Levonorgestre-lintrauterine system(LNG-IUS) plus Metformin compared with Megestrol Acetate (MA)plus Metformin as fertility-sparing treatment in patients with atypical endometrial hyperplasia and well differentiated endometrial cancer:a single-center retrospective study

Levonorgestre-lintrauterine system(LNG-IUS) plus Metformin compared with Megestrol Acetate (MA)plus Metformin as fertility-sparing treatment in patients with atypical endometrial hyperplasia and well differentiated endometrial cancer:a single-center retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Levonorgestre-lintrauterine system(LNG-IUS) plus Metformin compared with Megestrol Acetate (MA)plus Metformin as fertility-sparing treatment in patients with atypical endometrial hyperplasia and well differentiated endometrial cancer:a single-center retrospective study Meicheng Wang, Xin Zhao, Yansong Liu, Pengpeng Gu, Yan Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6580786/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The prevalence of early-stage endometrial cancer who have not given birth has risen signiffcantly in recent years.This study aimed to investigate the efficacy of Levonorgestre-lintrauterine system(LNG-IUS) combined with high-dose progest and metformin in fertility-preserving treatment patients of early-stage endometrial cancer and atypical endometrial hyperplasia. Methods A retrospective analysis was conducted on clinical data of 82 patients (15 cases of early-stage endometrial cancer and 67 cases of atypical endometrial hyperplasia), who required fertility-preserving treatment,at Shenyang Women and Children′s Hospital, from January 1, 2015, to December 30,2024.Patients were divided into the test group(32 cases treated with LNG-IUS and metformin) and the control group(50 cases treated with high-dose progestin and metformin). Regularly review endometrial pathology after surgery and analyze the efficacy of both groups. Results There was no statistically significant difference in general clinical data between the two groups; The test group had a higher complete remission rate (84.375%, P = 0.005), shorter complete remission time(5.333 ± 3.150months,P = 0.046), lower recurrence rate after remission(7.407%,P = 0.037),and higher pregnancy rate after remission(51.852%,P < 0.001).Meanwhile, stepwise regression analysis revealed that the treatment plan、 BMI ≥ 30Kg/m 2 、pathological type and suffering from PCOS are independent risk factors for complete remission in patients (P < 0.01). Treatment plan BMI ≥ 30Kg/m 2 、suffering from insulin resistance or diabetes,the time of complete remission are independent risk factors for relapse after complete remission(P < 0.01).Treatment plan、BMI ≥ 30Kg/m 2 、complete remission time are independent risk factors for complete remission pregnancy(P < 0.01). Conclusion The combination of LNG-IUS and Metformin has a more satisfactory therapeutic effect and pregnancy outcomes compared to the combination of high-dose progest and Metformin, that is safe and highly effective. atypical hyperplasia of endometrium Early endometrial cancer Preservation of fertility function treatment Levonorgestrel intrauterine contraceptive system Metformin Introduction Endometrial cancer(EC)is the second women common malignant reproductive cancer in China, with a rising trend year by year [ 1 – 2 ] .In aged 20–44 women in China,the incidence of early EC is about 7.1%,most of them being type I [ 3 ] (related to the lack of sustained high estrogen resistance), and the prognosis is relatively good, with a 5-year survival rate as high as 95% [ 4 ] .Common clinical manifestations of early EC patients include metabolic syndrome, polycystic ovary syndrome (PCOS), etc; The common pathological type is endometrioid adenocarcinoma, which often evolves from atypical endometrial hyperplasia (AEH), but progresses slowly.The standard treatment plan for early EC is to undergo total uterus and bilateral adnexectomy,but modern women have delayed their childbearing age and have not given birth when they are ill.Therefore, there is an urgent need for safe and effective treatment and pregnancy [ 5 ] .Patients with early EC and AEH who wish to have children need to undergo strict screening and choose fertility-preserving treatment.There were reported that the complete remission rate can reach 60%, the recurrence rate can reach 26%, and the pregnancy rate can reach 31%. It is worth looking forward to the therapeutic effect [ 6 – 8 ] .At present, progesterone is the preferred treatment for fertility-preserving treatment, but oral progesterone has many drug side effects; Levonorgestre -lintrauterine system(LNG-IUS) is a local progesterone release system that can reduce systemic drug side effects without compromising efficacy; In addition, metformin, as an insulin sensitizer, can improve metabolic syndrome and enhance therapeutic efficacy.These provide new ideas for the implementation of joint programs for fertility-preserving treatment.This article evaluates the efficacy, recurrence, and pregnancy outcomes of using LNG-IUS + Metformin and high-dose progest + Metformin in early EC and AEH patients, in order to obtain a better treatment plan. Methods Study design and population This study retrospectively collected general clinical data of patients with early EC and AEH requiring care who visited Shenyang Maternity and Infant Hospital from January 1, 2015 to December 30, 2021. Data collection The inclusion criteria were:1)25years ≤ age ≤ 45years;2)Having a strong need for pregnancy, signing a risk and treatment informed consent form, and having good compliance;3)The surgery is completed by a fixed team of our hospital;4)The pathological result after the first hysteroscopic curettage(which needs to be diagnosed by two pathologists together before it can be considered as the final pathological result)is AEH、 Endometrioid adenocarcinoma in G1 phase, without extrauterine metastasis or lymph node metastasis,invasion of the uterine vasculature, without uterine muscle layer or cervical invasion;5)Pelvic magnetic resonance imaging(MRI)examination to determine the size and extent of lesion invasion, in compliance with national standards International Federation of Obstetrics and Gynecology(FIGO)staging stage IA;6)Progesterone receptor positive sexual expression;7)No other factors affecting fertility;8)No contraindications for pregnancy;9)No contraindications for LNG-IUS,high-dose progest,and metformin treatment;10)No history of malignant tumors in the breast, female reproductive system/digestive tract [ 9 ] .Exclusion criteria:1)Endometrial cancer of other pathological types;2)The degree of histological differentiation is poor;3)Merge malignant tumors from other parts;4)There are metastatic lesions. Ethics statemen All enrolled patients have been approved and approved by the Medical Ethics Committee of Shenyang Women and Children′s Hospital(Ethics Number: 201935), and have given informed consent to the treatment plan. Treatment plan and monitoring indicators 82 patients who underwent hysteroscopic curettage and had early EC and AEH pathology type and met the inclusion criteria were divided into two groups.According to different treatment methods, the test group is consisted of 32 patients who received intrauterine placement of LNG-IUS and oral metformin,the control group is consisted of 50 patients who received oral high-dose progest and metformin .In the test group, there were 6 cases of early EC pathology type and 26 cases of AEH pathology type, with an average age of (33.900 ± 4.077) years. After surgery, taking orally metformin (500mg/time, twice a day), and LNG-IUS was placed in the uterine cavity 3–7 days after the first hysteroscopy.In the control group, there were 9 cases of early EC pathology type and 41 cases of AEH pathology type, with an average age of (33.875 ± 4.709) years. After surgery, patients taking orally metformin (500mg/time, twice a day) and Megestrol Acetate (MA) (160mg/time, once a day). At the 3rd, 6th, 9th, 12th, 18th, 24th month after the first treatment, hysteroscopic endometrial biopsy was performed, and the medical history (whether suffering from insulin resistance or diabetes, hypertension, hyperlipidemia, anemia, dysmenorrhea, increased menstruation, decreased menstruation, prolonged menstruation, prolonged cycle), age ,BMI, PCOS, gynecological ultrasound, full abdominal CT, pelvic MRI (to evaluate the size of endometrial lesions and the degree of infiltration into the uterine muscle layer, whether there is extrauterine metastasis), Functional Assessment of Cancer Therapy (FACT-G) [ 10 ] , Self Rating Anxiety Scale (SAS) [ 11 ] , and Self Rating Depression Scale (SDS) [ 12 ] . The Chinese version of FACT-G Scale (V4.0) includes 4 domains and 27 items, divided into physiological Well-being (PWB), social/family Well-being (SWB), emotional Well-being (EWB), and functional status domain. (FWB), total score range: 0-108 points, the higher the total score, the better the quality of life .SAS consists of 20 questions, with a total score of ≥ 50 indicating symptoms of anxiety, the higher the score, the more severe the symptoms. SDS consists of 20 questions, with a total score > 53 indicating symptoms of depression,the higher the score, the more severe the symptoms .The general clinical data of the two groups of patients in this study showed no significant statistical difference (P > 0.05). Please refer to Table 1 for details. Follow up During the treatment cycle, every 12 weeks is considered as a course of treatment, and the efficacy needs to be evaluated after each course, mainly including imaging (gynecological ultrasound,pelvic MRI) and postoperative pathology of hysteroscopy curettage. Evaluation criteria: Complete response (CR): Endometrial reversal, complete remission of the lesion .Partial response (PR): Decreased level of endometrial lesions. Stable condition (SD): Endometrial lesions have neither improved nor progressed/partially resolved.Disease progression (PD):Disease progression, such as atypical hyperplasia of the endometrium progressing to endometrial cancer,endometrial well differentiated adenocarcinoma progresses to G2 and G3 stages/develops into other types of endometrial cancer.Disease recurrence: After complete remission of endometrial lesions, they may develop into endometrial cancer again during subsequent follow-up [ 13 ] Relief rate: The number of people who have fully recovered divided by the total number of people receiving care and treatment Recurrence rate: The number of relapses divided by by the total number of people receiving care and treatment. Pregnancy rate: The number of pregnancies divided by the total number of people receiving care and treatment .Live birth rate: The number of pregnancies at 28 weeks and above divided by the total number of pregnancies. In addition, patients will be followed up for any adverse reactions to the medication and receive relevant guidance for treatment. Within the first 3 months, liver and kidney function will be rechecked monthly, and every 3 months thereafter. If the disease progresses during treatment or if there is no improvement or partial remission during the 12-month treatment period, or if the disease recurs after cure during the 12–24 month follow-up period, the patient should be informed of the risks of continuing care and advised to undergo hysterectomy,please refer to Table 2 for details.Comparing the complete remission time between two groups of patients,please refer to Table 3 for details. Post cure management: After two consecutive efficacy evaluations of CR, if there is a plan for early pregnancy, assisted reproductive technology (ART) can be applied under endometrial protection measures; Patients with regular menstruation and ovulation can choose to expect a natural pregnancy of 3–6 months. If there is no pregnancy in the short term, ART should also be chosen; If there is no recent pregnancy plan, individualized maintenance treatment should be given to prevent recurrence. The combination of intrauterine LNG-IUS and periodic oral low-dose progesterone regimen is often used. Ultrasound or endometrial pathology should be rechecked every 3–6 months. Post pregnancy management: ① During pregnancy: monitor metabolic system related complications; Assess the risk of venous thrombosis formation; Be alert to placenta accreta or placenta previa; Be alert to the possibility of cervical incompetence .Delivery period: Choose the gestational weeks and delivery method to terminate based on the condition of the pregnancy, and be alert to postpartum hemorrhage .After delivery: If there is no need for further pregnancy and there are high-risk factors for EC recurrence, surgical treatment can be performed; If there is a need for pregnancy and there are no high-risk factors for EC recurrence, treatment should be maintained and close follow-up should be conducted. Statistical analysis Statistical analysis was conducted using SPSS 25.0 software. The quantitative data were tested for normality using the K-S method (P>0.05), and were expressed as ( ± s).Independent sample t-test was used for inter group comparisons, while frequency (n) and rate (%) were used for count data. The chi square test was used for inter group comparisons.Count data are expressed in frequency (n) and rate (%), and comparison between groups is performed using the chi square test.When the frequency of classification in the count data is too low (<1), Fisher's exact test is used for inter group comparison.Single factor analysis of variance and multiple factor stepwise regression analysis were used to identify the factors that affect patients' complete remission, recurrence, and pregnancy outcomes. P<0 05 indicates a statistically significant difference. Results Characteristics of participants There is no statistically significant difference in general clinical data between the two groups of patients(Table1). Table1 Comparison of general clinical data between two groups of patients Characteristic Test group （n=32） Control group（n=50） t/x 2 P-value Pathological type AEH 26（81.250） 41 （82.000） 0.007 0.932 EC 6（18.750） 9（18.000） Age（years） ≤35 21（65.625） 34（68.000） 0.050 0.820 ＞35 11（34.375） 16（32.000） BMI（kg/m 2 ） ≥30 21（65.625） 32（64.000） 1.086 0.297 ＜30 11（34.375） 18（36.000） Insulin resistance or diabetes 1（3.125） 4（8.000） 0.810 0.368 Hypertension 3（9.375） 4（8.000） 0.047 0.828 Hyperlipidemia 5（15.625） 12（24.000） 0.833 0.361 Anaemia 1（3.125） 1（2.000） 0.104 0.747 PCOS 1（3.125） 5（10.000） 1.360 0.244 Dysmenorrhea 2（6.250） 5（10.000） 0.351 0.553 Increased menstrual flow 2（6.250） 5（10.000） 0.351 0.553 Decreased menstrual flow 2（6.250） 1（2.000） 1 0.317 Menostaxis 2（6.250） 5（10.000） 0.351 0.553 Extended cycle 2（6.250） 11（22.000） 3.628 0.057 Abnormal gynecological ultrasound 1（3.125） 4（8.000） 0.047 0.828 Gynecological full abdominal CT abnormality 1（3.125） 1（2.000） 0.104 0.747 Abnormal gynecological MRI 1（3.125） 6（12.000） 0.138 0.711 FACT-G（score） 65.500±3.637 66.220±3.996 0.824 0.413 SAS（score） 39.094±2.570 38.540±3.919 -0.707 0.482 SDS（score） 38.344±2.573 38.620±4.276 0.329 0.743 Therapeutic effects Compared with the control group, during 24 months of care and treatment, the test group achieved complete remission in 27 people (84.375%), partial remission in 3 people (9.375%), stable condition in 1 person (3.125%), and disease progression in 1 person (3.125%); In the control group chieved complete remission in 27 people (54.000%), partial remission in 14 people (28.000%), stable condition in 6 people (12.000%),disease progression in 3 people (6.000%).Comparing the two groups, the test group had a higher remission rate (P=0.005)(Table2). Table2 Comparison of therapeutic effects between two groups of patients Therapeutic effects Test group （n=32） Control group（n=50） x 2 P-value Curative effect CR 27（84.375） 27（54.000） 8.006 0.005 PR 3（9.375） 14（28.000） SD 1（3.125） 6（12.000） PD 1（3.125） 3（6.000） Recurrence 2（6.250） 12（24.000） 4.342 0.037 Pregnancy 14（43.750） 10（20.000） 13.234 ＜0.001 Miscarriage 1（3.125） 2（4.000） Live Birth 13（40.625） 8（16.000） Complete remission time In the test group, 15 people achieved complete remission within 3 months, 6 peo ple achieved complete remission within 6 months, 3 people achieved complete remission within 9 months, and 3 people achieved complete remission within 12 months, with an average remission time of (5.333 ± 3.150) months; In the control group, 7 people achieved complete remission within 3 months, 8 people achieved complete remission within 6 months, 7 people achieved complete remission within 9 months, and 5 people achieved complete remission within 12 months, with an average remission time of (7.111 ± 3.238) months. The test group had a shorter remission time (P=0.046)(Tables 3). Table3 Comparison of complete remission time between two groups of patients in the complete remission population Complete relief time（months） CR of the test group （n=27） CR of the control group （n=27） t P-value 3 15（55.556） 7（25.926） 6 6（22.222） 8（29.630） 9 3（11.111） 7（25.926） 12 3（11.111） 5（18.518） Average time to complete remission 5.333±3.150 7.111±3.238 -2.045 0.046 Recurrence after c omplete remission After complete remission, 2 people in the test group experienced recurrence (2/27, 7.407%), while 12 people in the control group experienced recurrence (12/27, 44.444%). The test group had a lower recurrence rate (P=0.037)(Table 2). Pregnancy after c omplete remission The total number of pregnancies in the test group was 14 (14/27, 51.852%), with 1 miscarriage (3.704%) and 13 successful deliveries (48.148%). The control group had 10 pregnancies (37.037%), with 2 miscarriages (7.407%) and 8 successful deliveries (29.630%). The test group had a higher pregnancy rate (P<0.001)(Table 2). Analysis of related factors affecting remission, recurrence, and pregnancy According to the stepwise regression analysis, during the 24 month treatment, the complete remission rate of the two groups of patients was correlated with the treatment plan, and negatively correlated with the pathological type of EC, PCOS and BMI>30kg/m 2 (P30kg/m 2 (P30kg/m 2 (P<0.001)(Table 4, 5, 6, 7, 8, and 9). Table 4 Analysis of variance of Complete remission Number of completely remission people （n=54） Number of not fully remission people （n=28） F P-value Treatment Plan Test group Control group 27 27 5 23 8.656 0.004 Pathological type AEH EC 50 4 17 11 14.439 ＜0.01 Age＞35years 19 8 0.358 0.551 BMI≥30kg/m 2 16 18 10.016 0.002 Insulin resistance or diabetes 3 2 0.079 0.779 Hypertension 5 2 0.103 0.749 Hyperlipidemia 9 8 1.582 0.212 Anaemia 1 1 0.224 0.637 PCOS 1 5 7.426 0.008 Table 5 Stepwise regression analysis of Complete remission Unstandardized coefficient Standardized Coefficient t P-value VIF R² F B Std,error Beta Model 0.753 0.071 0 10.607 0.000*** - 0.359 F=10.779 P=0.000*** Treatment Plan 0.255 0.09 0.262 2.835 0.006*** 1.028 Pathological type -0.441 0.114 -0.36 -3.874 0.000*** 1.035 BMI≥30kg/m 2 -0.198 0.091 -0.206 -2.186 0.032** 1.067 PCOS -0.423 0.169 -0.232 -2.502 0.014** 1.036 Table 6 Analysis of variance of recurrence after complete remission Number of non recurrent people （n=40） Number of relapses people（n=14） F P-value Reatment Plan Test group Control group 25 15 12 2 11.304 0.001 Pathological type AEH EC 39 1 11 3 5.798 0.020 Complete relief time 5.175±2.800 9.214±2.751 21.771 ＜0.001 Age＞35years 16 3 1.555 0.218 BMI≥30kg/m 2 7 9 13.131 0.001 Insulin resistance or diabetes 0 3 - 0.015 Hypertension 2 3 3.419 0.070 Hyperlipidemia 5 1 1.926 0.171 Anaemia 0 1 - 0.259 PCOS 0 1 - 0.259 Table 7 Stepwise regression analysis of recurrence after complete remission Unstandardized coefficient Standardized Coefficient t P-value VIF R² F B Std,error Beta Model -0.036 0.111 0 -0.326 0.746 - 0.578 F=16.806 P=0.000*** Treatment Plan -0.269 0.085 -0.307 -3.182 0.003*** 1.081 Insulin resistance or diabetes 0.403 0.188 0.211 2.147 0.037** 1.12 BMI≥30kg/m 2 0.355 0.091 0.37 3.899 0.000*** 1.044 Complete relief time 0.049 0.013 0.361 3.602 0.001*** 1.17 Table 8 Analysis of variance of pregnancy after complete remission Number of pregnant women（n=29） Number of unpregnant women（n=25） F P-value Reatment Plan Test group Control group 19 10 8 17 6.54 0.014 Pathological type AEH EC 27 2 23 2 0.023 0.880 Complete relief time 4.862±3.148 8.28±3.035 13.173 0.001 Age＞35years 9 10 0.46 0.501 BMI≥30kg/m 2 3 13 13.566 0.001 Insulin resistance or diabetes 1 2 0.516 0.476 Hypertension 3 2 0.184 0.669 Hyperlipidemia 3 6 1.796 0.186 Anaemia 1 0 0.86 1.00 PCOS 1 0 0.86 1.00 Table 9 Stepwise regression analysis of pregnancy after complete remission Unstandardized coefficient Standardized Coefficient t P-value VIF R² F B Std,error Beta Model 0.876 0.145 0 6.052 0.000*** - 0.424 F=12.274，P=0.000*** Treatment Plan 0.241 0.111 0.242 2.165 0.035** 1.081 BMI≥30kg/m 2 -0.458 0.118 -0.419 -3.882 0.000*** 1.012 Complete relief time -0.052 0.017 -0.34 -3.026 0.004*** 1.093 Discussions Endometrial cancer is one of the three major malignant tumors of the female reproductive tract, among which atypical hyperplasia of the endometrium is a precancerous lesion of EC. The occurrence of endometrial cancer is mostly related to long-term persistent estrogen stimulation, obesity, hypertension, diabetes, infertility and other physical factors and genetic factors [ 14 ] .In the very early gynecological examination, the patient showed no obvious abnormalities and had concealment; As the condition progresses, conditions such as uterine enlargement, slight softness, irregular vaginal bleeding, and long-term anovulation leading to infertility gradually appear.Under long-term estrogen exposure,approximately 29% of AEH patients can develop cancer within 15 years. Identifying and treating EC and its precancerous lesions is crucial.The preferred surgical treatment for EC is total hysterectomy and bilateral adnexectomy. After surgery, women permanently lose their reproductive endocrine and fertility functions .With the increase of the incidence rate of female malignant cancer and the delay of women's childbearing age in China, the incidence rate of EC and AEH under 45 years of age has gradually increased, of which 70% of women have not yet given birth [ 15 ] . The fertility-preserving treatmen of young patients is very urgent. Exploring the safe and effective fertility-preserving treatmen of early EC and AEH has become the focus .Most patients undergoing care and treatment have fertility needs and cancer burden, high expectations for pregnancy outcomes, long drug treatment cycles, and uncertain efficacy. In addition, patients also have concerns about adverse reactions during treatment, and psychological factors are complex. Social- physiological-psychological pressure is high, often leading to negative emotions such as depression or anxiety, which can trigger non-specific stress states in patients and act on the neuroendocrine immune axis, resulting in a decline in the patient's immune system function and affecting the efficacy. There was no statistically significant difference in SAS and SDS between the two groups of patients before treatment [ 16 ] , but their scores were relatively high, indicating a certain level of anxiety and depression. During the treatment period, patients also need psychological support and attention from medical staff and families, paying attention to mental health, which can also improve the efficacy to a certain extent. Early EC patients have shown good therapeutic effects after undergoing standardized care and treatment.The primary condition for fertility-preserving treatment is the successful reversal of endometrial pathology.Endometrial lesions often have characteristics such as progesterone receptor (+), focal, no muscle layer infiltration, and high differentiation, which provides the possibility for efficient progesterone treatment.The currently recognized first choice for fertility-preserving treatment is highly effective progesterone. High doses of progesterone inhibit estrogen, causing atrophy of the affected endometrium and promoting the transition of the endometrium to the secretory phase .The most commonly used systemic medication in the first line is medroxyprogesterone acetate or medroxyprogesterone acetate, and local medication is the intrauterine infusion of LNG-IUS .Early EC and AEH patients are often accompanied by obesity and abnormal blood sugar [ 17 ] , and the side effects of systemic high efficiency progesterone drugs, such as increased vasospasm, thrombosis, sodium water retention, abnormal blood sugar, weight gain, digestive tract reaction, mental anxiety or depression, liver and kidney function damage, these also affect the efficacy.How to safely and effectively use progesterone and reduce drug side effects is currently a new direction in treatment. The control group chose to use high-efficiency progesterone, while the test group used LNG-IUS, a new type of intrauterine hormone slow-release contraceptive system with a small "T-shaped" main body. Its medication compartment stores 52mg LNG and continuously releases about 20µg LNG per day for 5 years.It is locally applied to the endometrium to cause atrophy and regression of the lesion [ 18 – 19 ] . Intrauterine placement of LNG-IUS not only increases the concentration of LNG in the endometrium to 470-1500ng/mL, but also effectively promotes the inactivation of lesions locally; Moreover, about 0.2µg of LNG is released into the bloodstream, which generates negative feedback on the hypothalamic pituitary ovarian reproductive endocrine axis, inhibits ovulation, reduces estrogen, and suppresses endometrial proliferation.In addition, the patient has a history of multiple uterine cavity surgeries, which increases the risk of damage to the basal layer of the endometrium and further increases the risk of Asherman's syndrome. The endometrium becomes thinner, affecting pregnancy [ 20 – 21 ] ,intrauterine implantation of ING-INS not only reduce the incidence of uterine cavity adhesions, but also increase the pregnancy rate .Local medication not only effectively treats the endometrium, but also reduces systemic drug side effects and surgical complications during treatment, shortens relief time, increases compliance, and shorten time for the next step of fertility needs. This study indicates that, BMI ≥ 30Kg/m 2 、 Pathological type, presence of PCOS, and treatment method are independent risk factors for complete remission in patients (P < 0.05). Studies have shown that obesity, high blood sugar, and prolonged remission time are high-risk factors for recurrence, with obesity being the most common [ 22 – 24 ] .When patients are obese, the body undergoes tumor biological changes that activate oncogenes, resulting in delaying treatment progress. At the same time, patients with high BMI ,have poor response to progesterone, slow remission, higher recurrence rate after remission, and lower pregnancy rate [ 25 ] . This is consistent with the results of this study. In addition, the pathological type of the patient also affects the complete remission of the patient. Early endometrial cancer, which has already undergone carcinogenesis, requires a longer time for complete remission compared to patients with atypical endometrial hyperplasia, and the complete remission rate is relatively lower. At present, research generally believes that the cause of endometrioid lesions is the long-term effect of estrogen without progesterone antagonism. Multiple experimental studies have shown that long-term ovulation disorders in PCOS patients lead to an excess of endogenous estrogen, combined with hyperandrogenism, hyperinsulinemia, and insulin resistance, which inhibit the secretion of progesterone, disrupt the periodic changes of the endometrium, and cause endometrial lesions, reducing the effectiveness of maintenance therapy and affecting complete remission [ 26 – 27 ] . Diabetes patients can affect the body's sex hormone level and the whole body's defense function through insulin levels, thereby affecting disease progress and recurrence. Standardizing the diagnosis and treatment of diabetes is crucial to reducing disease recurrence In addition, abnormal blood sugar further leads to a reduction in glucose supply to the endometrium, a decrease in endometrial receptivity, and is not conducive to subsequent pregnancy [ 28 ] . The longer the remission time, the less sensitive the patient is to progesterone, and the higher the recurrence rate and lower the pregnancy rate after complete remission. In recent years, metformin has gradually received attention as an insulin sensitizer. It can reduce intestinal glucose absorption, increase tissue uptake and utilization of glucose, reduce high blood sugar, reduce BMI, reduce exogenous estrogen sources, maintain normal androgen levels, reduce IGF-1 inhibition of cancer stem cells, inhibit further epithelial mesenchymal transition of cancer cells, induce cell aging, increase PR expression, regulate ovulation, alleviate PCOS symptoms, and also improve the body's sensitivity to progesterone. This provides the possibility for synergistic treatment of high-efficiency progesterone .The incidence of side effects of metformin is also relatively low, and the medication has high safety [29–31] . This study use ING-INS + metformin and MA + metformin,regularly re examination of endometrial pathology showed that 27 people (84.375%) in the test group achieved complete remission,while 27 people (54.000%) in the control group achieved complete remission .The average relief time of the test group were (5.333 ± 3.150) months,while the average remission time of the control group were (7.111 ± 3.238) months After remission.2 people (7.407%)in the test group relapsed, while 12 people (44.444%)in the control group relapsed .14 people (51.852%)in the test group were pregnant, while 10 people(37.037%)in the control group were pregnant.Comparing the two groups, the test group showed better efficacy, lower recurrence rate, and higher pregnancy rate. Local medication and combination therapy had significant effects. Hirata T et al reported [ 32 ] that the median time from complete response (CR) to successful pregnancy is 7.41 months; the median time from CR to recurrence is 9.6–17.6 months.Fertility-preserving treatment is aimed at giving young patients the opportunity and time to conceive, not a cure.It is recommended to conceive as soon as possible after complete remission. The use of assisted reproductive technology can shorten the time from recovery to pregnancy for patients.In addition,during pregnancy, progesterone can promote endometrial decidualization; During childbirth and the postpartum period, decidua shedding can further occur, which has a certain degree of therapeutic effect and reduces recurrence .But at the same time, during the preparation and pregnancy periods, Strictly monitoring of endometrial pathology and ovulation induction should be carried out to prevent the recurrence caused by the increase of endogenous estrogen. During the fertility-preserving treatment, if the patient has disease progression, relapse after cure, no progress after 12 months of treatment or needs to complete pregnancy,fertility-preserving treatment should be terminated immediately and the operation should be carried out as soon as possible. If the patient insists on preserving the uterus, they can try to preserve it under Strict monitoring and have lifelong follow-up. If the condition progresses, surgery must be performed in a timely manner. In summary, the combination of LNG-IUS and Metformin has better therapeutic effects and pregnancy outcomes, improving patients' happiness index. The research data in this article is relatively limited, and the inclusion of influencing factors is not comprehensive enough, lacking a certain degree of scientific validity and reliability. Further data collection is needed to expand the sample size, and further research comparison and in-depth analysis are needed to conduct.Establish multi center, multi-level long-term comprehensive research to provide more scientific and effective treatment plans for clinical practice. Declarations Acknowledgements The authors wish to thank the women who participated in this trial, and staff who worked on the study. Author Contributions Meicheng Wang,Xin Zhao and Yansong Liu were involved in the conception and design of the study and drafted and performed the statistical analysis, interpreted the data, and wrote the manuscript.Xin Zhao and Yansong Liu were in charge of the operation. Pengpeng Gu and Yan Sun helped modify the manuscript.All authors reviewed the results. All authors contributed to the article and approved the submitted version. Funding The present study was not funded by any specific project grant or sponsor. Data Availability The original contributions presented in the study are included in the article/supplementary materials, and further inquiries can be directed to the corresponding author. All methods were performed in accordance with relevant guidelines and regulations. Ethics approval and consent to participate This study was approved by the Ethical Committee of Shenyang Women’s and Children’s Hospital. Written informed consent was obtained from the patients for the publication of any potentially identifiable images or data included in this article.This study adheres to the Declaration of Helsinki. Competing interests The authors declare no competing interests. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relations that could be construed as a potential conflict of interest. Consent for publication Written informed consent for publication was obtained from all participants. References Ring KL, Mills AM, Modesitt SC. hyperplasia[J] Obstet &Gynecology 2022,140(6):1061–75. Contreras NA, Sabadell J, Verdaguer P et al. Fertility-sparing approaches in atypical endometrial hyperplasia and endometrial cancer patients:current evidence and future directions[J]. Int J Mol Sci 2022 23(5):2531. Corzo C. Barrientos SN,Westin SN,et al.Updates on conservative management of enometrial cancer[J]. J Minim Invasive Gynecol. 2018;25(2):308–13. Chen J, Cao D,Yang J et al. Management of recurrent endometrial cancer or atypical endometrial hyperplasia patients after primary fertility- sparing therapy[J].Front Oncol,2021,11(9):738370. Kalampokas E, Giannis G, Kalampokas T et al. Current approaches to the management of patients with endometrial cancer[J].Cancers,2022,14(18): 4500. Xu Z, Tian Y, Fu J, et al. Efficacy and prognosis of fertility-preserved hysteroscopic surgery combined with progesterone in the treatment of complex endometrial hyperplasia and early endometrial carcinoma[J]. J BUON. 2020;25(3):1525–33. Piatek S, Michalski W, Sobiczewski P, et al. The results of different fertility-sparing treatment modalities and obstetric outcomes in patients with early endometrial cancer and atypical endometrial hyperplasia:case series of 30 patients and systematic review[J]. Eur J Obstet Gynecol Reprod Biol. 2021;263(8):139–47. Chae SH, Shim SH, Lee SJ et al. Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer[J]. Int J Gynecol Cancer 2019,29(1):77–85. Group SW, Burke WM, Orr J et al. Endometrial cancer:a review and current management strategies:partⅡ[J].Gynecol Oncol,2014,134(2):393–402. Cella DF Tulsky, Gray DS. The functional assessment of cancer therapy scale:development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9. Dunstan DA. Scott N.Norms for Zung's self-rating anxiety scale.BMC Psychiatry,2020,20(1):90. Zung. WW.A self-rating depression scale[J].Arch Gen Psychiatry,1965, 12(4):63–70. Rong Z. YiQin W,Expert consensus on fertility preservation treatment for early endometrial cancer(2022)[J].Chin J Clin Obstet Gynecol,2023,24(2):215–9. 10.13390/j.issn.1672-1861.2023.02.032 Nees LK, Heublein S, Steinmacher S et al. Endometrial hyperplasia as a risk factor of endometrial cancer[J]. Arch Gynecol Obstet,2022:1–15. Gil González Y,Pérez, Morales ME, Emergi Zhrigen Y et al. Role of hysteroscopy during conservative management of atypical endometrial hyperplasia and early-stage endometrial cancer in patients who desire pregnancy[J]. J Obstet Gynecol 2022,42(8): 3435–40. Gonzalez FS. Fernadez RC,Paz CD,et,al.Treating anxiety and depression of cancer survivors:behavioral activation versus acceptance and commitment therapy[J].Psicothema,2018,30(1):14–20. Park JY, Seong SJ, Kim TJ et al. Significance of body weight change during fertility-sparing progestin therapy in young women with early endometrial cancer[J]. Gynecol Oncol 2017,146(1):39–43. Behery MM, Saleh HS, Ibrahiem MA et al. Levonorgestrel-releasing intrauterine device versus dydrogesterone for management of endometrial hyperplasia without atypia[J]. Reprod Sci 2015,22(3):329–34. Morelli M, Di CA,Venturella RA, et al. Efficacy of the levonorgestrel intrauterine system(LNG-IUS)in the prevention of the atypical endometrial hyperplasia and endometrial cancer:retrospective data from selected obese menopausal symptomatic wome[J]. Gynecol Endocrinol. 2013;29(2):156–9. Fan Y, Li X, Wang J, et al. Analysis of pregnancy-associated factors after fertility-sparing therapy in young women with early stage endometrial cancer or atypical endometrial hyperplasia[J]. Reprod Biol Endocrinol. 2021;19(1):118. Kou L, Jiang X, Xiao S, et al. Therapeutic options and drug delivery strategies for the prevention ofintrauterine adhesions[J]. J Control Release. 2020;318(2):25–37. Mitsuhashi A. Shozu M.New therapeutic approaches for the fertility- sparing treatment of endometrial cancer[J]. J Obstet Gynaecol Res. 2020;46(2):215–22. Belladelli F. Montorsi F,Martini A.Metabolic syndrome,obesity and cancer risk[J].Current opinion in urology,2022,32(6):594–7. Raffone A, Travaglino A,Saccone G et al. Diabetes mellitus is associated with occult cancer in endometrial hyperplasia [J]. Pathol Oncol Res 2020,26(3):1377–84. Ruze R, Song J, Yin X et al. Mechanisms of obesity-and diabetes mellitus-related pancreatic carcinogenesis:a comprehensive and systematic review[J].Signal transduction and targeted therapy,2023,8(1): 139. Winarto H, Habiburrahman M, Febriana IS, et al. Is there any difference in insulin resistance status between cases of benign and malignant ovarian neoplasms?A study on surrogate markers of insulin resistance in Indonesian non-diabetic women[J]. Oncol Lett. 2022;25(1):23. Pace L, Actis S, Mancarella M et al. Clinical,sonographic,and hysteroscopic features of endometrial carcinoma diagnosed after hysterectomy in patients with a preoperative diagnosis of atypical hyperplasia:a single-center retrospective study[J].Diagnostics,2022, 12(12):3029. Lu T. YanPing M,XiLin C,Research progress on the impact of insulin resistance on the outcome of assisted reproductive technology [J]. Chin J Reprod Contracept 2021,41(1):75–8. 10.3760/cma.j.cn101441-20191202-00538 Lai Y. Sun C.Association of abnormal glucose metabolism and insulin resistance in patients with atypical and typical endometrial cancer[J]. Oncol Lett. 2017;15(2):2173–8. Christopher H, Rebeccal S, Ashita G, et al. Use of metformin in obese women with type I endometrial cancer is associated with a reduced incidence of cancer recurrence[J]. Int J Gynec Cancer. 2016;26(2):313–7. Perez LPV, Gianuzzi X et al. Systematic review and Meta-analysis of the effect of metformin treatment on overall mortality rates in women with endometrial cancer and type 2 diabetes mellitus[J]. Maturitas 2017,101(7):6–11. Hirata T, Kondo E,Magawa S et al. Safety and efficacy of levonorgestrel-releasing intrauterine device in the treatment of atypical endometrial hyperplasia and early endometrial cancer[J]. J Obstet Gynecol Res 2022,48(12):3219–25. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6580786","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":470504040,"identity":"775e6c56-e2dc-4644-9a63-97de97da88d7","order_by":0,"name":"Meicheng Wang","email":"","orcid":"","institution":"Shenyang Women and Children's Hospital,Liaoning","correspondingAuthor":false,"prefix":"","firstName":"Meicheng","middleName":"","lastName":"Wang","suffix":""},{"id":470504041,"identity":"3aa86b1e-434c-4431-bef8-790dff36b3bb","order_by":1,"name":"Xin Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIie3QMQrCMBSA4VcKdsng+EqhNxACBUWQnsWHoGtHxxShLj2AIvQYzikZuniAbjY3yAEEtasgiZtD/vl9Ie8B+Hx/GIewlMBXgFFZauNGAiGh2AIydcjQnRgFiLtqylzIIiqFNDxM47OuACFPZ8JClnUr2hOfZElC1VDAJptL28d6EopxRk1CR44g6Woldz0SpCZuK2ROpA9GwumCgSu50bjLOotreh+Zu+zSqXYwj2eKXae12eeplXy+8Nu4z+fz+b70AkH3RyrQW9o+AAAAAElFTkSuQmCC","orcid":"","institution":"Shenyang Women and Children's Hospital,Liaoning","correspondingAuthor":true,"prefix":"","firstName":"Xin","middleName":"","lastName":"Zhao","suffix":""},{"id":470504042,"identity":"8137ffdc-8f3e-469c-9e69-b1cd80e43fb7","order_by":2,"name":"Yansong Liu","email":"","orcid":"","institution":"Shenyang Women and Children's Hospital,Liaoning","correspondingAuthor":false,"prefix":"","firstName":"Yansong","middleName":"","lastName":"Liu","suffix":""},{"id":470504043,"identity":"68e3dfd8-08f6-4c28-a716-22fcc5c710c9","order_by":3,"name":"Pengpeng Gu","email":"","orcid":"","institution":"Shenyang Women and Children's Hospital,Liaoning","correspondingAuthor":false,"prefix":"","firstName":"Pengpeng","middleName":"","lastName":"Gu","suffix":""},{"id":470504044,"identity":"7040c7bc-857b-46a6-ac61-ae7fb5a9bf35","order_by":4,"name":"Yan Sun","email":"","orcid":"","institution":"Shenyang Women and Children's Hospital,Liaoning","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2025-05-02 20:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6580786/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6580786/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106462968,"identity":"3ced374c-88fb-4f0b-94bd-04ed684e166e","added_by":"auto","created_at":"2026-04-08 20:54:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":984545,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6580786/v1/b0c98917-37a0-48a2-b094-66fd50d74a29.pdf"},{"id":84601883,"identity":"677b7fd6-0af2-4603-8069-1d58374c80b1","added_by":"auto","created_at":"2025-06-14 09:43:52","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":32450,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6580786/v1/3df6e3e19f9011bc62150dde.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Levonorgestre-lintrauterine system(LNG-IUS) plus Metformin compared with Megestrol Acetate (MA)plus Metformin as fertility-sparing treatment in patients with atypical endometrial hyperplasia and well differentiated endometrial cancer:a single-center retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometrial cancer(EC)is the second women common malignant reproductive cancer in China, with a rising trend year by year\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.In aged 20\u0026ndash;44 women in China,the incidence of early EC is about 7.1%,most of them being type I\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e(related to the lack of sustained high estrogen resistance), and the prognosis is relatively good, with a 5-year survival rate as high as 95%\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.Common clinical manifestations of early EC patients include metabolic syndrome, polycystic ovary syndrome (PCOS), etc; The common pathological type is endometrioid adenocarcinoma, which often evolves from atypical endometrial hyperplasia (AEH), but progresses slowly.The standard treatment plan for early EC is to undergo total uterus and bilateral adnexectomy,but modern women have delayed their childbearing age and have not given birth when they are ill.Therefore, there is an urgent need for safe and effective treatment and pregnancy\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.Patients with early EC and AEH who wish to have children need to undergo strict screening and choose fertility-preserving treatment.There were reported that the complete remission rate can reach 60%, the recurrence rate can reach 26%, and the pregnancy rate can reach 31%. It is worth looking forward to the therapeutic effect\u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.At present, progesterone is the preferred treatment for fertility-preserving treatment, but oral progesterone has many drug side effects; Levonorgestre -lintrauterine system(LNG-IUS) is a local progesterone release system that can reduce systemic drug side effects without compromising efficacy; In addition, metformin, as an insulin sensitizer, can improve metabolic syndrome and enhance therapeutic efficacy.These provide new ideas for the implementation of joint programs for fertility-preserving treatment.This article evaluates the efficacy, recurrence, and pregnancy outcomes of using LNG-IUS\u0026thinsp;+\u0026thinsp;Metformin and high-dose progest\u0026thinsp;+\u0026thinsp;Metformin in early EC and AEH patients, in order to obtain a better treatment plan.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and population\u003c/h2\u003e \u003cp\u003e This study retrospectively collected general clinical data of patients with early EC and AEH requiring care who visited Shenyang Maternity and Infant Hospital from January 1, 2015 to December 30, 2021.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria were:1)25years\u0026thinsp;\u0026le;\u0026thinsp;age\u0026thinsp;\u0026le;\u0026thinsp;45years;2)Having a strong need for pregnancy, signing a risk and treatment informed consent form, and having good compliance;3)The surgery is completed by a fixed team of our hospital;4)The pathological result after the first hysteroscopic curettage(which needs to be diagnosed by two pathologists together before it can be considered as the final pathological result)is AEH、 Endometrioid adenocarcinoma in G1 phase, without extrauterine metastasis or lymph node metastasis,invasion of the uterine vasculature, without uterine muscle layer or cervical invasion;5)Pelvic magnetic resonance imaging(MRI)examination to determine the size and extent of lesion invasion, in compliance with national standards International Federation of Obstetrics and Gynecology(FIGO)staging stage IA;6)Progesterone receptor positive sexual expression;7)No other factors affecting fertility;8)No contraindications for pregnancy;9)No contraindications for LNG-IUS,high-dose progest,and metformin treatment;10)No history of malignant tumors in the breast, female reproductive system/digestive tract \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.Exclusion criteria:1)Endometrial cancer of other pathological types;2)The degree of histological differentiation is poor;3)Merge malignant tumors from other parts;4)There are metastatic lesions.\u003c/p\u003e\n\u003ch3\u003eEthics statemen\u003c/h3\u003e\n\u003cp\u003e All enrolled patients have been approved and approved by the Medical Ethics Committee of Shenyang Women and Children\u0026prime;s Hospital(Ethics Number: 201935), and have given informed consent to the treatment plan.\u003c/p\u003e\n\u003ch3\u003eTreatment plan and monitoring indicators\u003c/h3\u003e\n\u003cp\u003e82 patients who underwent hysteroscopic curettage and had early EC and AEH pathology type and met the inclusion criteria were divided into two groups.According to different treatment methods, the test group is consisted of 32 patients who received intrauterine placement of LNG-IUS and oral metformin,the control group is consisted of 50 patients who received oral high-dose progest and metformin .In the test group, there were 6 cases of early EC pathology type and 26 cases of AEH pathology type, with an average age of (33.900\u0026thinsp;\u0026plusmn;\u0026thinsp;4.077) years. After surgery, taking orally metformin (500mg/time, twice a day), and LNG-IUS was placed in the uterine cavity 3\u0026ndash;7 days after the first hysteroscopy.In the control group, there were 9 cases of early EC pathology type and 41 cases of AEH pathology type, with an average age of (33.875\u0026thinsp;\u0026plusmn;\u0026thinsp;4.709) years. After surgery, patients taking orally metformin (500mg/time, twice a day) and Megestrol Acetate (MA) (160mg/time, once a day). At the 3rd, 6th, 9th, 12th, 18th, 24th month after the first treatment, hysteroscopic endometrial biopsy was performed, and the medical history (whether suffering from insulin resistance or diabetes, hypertension, hyperlipidemia, anemia, dysmenorrhea, increased menstruation, decreased menstruation, prolonged menstruation, prolonged cycle), age ,BMI, PCOS, gynecological ultrasound, full abdominal CT, pelvic MRI (to evaluate the size of endometrial lesions and the degree of infiltration into the uterine muscle layer, whether there is extrauterine metastasis), Functional Assessment of Cancer Therapy (FACT-G) \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, Self Rating Anxiety Scale (SAS) \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, and Self Rating Depression Scale (SDS) \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. The Chinese version of FACT-G Scale (V4.0) includes 4 domains and 27 items, divided into physiological Well-being (PWB), social/family Well-being (SWB), emotional Well-being (EWB), and functional status domain. (FWB), total score range: 0-108 points, the higher the total score, the better the quality of life .SAS consists of 20 questions, with a total score of \u0026ge;\u0026thinsp;50 indicating symptoms of anxiety, the higher the score, the more severe the symptoms. SDS consists of 20 questions, with a total score\u0026thinsp;\u0026gt;\u0026thinsp;53 indicating symptoms of depression,the higher the score, the more severe the symptoms .The general clinical data of the two groups of patients in this study showed no significant statistical difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Please refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details.\u003c/p\u003e\n\u003ch3\u003eFollow up\u003c/h3\u003e\n\u003cp\u003eDuring the treatment cycle, every 12 weeks is considered as a course of treatment, and the efficacy needs to be evaluated after each course, mainly including imaging (gynecological ultrasound,pelvic MRI) and postoperative pathology of hysteroscopy curettage. Evaluation criteria: Complete response (CR): Endometrial reversal, complete remission of the lesion .Partial response (PR): Decreased level of endometrial lesions. Stable condition (SD): Endometrial lesions have neither improved nor progressed/partially resolved.Disease progression (PD):Disease progression, such as atypical hyperplasia of the endometrium progressing to endometrial cancer,endometrial well differentiated adenocarcinoma progresses to G2 and G3 stages/develops into other types of endometrial cancer.Disease recurrence: After complete remission of endometrial lesions, they may develop into endometrial cancer again during subsequent follow-up \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e Relief rate: The number of people who have fully recovered divided by the total number of people receiving care and treatment Recurrence rate: The number of relapses divided by by the total number of people receiving care and treatment. Pregnancy rate: The number of pregnancies divided by the total number of people receiving care and treatment .Live birth rate: The number of pregnancies at 28 weeks and above divided by the total number of pregnancies. In addition, patients will be followed up for any adverse reactions to the medication and receive relevant guidance for treatment. Within the first 3 months, liver and kidney function will be rechecked monthly, and every 3 months thereafter. If the disease progresses during treatment or if there is no improvement or partial remission during the 12-month treatment period, or if the disease recurs after cure during the 12\u0026ndash;24 month follow-up period, the patient should be informed of the risks of continuing care and advised to undergo hysterectomy,please refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for details.Comparing the complete remission time between two groups of patients,please refer to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for details.\u003c/p\u003e \u003cp\u003ePost cure management: After two consecutive efficacy evaluations of CR, if there is a plan for early pregnancy, assisted reproductive technology (ART) can be applied under endometrial protection measures; Patients with regular menstruation and ovulation can choose to expect a natural pregnancy of 3\u0026ndash;6 months. If there is no pregnancy in the short term, ART should also be chosen; If there is no recent pregnancy plan, individualized maintenance treatment should be given to prevent recurrence. The combination of intrauterine LNG-IUS and periodic oral low-dose progesterone regimen is often used. Ultrasound or endometrial pathology should be rechecked every 3\u0026ndash;6 months.\u003c/p\u003e \u003cp\u003ePost pregnancy management: ① During pregnancy: monitor metabolic system related complications; Assess the risk of venous thrombosis formation; Be alert to placenta accreta or placenta previa; Be alert to the possibility of cervical incompetence .Delivery period: Choose the gestational weeks and delivery method to terminate based on the condition of the pregnancy, and be alert to postpartum hemorrhage .After delivery: If there is no need for further pregnancy and there are high-risk factors for EC recurrence, surgical treatment can be performed; If there is a need for pregnancy and there are no high-risk factors for EC recurrence, treatment should be maintained and close follow-up should be conducted.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e\u003cp\u003eStatistical analysis was conducted using SPSS 25.0 software. The quantitative data were tested for normality using the K-S method (P\u0026gt;0.05), and were expressed as (\u003cimg width=\"11\" height=\"21\" src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img1749893899.gif\" alt=\"image\"\u003e\u0026plusmn; s).Independent sample t-test was used for inter group comparisons, while frequency (n) and rate (%) were used for count data. The chi square test was used for inter group comparisons.Count data are expressed in frequency (n) and rate (%), and comparison between groups is performed using the chi square test.When the frequency of classification in the count data is too low (\u0026lt;1), Fisher\u0026apos;s exact test is used for inter group comparison.Single factor analysis of variance and multiple factor stepwise regression analysis were used to identify the factors that affect patients\u0026apos; complete remission, recurrence, and pregnancy outcomes. P\u0026lt;0 05 indicates a statistically significant difference.\u003c/p\u003e\n \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no statistically significant difference in general clinical data between the two groups of patients(Table1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable1\u0026nbsp;\u003c/strong\u003e Comparison of general clinical data between two groups of patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"596\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eTest group\u003c/p\u003e\n \u003cp\u003e（n=32）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eControl group（n=50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003et/x\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eAEH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e26（81.250）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e41 （82.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e6（18.750）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e9（18.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eAge（years）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026le;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e21（65.625）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e34（68.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e＞35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e11（34.375）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e16（32.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eBMI（kg/m\u003csup\u003e2\u003c/sup\u003e）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026ge;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e21（65.625）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e32（64.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e1.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e＜30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e11（34.375）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e18（36.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eInsulin resistance or diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1（3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e4（8.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3（9.375）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e4（8.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eHyperlipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5（15.625）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e12（24.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eAnaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1（3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1（2.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003ePCOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1（3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e5（10.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e1.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eDysmenorrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2（6.250）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e5（10.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eIncreased menstrual flow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2（6.250）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e5（10.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eDecreased menstrual flow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2（6.250）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1（2.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eMenostaxis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2（6.250）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e5（10.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eExtended cycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2（6.250）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e11（22.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e3.628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eAbnormal gynecological ultrasound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1（3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e4（8.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eGynecological full abdominal CT abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1（3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1（2.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eAbnormal gynecological MRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1（3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e6（12.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eFACT-G（score）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e65.500\u0026plusmn;3.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e66.220\u0026plusmn;3.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.413\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eSAS（score）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e39.094\u0026plusmn;2.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e38.540\u0026plusmn;3.919\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003eSDS（score）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e38.344\u0026plusmn;2.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e38.620\u0026plusmn;4.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.743\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTherapeutic effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with the control group, during 24 months of care and treatment, the test group achieved complete remission in 27 people (84.375%), partial remission in 3 people (9.375%), stable condition in 1 person (3.125%), and disease progression in 1 person (3.125%); In the control group chieved complete remission in 27 people (54.000%), partial remission in 14 people (28.000%), stable condition in 6 people (12.000%),disease progression in 3 people (6.000%).Comparing the two groups, the test group had a higher remission rate (P=0.005)(Table2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable2\u0026nbsp;\u003c/strong\u003e Comparison of therapeutic effects between two groups of patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"594\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eTherapeutic effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eTest group\u003c/p\u003e\n \u003cp\u003e（n=32）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eControl group（n=50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003ex\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eCurative effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e27（84.375）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e27（54.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e8.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003ePR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3（9.375）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e14（28.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1（3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6（12.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1（3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3（6.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2（6.250）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e12（24.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003ePregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e14（43.750）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e10（20.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e13.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eMiscarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1（3.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2（4.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eLive Birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e13（40.625）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8（16.000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComplete\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eremission\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;time\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;In the test group, 15 people achieved complete remission within 3 months, 6 peo ple achieved complete remission within 6 months, 3 people achieved complete remission within 9 months, and 3 people achieved complete remission within 12 months, with an average remission time of (5.333 \u0026plusmn; 3.150) months; In the control group, 7 people achieved complete remission within 3 months, 8 people achieved complete remission within 6 months, 7 people achieved complete remission within 9 months, and 5 people achieved complete remission within 12 months, with an average remission time of (7.111 \u0026plusmn; 3.238) months. The test group had a shorter remission time (P=0.046)(Tables 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable3\u003c/strong\u003e\u0026nbsp; Comparison of complete remission time between two groups of patients in the complete remission population\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"619\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eComplete relief time（months）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eCR of the test group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;（n=27）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eCR of the control group\u003c/p\u003e\n \u003cp\u003e（n=27）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e15（55.556）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7（25.926）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6（22.222）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e8（29.630）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e3（11.111）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7（25.926）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e3（11.111）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e5（18.518）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eAverage time to complete remission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5.333\u0026plusmn;3.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7.111\u0026plusmn;3.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-2.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eRecurrence after c\u003c/strong\u003e\u003cstrong\u003eomplete\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eremission\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter complete remission, 2 people in the test group experienced recurrence (2/27, 7.407%), while 12 people in the control group experienced recurrence (12/27, 44.444%). The test group had a lower recurrence rate (P=0.037)(Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePregnancy\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;after c\u003c/strong\u003e\u003cstrong\u003eomplete\u003c/strong\u003e \u003cstrong\u003eremission\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe total number of pregnancies in the test group was 14 (14/27, 51.852%), with 1 miscarriage (3.704%) and 13 successful deliveries (48.148%). The control group had 10 pregnancies (37.037%), with 2 miscarriages (7.407%) and 8 successful deliveries (29.630%). The test group had a higher pregnancy rate (P\u0026lt;0.001)(Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of related factors affecting remission, recurrence, and pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the stepwise regression analysis, during the 24 month treatment, the complete remission rate of the two groups of patients was correlated with the treatment plan, and negatively correlated with the pathological type of EC, PCOS and BMI\u0026gt;30kg/m\u003csup\u003e2\u003c/sup\u003e (P\u0026lt;0.001). The recurrence rate after treatment was correlated with the treatment plan, and positively correlated with the longer the complete remission time, diabetes or insulin resistance, and BMI\u0026gt;30kg/m\u003csup\u003e2\u003c/sup\u003e (P\u0026lt;0.001). The pregnancy rate after treatment was correlated with the treatment plan, and negatively correlated with the longer the complete remission time and BMI\u0026gt;30kg/m\u003csup\u003e2\u003c/sup\u003e (P\u0026lt;0.001)(Table 4, 5, 6, 7, 8, and 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003eAnalysis of variance of Complete remission\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"563\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eNumber of completely remission \u0026nbsp;people\u003c/p\u003e\n \u003cp\u003e（n=54）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eNumber of not fully remission people\u003c/p\u003e\n \u003cp\u003e（n=28）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eTreatment Plan\u003c/p\u003e\n \u003cp\u003eTest group\u003c/p\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e8.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003cp\u003eAEH\u003c/p\u003e\n \u003cp\u003eEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e14.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e＜0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eAge＞35years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eBMI\u0026ge;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e10.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eInsulin resistance or diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.779\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.749\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eHyperlipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eAnaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePCOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e7.426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e Stepwise regression analysis of Complete remission\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"564\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003eUnstandardized coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eStandardized Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 43px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 35px;\"\u003e\n \u003cp\u003eVIF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 34px;\"\u003e\n \u003cp\u003eR\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eStd,error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e10.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 34px;\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 103px;\"\u003e\n \u003cp\u003eF=10.779\u003c/p\u003e\n \u003cp\u003eP=0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eTreatment Plan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e2.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.006***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e-0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e-0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-3.874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eBMI\u0026ge;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e-0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e-0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-2.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.032**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003ePCOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e-0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e-0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-2.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.014**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u0026nbsp;\u003c/strong\u003e Analysis of variance of recurrence after complete remission\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"564\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eNumber of non recurrent people\u003c/p\u003e\n \u003cp\u003e（n=40）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eNumber of relapses\u0026nbsp;people（n=14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eReatment Plan\u003c/p\u003e\n \u003cp\u003eTest group\u003c/p\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e11.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003cp\u003eAEH\u003c/p\u003e\n \u003cp\u003eEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e5.798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eComplete relief time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5.175\u0026plusmn;2.800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e9.214\u0026plusmn;2.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e21.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eAge＞35years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eBMI\u0026ge;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e13.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eInsulin resistance or diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e3.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eHyperlipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eAnaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePCOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e\u0026nbsp; Stepwise regression analysis of recurrence after complete remission\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"560\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 89px;\"\u003e\n \u003cp\u003eUnstandardized coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eStandardized Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 35px;\"\u003e\n \u003cp\u003eVIF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 33px;\"\u003e\n \u003cp\u003eR\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 50px;\"\u003e\n \u003cp\u003eStd,error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 42px;\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e-0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 33px;\"\u003e\n \u003cp\u003e0.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 72px;\"\u003e\n \u003cp\u003eF=16.806\u003c/p\u003e\n \u003cp\u003eP=0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eTreatment Plan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 42px;\"\u003e\n \u003cp\u003e-0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e-0.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e-3.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.003***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eInsulin resistance or diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e2.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.037**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eBMI\u0026ge;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e3.899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eComplete relief time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e3.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8\u0026nbsp;\u003c/strong\u003e Analysis of variance of pregnancy after complete remission\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"550\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNumber of pregnant women（n=29）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eNumber of unpregnant women（n=25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eReatment Plan\u003c/p\u003e\n \u003cp\u003eTest group\u003c/p\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e6.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003cp\u003eAEH\u003c/p\u003e\n \u003cp\u003eEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.880\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eComplete relief time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.862\u0026plusmn;3.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e8.28\u0026plusmn;3.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e13.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAge＞35years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eBMI\u0026ge;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e13.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eInsulin resistance or diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHyperlipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAnaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePCOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9\u0026nbsp;\u003c/strong\u003e Stepwise regression analysis of pregnancy after complete remission\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"537\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 90px;\"\u003e\n \u003cp\u003eUnstandardized coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003eStandardized Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 51px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 35px;\"\u003e\n \u003cp\u003eVIF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 35px;\"\u003e\n \u003cp\u003eR\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 71px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eStd,error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.876\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e6.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 35px;\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 71px;\"\u003e\n \u003cp\u003eF=12.274，P=0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eTreatment Plan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e2.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.035**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eBMI\u0026ge;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 44px;\"\u003e\n \u003cp\u003e-0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e-3.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.000***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eComplete relief time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 44px;\"\u003e\n \u003cp\u003e-0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e-3.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.004***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e1.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussions","content":"\u003cp\u003eEndometrial cancer is one of the three major malignant tumors of the female reproductive tract, among which atypical hyperplasia of the endometrium is a precancerous lesion of EC. The occurrence of endometrial cancer is mostly related to long-term persistent estrogen stimulation, obesity, hypertension, diabetes, infertility and other physical factors and genetic factors \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.In the very early gynecological examination, the patient showed no obvious abnormalities and had concealment; As the condition progresses, conditions such as uterine enlargement, slight softness, irregular vaginal bleeding, and long-term anovulation leading to infertility gradually appear.Under long-term estrogen exposure,approximately 29% of AEH patients can develop cancer within 15 years. Identifying and treating EC and its precancerous lesions is crucial.The preferred surgical treatment for EC is total hysterectomy and bilateral adnexectomy. After surgery, women permanently lose their reproductive endocrine and fertility functions .With the increase of the incidence rate of female malignant cancer and the delay of women's childbearing age in China, the incidence rate of EC and AEH under 45 years of age has gradually increased, of which 70% of women have not yet given birth \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. The fertility-preserving treatmen of young patients is very urgent. Exploring the safe and effective fertility-preserving treatmen of early EC and AEH has become the focus .Most patients undergoing care and treatment have fertility needs and cancer burden, high expectations for pregnancy outcomes, long drug treatment cycles, and uncertain efficacy. In addition, patients also have concerns about adverse reactions during treatment, and psychological factors are complex. Social- physiological-psychological pressure is high, often leading to negative emotions such as depression or anxiety, which can trigger non-specific stress states in patients and act on the neuroendocrine immune axis, resulting in a decline in the patient's immune system function and affecting the efficacy. There was no statistically significant difference in SAS and SDS between the two groups of patients before treatment \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, but their scores were relatively high, indicating a certain level of anxiety and depression. During the treatment period, patients also need psychological support and attention from medical staff and families, paying attention to mental health, which can also improve the efficacy to a certain extent.\u003c/p\u003e \u003cp\u003eEarly EC patients have shown good therapeutic effects after undergoing standardized care and treatment.The primary condition for fertility-preserving treatment is the successful reversal of endometrial pathology.Endometrial lesions often have characteristics such as progesterone receptor (+), focal, no muscle layer infiltration, and high differentiation, which provides the possibility for efficient progesterone treatment.The currently recognized first choice for fertility-preserving treatment is highly effective progesterone. High doses of progesterone inhibit estrogen, causing atrophy of the affected endometrium and promoting the transition of the endometrium to the secretory phase .The most commonly used systemic medication in the first line is medroxyprogesterone acetate or medroxyprogesterone acetate, and local medication is the intrauterine infusion of LNG-IUS .Early EC and AEH patients are often accompanied by obesity and abnormal blood sugar \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, and the side effects of systemic high efficiency progesterone drugs, such as increased vasospasm, thrombosis, sodium water retention, abnormal blood sugar, weight gain, digestive tract reaction, mental anxiety or depression, liver and kidney function damage, these also affect the efficacy.How to safely and effectively use progesterone and reduce drug side effects is currently a new direction in treatment. The control group chose to use high-efficiency progesterone, while the test group used LNG-IUS, a new type of intrauterine hormone slow-release contraceptive system with a small \"T-shaped\" main body. Its medication compartment stores 52mg LNG and continuously releases about 20\u0026micro;g LNG per day for 5 years.It is locally applied to the endometrium to cause atrophy and regression of the lesion \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Intrauterine placement of LNG-IUS not only increases the concentration of LNG in the endometrium to 470-1500ng/mL, but also effectively promotes the inactivation of lesions locally; Moreover, about 0.2\u0026micro;g of LNG is released into the bloodstream, which generates negative feedback on the hypothalamic pituitary ovarian reproductive endocrine axis, inhibits ovulation, reduces estrogen, and suppresses endometrial proliferation.In addition, the patient has a history of multiple uterine cavity surgeries, which increases the risk of damage to the basal layer of the endometrium and further increases the risk of Asherman's syndrome. The endometrium becomes thinner, affecting pregnancy\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e,intrauterine implantation of ING-INS not only reduce the incidence of uterine cavity adhesions, but also increase the pregnancy rate .Local medication not only effectively treats the endometrium, but also reduces systemic drug side effects and surgical complications during treatment, shortens relief time, increases compliance, and shorten time for the next step of fertility needs.\u003c/p\u003e \u003cp\u003eThis study indicates that, BMI\u0026thinsp;\u0026ge;\u0026thinsp;30Kg/m\u003csup\u003e2\u003c/sup\u003e、 Pathological type, presence of PCOS, and treatment method are independent risk factors for complete remission in patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Studies have shown that obesity, high blood sugar, and prolonged remission time are high-risk factors for recurrence, with obesity being the most common \u003csup\u003e[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e .When patients are obese, the body undergoes tumor biological changes that activate oncogenes, resulting in delaying treatment progress. At the same time, patients with high BMI ,have poor response to progesterone, slow remission, higher recurrence rate after remission, and lower pregnancy rate \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. This is consistent with the results of this study. In addition, the pathological type of the patient also affects the complete remission of the patient. Early endometrial cancer, which has already undergone carcinogenesis, requires a longer time for complete remission compared to patients with atypical endometrial hyperplasia, and the complete remission rate is relatively lower. At present, research generally believes that the cause of endometrioid lesions is the long-term effect of estrogen without progesterone antagonism. Multiple experimental studies have shown that long-term ovulation disorders in PCOS patients lead to an excess of endogenous estrogen, combined with hyperandrogenism, hyperinsulinemia, and insulin resistance, which inhibit the secretion of progesterone, disrupt the periodic changes of the endometrium, and cause endometrial lesions, reducing the effectiveness of maintenance therapy and affecting complete remission \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDiabetes patients can affect the body's sex hormone level and the whole body's defense function through insulin levels, thereby affecting disease progress and recurrence. Standardizing the diagnosis and treatment of diabetes is crucial to reducing disease recurrence In addition, abnormal blood sugar further leads to a reduction in glucose supply to the endometrium, a decrease in endometrial receptivity, and is not conducive to subsequent pregnancy \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. The longer the remission time, the less sensitive the patient is to progesterone, and the higher the recurrence rate and lower the pregnancy rate after complete remission.\u003c/p\u003e \u003cp\u003eIn recent years, metformin has gradually received attention as an insulin sensitizer. It can reduce intestinal glucose absorption, increase tissue uptake and utilization of glucose, reduce high blood sugar, reduce BMI, reduce exogenous estrogen sources, maintain normal androgen levels, reduce IGF-1 inhibition of cancer stem cells, inhibit further epithelial mesenchymal transition of cancer cells, induce cell aging, increase PR expression, regulate ovulation, alleviate PCOS symptoms, and also improve the body's sensitivity to progesterone. This provides the possibility for synergistic treatment of high-efficiency progesterone .The incidence of side effects of metformin is also relatively low, and the medication has high safety\u003csup\u003e[29\u0026ndash;31]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study use ING-INS\u0026thinsp;+\u0026thinsp;metformin and MA\u0026thinsp;+\u0026thinsp;metformin,regularly re examination of endometrial pathology showed that 27 people (84.375%) in the test group achieved complete remission,while 27 people (54.000%) in the control group achieved complete remission .The average relief time of the test group were (5.333\u0026thinsp;\u0026plusmn;\u0026thinsp;3.150) months,while the average remission time of the control group were (7.111\u0026thinsp;\u0026plusmn;\u0026thinsp;3.238) months After remission.2 people (7.407%)in the test group relapsed, while 12 people (44.444%)in the control group relapsed .14 people (51.852%)in the test group were pregnant, while 10 people(37.037%)in the control group were pregnant.Comparing the two groups, the test group showed better efficacy, lower recurrence rate, and higher pregnancy rate. Local medication and combination therapy had significant effects.\u003c/p\u003e \u003cp\u003eHirata T et al reported \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e that the median time from complete response (CR) to successful pregnancy is 7.41 months; the median time from CR to recurrence is 9.6\u0026ndash;17.6 months.Fertility-preserving treatment is aimed at giving young patients the opportunity and time to conceive, not a cure.It is recommended to conceive as soon as possible after complete remission. The use of assisted reproductive technology can shorten the time from recovery to pregnancy for patients.In addition,during pregnancy, progesterone can promote endometrial decidualization; During childbirth and the postpartum period, decidua shedding can further occur, which has a certain degree of therapeutic effect and reduces recurrence .But at the same time, during the preparation and pregnancy periods, Strictly monitoring of endometrial pathology and ovulation induction should be carried out to prevent the recurrence caused by the increase of endogenous estrogen.\u003c/p\u003e \u003cp\u003eDuring the fertility-preserving treatment, if the patient has disease progression, relapse after cure, no progress after 12 months of treatment or needs to complete pregnancy,fertility-preserving treatment should be terminated immediately and the operation should be carried out as soon as possible. If the patient insists on preserving the uterus, they can try to preserve it under Strict monitoring and have lifelong follow-up. If the condition progresses, surgery must be performed in a timely manner.\u003c/p\u003e \u003cp\u003eIn summary, the combination of LNG-IUS and Metformin has better therapeutic effects and pregnancy outcomes, improving patients' happiness index. The research data in this article is relatively limited, and the inclusion of influencing factors is not comprehensive enough, lacking a certain degree of scientific validity and reliability. Further data collection is needed to expand the sample size, and further research comparison and in-depth analysis are needed to conduct.Establish multi center, multi-level long-term comprehensive research to provide more scientific and effective treatment plans for clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the women who participated in this trial, and staff who worked on the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMeicheng Wang,Xin Zhao and Yansong Liu were involved in the conception and design of the study and drafted and performed the statistical analysis, interpreted the data, and wrote the manuscript.Xin Zhao and Yansong Liu were in charge of the operation. Pengpeng Gu and Yan Sun helped modify the manuscript.All authors reviewed the results. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was not funded by any specific project grant or sponsor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article/supplementary materials, and further inquiries can be directed to the corresponding author. All methods were performed in accordance with\u0026nbsp;\u003c/p\u003e\n\u003cp\u003erelevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethical Committee of Shenyang Women\u0026rsquo;s and\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChildren\u0026rsquo;s Hospital. Written informed consent was obtained from the patients for the publication of any potentially identifiable images or data included in this article.This study adheres to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ecommercial or financial relations that could be construed as a potential\u0026nbsp;\u003c/p\u003e\n\u003cp\u003econflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication was obtained from all participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRing KL, Mills AM, Modesitt SC. hyperplasia[J] Obstet \u0026amp;Gynecology 2022,140(6):1061\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eContreras NA, Sabadell J, Verdaguer P et al. Fertility-sparing approaches in atypical endometrial hyperplasia and endometrial cancer patients:current evidence and future directions[J]. Int J Mol Sci 2022 23(5):2531.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorzo C. Barrientos SN,Westin SN,et al.Updates on conservative management of enometrial cancer[J]. J Minim Invasive Gynecol. 2018;25(2):308\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J, Cao D,Yang J et al. Management of recurrent endometrial cancer or atypical endometrial hyperplasia patients after primary fertility- sparing therapy[J].Front Oncol,2021,11(9):738370.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalampokas E, Giannis G, Kalampokas T et al. Current approaches to the management of patients with endometrial cancer[J].Cancers,2022,14(18): 4500.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu Z, Tian Y, Fu J, et al. Efficacy and prognosis of fertility-preserved hysteroscopic surgery combined with progesterone in the treatment of complex endometrial hyperplasia and early endometrial carcinoma[J]. J BUON. 2020;25(3):1525\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePiatek S, Michalski W, Sobiczewski P, et al. The results of different fertility-sparing treatment modalities and obstetric outcomes in patients with early endometrial cancer and atypical endometrial hyperplasia:case series of 30 patients and systematic review[J]. Eur J Obstet Gynecol Reprod Biol. 2021;263(8):139\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChae SH, Shim SH, Lee SJ et al. Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer[J]. Int J Gynecol Cancer 2019,29(1):77\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroup SW, Burke WM, Orr J et al. Endometrial cancer:a review and current management strategies:partⅡ[J].Gynecol Oncol,2014,134(2):393\u0026ndash;402.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCella DF Tulsky, Gray DS. The functional assessment of cancer therapy scale:development and validation of the general measure. J Clin Oncol. 1993;11(3):570\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDunstan DA. Scott N.Norms for Zung's self-rating anxiety scale.BMC Psychiatry,2020,20(1):90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZung. WW.A self-rating depression scale[J].Arch Gen Psychiatry,1965, 12(4):63\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRong Z. YiQin W,Expert consensus on fertility preservation treatment for early endometrial cancer(2022)[J].Chin J Clin Obstet Gynecol,2023,24(2):215\u0026ndash;9.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13390/j.issn.1672-1861.2023.02.032\u003c/span\u003e\u003cspan address=\"10.13390/j.issn.1672-1861.2023.02.032\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNees LK, Heublein S, Steinmacher S et al. Endometrial hyperplasia as a risk factor of endometrial cancer[J]. Arch Gynecol Obstet,2022:1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGil Gonz\u0026aacute;lez Y,P\u0026eacute;rez, Morales ME, Emergi Zhrigen Y et al. Role of hysteroscopy during conservative management of atypical endometrial hyperplasia and early-stage endometrial cancer in patients who desire pregnancy[J]. J Obstet Gynecol 2022,42(8): 3435\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonzalez FS. Fernadez RC,Paz CD,et,al.Treating anxiety and depression of cancer survivors:behavioral activation versus acceptance and commitment therapy[J].Psicothema,2018,30(1):14\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark JY, Seong SJ, Kim TJ et al. Significance of body weight change during fertility-sparing progestin therapy in young women with early endometrial cancer[J]. Gynecol Oncol 2017,146(1):39\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehery MM, Saleh HS, Ibrahiem MA et al. Levonorgestrel-releasing intrauterine device versus dydrogesterone for management of endometrial hyperplasia without atypia[J]. Reprod Sci 2015,22(3):329\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorelli M, Di CA,Venturella RA, et al. Efficacy of the levonorgestrel intrauterine system(LNG-IUS)in the prevention of the atypical endometrial hyperplasia and endometrial cancer:retrospective data from selected obese menopausal symptomatic wome[J]. Gynecol Endocrinol. 2013;29(2):156\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFan Y, Li X, Wang J, et al. Analysis of pregnancy-associated factors after fertility-sparing therapy in young women with early stage endometrial cancer or atypical endometrial hyperplasia[J]. Reprod Biol Endocrinol. 2021;19(1):118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKou L, Jiang X, Xiao S, et al. Therapeutic options and drug delivery strategies for the prevention ofintrauterine adhesions[J]. J Control Release. 2020;318(2):25\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitsuhashi A. Shozu M.New therapeutic approaches for the fertility- sparing treatment of endometrial cancer[J]. J Obstet Gynaecol Res. 2020;46(2):215\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBelladelli F. Montorsi F,Martini A.Metabolic syndrome,obesity and cancer risk[J].Current opinion in urology,2022,32(6):594\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaffone A, Travaglino A,Saccone G et al. Diabetes mellitus is associated with occult cancer in endometrial hyperplasia [J]. Pathol Oncol Res 2020,26(3):1377\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuze R, Song J, Yin X et al. Mechanisms of obesity-and diabetes mellitus-related pancreatic carcinogenesis:a comprehensive and systematic review[J].Signal transduction and targeted therapy,2023,8(1): 139.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinarto H, Habiburrahman M, Febriana IS, et al. Is there any difference in insulin resistance status between cases of benign and malignant ovarian neoplasms?A study on surrogate markers of insulin resistance in Indonesian non-diabetic women[J]. Oncol Lett. 2022;25(1):23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePace L, Actis S, Mancarella M et al. Clinical,sonographic,and hysteroscopic features of endometrial carcinoma diagnosed after hysterectomy in patients with a preoperative diagnosis of atypical hyperplasia:a single-center retrospective study[J].Diagnostics,2022, 12(12):3029.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu T. YanPing M,XiLin C,Research progress on the impact of insulin resistance on the outcome of assisted reproductive technology [J]. Chin J Reprod Contracept 2021,41(1):75\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.cn101441-20191202-00538\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.cn101441-20191202-00538\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai Y. Sun C.Association of abnormal glucose metabolism and insulin resistance in patients with atypical and typical endometrial cancer[J]. Oncol Lett. 2017;15(2):2173\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChristopher H, Rebeccal S, Ashita G, et al. Use of metformin in obese women with type I endometrial cancer is associated with a reduced incidence of cancer recurrence[J]. Int J Gynec Cancer. 2016;26(2):313\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerez LPV, Gianuzzi X et al. Systematic review and Meta-analysis of the effect of metformin treatment on overall mortality rates in women with endometrial cancer and type 2 diabetes mellitus[J]. Maturitas 2017,101(7):6\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirata T, Kondo E,Magawa S et al. Safety and efficacy of levonorgestrel-releasing intrauterine device in the treatment of atypical endometrial hyperplasia and early endometrial cancer[J]. J Obstet Gynecol Res 2022,48(12):3219\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"atypical hyperplasia of endometrium, Early endometrial cancer, Preservation of fertility function treatment, Levonorgestrel intrauterine contraceptive system, Metformin","lastPublishedDoi":"10.21203/rs.3.rs-6580786/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6580786/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe prevalence of early-stage endometrial cancer who have not given birth has risen signiffcantly in recent years.This study aimed to investigate the efficacy of Levonorgestre-lintrauterine system(LNG-IUS) combined with high-dose progest and metformin in fertility-preserving treatment patients of early-stage endometrial cancer and atypical endometrial hyperplasia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on clinical data of 82 patients (15 cases of early-stage endometrial cancer and 67 cases of atypical endometrial hyperplasia), who required fertility-preserving treatment,at Shenyang Women and Children\u0026prime;s Hospital, from January 1, 2015, to December 30,2024.Patients were divided into the test group(32 cases treated with LNG-IUS and metformin) and the control group(50 cases treated with high-dose progestin and metformin). Regularly review endometrial pathology after surgery and analyze the efficacy of both groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was no statistically significant difference in general clinical data between the two groups; The test group had a higher complete remission rate (84.375%, P\u0026thinsp;=\u0026thinsp;0.005), shorter complete remission time(5.333\u0026thinsp;\u0026plusmn;\u0026thinsp;3.150months,P\u0026thinsp;=\u0026thinsp;0.046), lower recurrence rate after remission(7.407%,P\u0026thinsp;=\u0026thinsp;0.037),and higher pregnancy rate after remission(51.852%,P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).Meanwhile, stepwise regression analysis revealed that the treatment plan、 BMI\u0026thinsp;\u0026ge;\u0026thinsp;30Kg/m\u003csup\u003e2\u003c/sup\u003e、pathological type and suffering from PCOS are independent risk factors for complete remission in patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Treatment plan BMI\u0026thinsp;\u0026ge;\u0026thinsp;30Kg/m\u003csup\u003e2\u003c/sup\u003e、suffering from insulin resistance or diabetes,the time of complete remission are independent risk factors for relapse after complete remission(P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).Treatment plan、BMI\u0026thinsp;\u0026ge;\u0026thinsp;30Kg/m\u003csup\u003e2\u003c/sup\u003e、complete remission time are independent risk factors for complete remission pregnancy(P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe combination of LNG-IUS and Metformin has a more satisfactory therapeutic effect and pregnancy outcomes compared to the combination of high-dose progest and Metformin, that is safe and highly effective.\u003c/p\u003e","manuscriptTitle":"Levonorgestre-lintrauterine system(LNG-IUS) plus Metformin compared with Megestrol Acetate (MA)plus Metformin as fertility-sparing treatment in patients with atypical endometrial hyperplasia and well differentiated endometrial cancer:a single-center retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-14 09:43:47","doi":"10.21203/rs.3.rs-6580786/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b15a1bea-49b0-4394-bfe0-661f2f33a41a","owner":[],"postedDate":"June 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T20:54:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-14 09:43:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6580786","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6580786","identity":"rs-6580786","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}