Abstract：
Ovulatory disorders are a common cause of abnormal uterine bleeding in women of reproductive age. The International Federation of Gynecology and Obstetrics currently offers a causal classification system for ovulatory disorders but does not provide clear management recommendations. There remains regional disparity in treatment practices, often influenced by institutional and insurance regulations as well as cultural and religious practices. A panel of experts evaluated current gaps in ovulatory disorder management guidelines and discussed potential strategies for addressing these unmet needs. Key gaps included a lack in consensus about the effectiveness of combined estrogen and progestogen versus progestogen alone, a paucity of evidence regarding the relative effectiveness of distinct hormonal molecules, a lack of data regarding optimal treatment duration, and limited guidance on optimal sequencing of treatment. Recommendations included development of a sequential treatment-line approach and development of a clinical guide addressing treatment scenarios common to all countries, which can then be adapted to local practices. It was also agreed that current guidelines do not address the unique clinical challenges of certain patient groups. The panel discussed how the complexity and variety of patient groups made the development of one single disease management algorithm unlikely; however, a simplified, decision-point hierarchy could potentially help direct therapeutic choices. Overall, the panel highlighted that greater advocacy for a tailored approach to the treatment of ovulatory disorders, including wider consideration of non-estrogen therapies, could help to improve care for people living with abnormal uterine bleeding due to ovarian dysfunction.
摘要：
排卵障碍是育龄妇女异常子宫出血的常见原因。国际妇产科联合会目前提供了排卵障碍的因果分类系统，但没有提供明确的治疗建议。治疗实践仍然存在地区差异，经常受到机构和保险法规以及文化和宗教习俗的影响。一个专家小组评估了当前排卵障碍管理指南中的差距，并讨论了解决这些未满足需求的潜在策略。主要差距包括缺乏关于雌激素和孕激素联合用药与单独使用孕激素的有效性的共识，缺乏关于不同激素分子相对有效性的证据，缺乏关于最佳治疗持续时间的数据，以及对最佳治疗顺序的指导有限。建议包括制定序贯治疗方法和制定解决所有国家共同的治疗方案的临床指南，然后可以适应当地的做法。还一致认为，目前的指南没有解决某些患者群体的独特临床挑战。小组讨论了患者群体的复杂性和多样性如何使单一疾病管理算法的发展变得不可能；然而，一个简化的，决策点层次结构可能有助于指导治疗选择。总的来说,专家小组强调，更多的倡导采用量身定制的方法治疗排卵障碍，包括更广泛地考虑非雌激素疗法，可以帮助改善因卵巢功能异常子宫出血的患者的护理。
