glucagon-like peptide (GLP)-1 receptor agonists (GLP-1Ra), such as exenatide, can bind to specific receptors on tissues such as the ovaries to improve the clinical phenotype of PCOS, while insulin-sensitizing agents, such as metformin, can also benefit to metabolic abnormalities in PCOS. Liquid chromatography-mass spectrometry (LC/MS) metabolomics revealed differences between the mechanisms of exenatide and metformin treatment of PCOS to some extent. Methods. In this study, 50 obese subjects with PCOS were randomly divided into the exenatide combined with metformin group (COM group, n = 28) and the metformin group (MF group, n = 22) for 12-week treatment. Before and after, serum samples were subjected to LC/MS analysis. Results. After treatment, there were 153 named differential metabolites in the COM group and 99 in the MF group. Most phosphatidylcholines (PC) and deoxycholic acid 3-glucuronide (DA3G) were significantly upregulated, while most glycerophosphoethanolamine (PE-NMe2), glycerophosphocholine (GPC), and threonine were downregulated in both groups. Only the decrease of neuromedin B, glutamate, and glutamyl groups and the increase of chenodeoxycholic acid sulfate docosadienoate (22: 2n6), and prostaglandin E2 have been observed in the COM group. In addition, salicylic acid and spisulosine increased and decanoylcarnitine decreased in the MF group. Both groups were enriched in glycerophospholipid, choline, and sphingolipid metabolism, while the COM group was especially superior in the glutamine and glutamate, bile secretion, and amino acid metabolism. Conclusion. Compared with metformin alone in the treatment of PCOS, the differential metabolites of the exenatide combined with metformin group are more extensive. The COM group may act on the hypothalamic-pituitary-gonadal axis (HPO) and its bypass, regulate multiple metabolism pathways such as phospholipids, amino acids, fatty acids, carnitine, bile acids, and glucose directly or indirectly in obese PCOS patients.

Background: Medicine is to some extent an empirical science that requires repeated clinical practice. To explore the needs of obstetricians & gynecologists (Ob & Gy) in different kinds of hospitals for continuing medical education (CME) training content and forms. Method: From April 2020 to May 2020, an online questionnaire was distributed on the largest academic training platform for Ob & Gy in China, which included doctors’ mastery of diseases, training content and forms of CME. Results: A total of 4458 questionnaires were returned, of which 3954 were included in the study. There is a significant statistical difference between doctors in general hospitals, maternity specialized hospitals, or maternity and child specialized hospitals in the mastery of most common gynecological and obstetric diseases, among which, doctors in general hospitals have a better mastery (p < 0.001). Generally, doctors in different types of hospitals have a lower mastery of gynecological endocrine-related diseases; doctors in general hospitals have a better mastery of abnormal uterine bleeding (Exp 1.25, 95% Confidence Interval (CI) 1.09~1.44, p = 0.00), and doctors in specialized hospitals are better at infertility and precocious puberty/delayed pubertal development (p = 0.00). The preferred professional direction and training for doctors in different types of hospitals were to strengthen the knowledge of gynecological endocrine diseases through online teaching. Conclusions: Doctors in different types of hospitals generally have lower mastery of gynecological endocrine-related diseases, and doctors in general hospitals have a better mastery of common gynecological and obstetric diseases than those in specialized hospitals. The training content with the greatest need focuses on common gynecological endocrine-related diseases. Online teaching is the most popular educational model.

Emerging evidence has linked the gut microbiome to obese/overweight PCOS patients. Since GLP-1Ras and/or exenatide could alleviate the phenotype of PCOS patients, we tend to identify their differences in the mechanism through a metagenome-wide association study and serum metabolomics profiling in a cohort of obese/overweight PCOS women. Obese patients with PCOS were distributed to two groups: one received exenatide combined with metformin (COM group, n=28) and the other used metformin alone (MF group, n=22) received metabolomic profiling. Fresh fecal specimens from the participants, including 29 PCOS patients and 6 healthy controls, were collected for metagenome analysis. In the Post_MF group, the enrichment of M58_7XD, AM30_15AC and AF42_9BH of R. gnavus were negatively correlated with 3b,16a-Di-hydroxyandrostenone sulfate (3b,16a-DHEAS) and 8,11,14-Nonadecatriynoic acid. Dorea longicatena in the MF_Post group and is positively correlated with 10-hydroxy-2E-decenoic id (10HDA). Interestingly, Mega-mona funiformis, Clostridium sp CAG _226, Firmicutes bacterium CAG_341, Pseudoflavonifractor sp MSJ 30, unclassified g Turicibacter in the COM group were positively associated with 3b,16a-DHEAS and 8,11,14-Non-adecatriynoic acid. Besides, Megamonas_funiformis was negatively correlated with Coriandrone B and Clos-tridium_sp_CAG_226, Firmicutebacterium_CAG_341 and Pseudoflavonifractor_sp_MSJ_30 were positively associated with the increase of 1alpha,21-dihydroxy-20-oxo-22,23,24,25,26,27-hexanorvitamin D3. Exenati-de combined with metformin increased the abundance of M. funiformis, Clostridium_sp, Firmicutes_bacterium Pseudoflavonifractor_sp and reduce certain Ruminococcus_spp better than the impact of metformin on the gut flora of obese PCOS patients and these changes were associated with the reduction of the derivatives of DHEA and 8,11,14-Nonadecatriynoic acid, resultantly alleviating PCOS-like phenotype like hyperandrogenemia and insulin resistance. In the MF group, the enrichment of Dorea longicatena was related to the production of 10HDA to improve the clinical phenotype of PCOS.

This study was planned to explore the potential mechanism of comorbidity between adolescent idiopathic scoliosis (AIS) and primary amenorrhea (PA) by network biology method. In the first step, the Genecards database was searched to obtain the disease targets of AIS, PA and Mayer-rokitans Kuster-Hauser syndrome (MRKH). In the second step, the Venn diagram was used to correlate the targets of AIS, PA and MRKH to obtain common targets. The third step is to submit the common targets to the String platform, build a protein-protein interaction network (PPI), and click on the Cluster button for clustering. Finally, use String plug-in analysis to perform biological enrichment and pathway analysis of key targets, download biological processes, molecular functions, and cellular components (Gene Ontology) TSV files, and download KEGG Pathways and Wiki Pathways files, as well as diseases associated with genes and human phenotype data, and finally visualize the data with the help of bioinformatics. A total of 5227 targets were obtained for AIS, 1561 targets for PA, and 697 intersection targets, and then 20 key targets were obtained by intersection with 52 targets of MRKH. Submit it to the String platform to draw the PPI network, involving a total of 19 nodes and 35 edges, and MCODE analyzes 3 major modules. According to the results of GO bio-enrichment analysis, it was found that comorbid genes mainly act on nuclear chromatin and protein-DNA complexes, affect the activity of DNA-binding transcription factors and participate in the morphogenesis of human tissues and organs, especially the genitourinary system and the central axis bone development. The KEGG pathway analysis targets are related to the WNT signaling pathway, which can affect the regulation of stem cell pluripotency. In addition, the Wiki pathway is mainly involved in mammalian sexual development, affecting the differentiation of osteoblasts and the occurrence of the kidney. Most likely to cause diseases of the reproductive system, and phenotypes with abnormal uterine and skeletal morphology. The integration of gene-protein interactions and metabolic pathways can systematically reflect the co-morbidity mechanism of AIS and PA. The high fitting of pathway gene targets can be used from the perspective of integrating traditional Chinese medicine and Western medicine, the macro and micro refer to each other and explain.

Objective To investigate the effect of exenatide treatment on the composition of intestinal flora and metabolic pathways in patients with obesity with polycystic ovary syndrome. Methods Patients with obesity with polycystic ovary syndrome (PCOS) were distributed to two groups: one received exenatide combined with metformin (COM group, n = 14) and the other used metformin alone (MF group, n = 15). Fresh fecal specimens from the participants, including 29 patients with obesity with PCOS and 6 healthy controls, were collected for metagenomic sequencing. The effect of exenatide combination with metformin or metformin alone on the composition and function of intestinal flora in patients with obesity with PCOS were compared by bioinformatics analysis. Results The level of BMI, TT, HbA1c, and HDL-c was significantly improved in both groups. The MF and COM groups were abundant in Firmicutes, Bacteroidetes, Uroviricota, Actinobacteria, and Proteobacteria. Abundance of Bacteroidetes, Proteobacteria, Hungatella, and certain probiotics like Phocaeicola and Anaerobutyricum significantly increased in both groups after treatment. Enriched microbial species in the MF and COM group were different. Clostridium, Fusobacterium, and Oxalobacter were the main bacteria in the post-MF group, while Lactococcus_garvieae, Clostridium_perfringens, and Coprococcus_sp_AF16_5 were the main bacteria in the post-COM group. The post-COM group had more probiotic species including Bifidobacterium, Prevotella, and Anaerobutyricum after treatment. Conclusion Both exenatide combined with metformin and metformin monotherapy can improve metabolic and endocrine markers, and the diversity and abundance of gut microbiota in patients with obesity with PCOS. The effects of the combination and monotherapy agents on intestinal flora were consistent to some extent but also unique respectively.

This study was planned to observe the clinical efficacy and safety of two different drugs (Dingkundan and Marvelon) for primary dysmenorrhea.: A total of 201 patients with primary dysmenorrhea were divided into placebo (n = 65), Dingkundan (n = 73) and Marvelon (n = 63) groups by random number table. Patients' baseline data were collected and the pain was evaluated using visual analogue scales (VAS) before treatment, medication for one, two, and three months, as well as one and two months after drug withdrawal. Bilateral uterine artery blood flow (RI, PI, S/D) was detected by ultrasonography and serum parameters, including prostaglandins (PGF2 alpha, PGE2), arginine vasopressin (AVP), oxytocin (OT), endothelin (ET), beta-endorphin (beta-EP) and nitric oxide (NO) were determined before treatment as well as medication for three months. The patients' baseline data, VAS scores, uterine artery blood flow and serum parameters were comparable among the three groups before treatment. Compared with the placebo group, VAS, serum parameters including PGF2 alpha, PGE2, ET, OT and AVP, as well as bilateral uterine artery blood flow significantly decreased, but beta-EP significantly increased in Dingkundan and Marvelon groups. The clinical efficacy of Dingkundan on primary dysmenorrhea is similar to that of Marvelon.

Background: This study aimed to compare the differences between reproductive endocrinologists (Repro-Endo) and obstetricians-gynecologists (Ob-Gyn; non-reproductive medicine specialty) in diagnosing, evaluating, and treating PCOS women with insulin resistance (IR).Methods: Repro-Endo and Ob-Gyn in China participated in this survey, and their responses were analyzed using chi(2) tests, Fisher exact tests, and multivariable logistic regression analysis.Results: The study analyzed 2412 survey responses (92.3% OB-Gyn; 98.5% women). Physician's age, hospital grade, specialty, and the number of PCOS patients who visit the physicians, revealed that Repro-Endo participants were more likely to suggest an oral glucose tolerance test (OR, 1.727; 95% CI, 1.272-2.345) as their first choice than Ob-Gyn participants. The most common treatments for patients with PCOS were lifestyle modification (>95%) and metformin use (>80%). More Repro-Endo participants prescribed metformin at a dose of 1.5 g/day compared with OB-Gyn (46.5% vs. 23.5%), and more OB-Gyn participants reported being unclear about the appropriate dosage of metformin for patients with obesity and PCOS (12.5% vs. 1.6%).Conclusion: This survey identified knowledge gaps in metabolic screening for patients with IR and PCOS. Similarly, it highlights the need to improve IR management education for physicians caring for PCOS women.

Background:PCOS is a prevalent endocrine and metabolic disorder in women characterized by abnormal blood glucose, dyslipidemia, and abnormal mental health. To improve patient care, the goal of our study is to find out if there are differences in how PCOS patients are treated at different hospital levels within the hierarchical medical system.Methods:Obstetricians and gynecologists from primary, secondary, and tertiary hospitals were the participants in the survey. The responses provided and collected were analyzed using various statistical techniques like the chi-square test, Fisher exact test, and logistic regression with multiple variables.Results:The investigation examined 2298 survey replies (13.1% primary hospitals, 52.4% secondary hospitals, and 34.5% tertiary hospitals). As hospital grade increases, more participants inquire about a patient's history of unfavorable pregnancies concerning hormone evaluation; the better the hospital's grade, the greater the number of participants who would undergo AMH and androgen-related tests. The higher the hospital level, the more participants would pick the oral glucose tolerance test (OGTT) to determine insulin resistance, the BMI Asian criteria for defining obesity, and blood lipids. Participants in primary (odds ratio (OR) = 0.383, 95% confidence interval (CI) 0.282-0.520) and secondary (OR = 0.607, 95% confidence interval (CI) 0.481-0.765) hospitals were significantly less likely to select OGTT than those in tertiary hospitals. Comparatively, fewer primary hospitals chose to do lipid profiling than tertiary hospitals (OR 0.689, 95% CI 0.523-0.909). With the increase in hospital level, participants were more knowledgeable about the multiple efficacies and dose alternatives of metformin and selected letrozole and assisted reproduction more frequently.Conclusion:Our study uncovered differences in the endocrine evaluation, metabolic screening, and management of PCOS patients across obstetrics and gynecology at various hospital levels. Simultaneously, it underlines the need to improve the hierarchical medical system and close the knowledge gap across hospitals.

Diminished ovarian reserve (DOR), generally defined as a decreased number or quality of oocytes, has a significant impact on quality of life and fertility in women. In recent years, the incidence of DOR has been increasing and the ages of patients are younger. The search for an effective DOR treatment has emerged as one of the preeminent research topics in reproductive health. An effective DOR therapy would improve ovarian function, fertility, and quality of life in patients. In this review we evaluated DOR treatment progress both in Western medicine and Chinese medicine, and elucidated the characteristics of each treatment.

The studies undertaken so far provide conflicting evidence concerning the impact of menopausal hormone therapy (MHT) on breast pain. Low-dose estrogen and natural progesterone have increasingly been recommended recently. However, little is known regarding their effects on breast pain. We aimed to assess the effects of different doses of oral conjugated combined estrogen (o-CEE) combined with micronized progesterone (m-P) or dydrogesterone (DD) on breast pain. A prospective randomized controlled trial was conducted among 103 postmenopausal women. They were randomized into three groups and received sequential hormone therapies respectively for 12 cycles: standard dose o-CEE plus m-P (Group A), low-dose o-CEE plus m-P (Group B), standard dose o-CEE plus DD (Group C). Self-reported mastalgia inluding a visual analogue scale (VAS) was assessed at baseline and cyclically. The incidence of breast pain significantly increased at the first cycle in varying degrees: Group C (70.6%) > Group A (50.0%) > Group B (29.7%). Compared with baseline, patients in Group A were more likely to experience greater breast pain for longer period in the first 4 cycles, while there were no significant changes in mastalgia intensity and duration in Group B. In Group C, the elevated mastalgia intensity didn't not decrease to baseline level until cycle 11, and the duration remained longer in 12 cycles. Participants started to experience mastalgia earlier in Group C, than in Group A during the addition of progestogen. MHT-related mastalgia was associated with dosages of estrogen and progestogen type. Low-dose estrogen combined with natural progesterone may have least impact on breast pain.