背景：卵巢功能紊乱引起的月经失调是影响育龄期女性生活质量的重要健康问题。月经周期的规律性、持续时间和经期症状均可对女性的生理及心理状态产生显著影响。多囊卵巢综合征（PCOS）和原发性痛经（PD）作为两类典型疾病——前者以月经周期异常为特征，后者以经期严重不适症状为主要表现——其发病机制研究虽已取得显著进展，但目前仍缺乏疗效明确且安全性理想的治疗方案。本研究拟解决以下临床问题：（1）基于中国分级诊疗体系的现状，分析医生群体对PCOS诊疗的认知现状；（2）探索PD的更有效治疗方法，旨在建立一种既能改善卵巢储备功能，又具有更佳疗效和更低副作用的治疗模型并探究其对于卵巢血管改善的机制。

方法：本研究的第一部分为横断面调查，旨在分析不同级别医院（一、二、三级）妇产科医生对目标疾病的诊疗认知现状。参与调查的医生涵盖妇科、产科及妇科内分泌等亚专科。第二部分为多中心、随机、平行对照临床试验，符合纳入标准的受试者被随机分配至三组：安慰剂组、口服避孕药组和光动力治疗组。受试者接受连续三个月经周期的干预，并在干预结束后继续随访两个周期。主要观察指标包括治疗前后的视觉模拟量表（VAS）评分、简化McGill疼痛问卷-2（SF-MPQ-2）评分、慢性月经症状量表（CMSS）评分，以及血清疼痛相关标志物水平。采用卡方检验、Fisher精确检验和多因素logistic回归等统计方法对数据进行分析。

结果：

横断面调查共回收有效问卷2298份，其中一级、二级、三级医院占比分别为13.1%、52.4%和34.5%。结果显示，医院等级与诊疗行为存在显著关联。在病史采集方面，随医院等级升高，医生更倾向于询问患者不良妊娠史（P < 0.05）；三级医院医生更常选择抗缪勒管激素（AMH）和雄激素水平检测（P < 0.01）。在代谢评估方面三级医院医生更频繁采用口服葡萄糖耐量试验（OGTT）诊断胰岛素抵抗（一级医院 vs. 三级医院：OR = 0.383, 95% CI 0.282–0.520；二级医院 vs. 三级医院：OR = 0.607, 95% CI 0.481–0.765），血脂评估的开展率随医院等级降低而显著减少（一级医院 vs. 三级医院：OR = 0.689, 95% CI 0.523–0.909），三级医院更普遍采用亚洲BMI标准诊断肥胖（P < 0.05）。治疗选择方面也存在差异，医院等级越高，医生对二甲双胍的疗效认知及剂量调整的掌握程度越高（P < 0.01），三级医院更倾向使用来曲唑（P < 0.05）及推荐辅助生殖技术（P < 0.01）。

与安慰剂组相比，激素治疗组和光动力治疗组（PDT组）均能有效改善原发性痛经症状（VAS评分，均P＜0.05）。激素治疗组起效迅速，在治疗初期即可显著缓解疼痛；而PDT组疗效呈现延迟性，约在治疗第2周期后开始出现显著改善（P＜0.05）。两组在治疗结束后的2个随访周期中，最终疗效无统计学差异（P＞0.05）。三组患者治疗后的SF-MPQ-2评分和CMSS评分均较基线下降，但组间差异无统计学意义（均P＞0.05）。机制分析显示，激素治疗和PDT可能通过降低血清前列腺素E2（PGE2）和内皮素-1（ET-1）水平发挥作用（与安慰剂组相比，均P＜0.05）。

结论：本研究揭示了不同级别医院妇产科医师在多囊卵巢综合征患者诊疗实践中的差异，主要体现在内分泌评估、代谢筛查及临床管理策略方面。研究结果提示，需进一步完善分级诊疗体系，并加强不同级别医疗机构间的规范化诊疗培训，以缩小临床实践差距。此外，本研究证实激素治疗与光动力治疗均可有效改善原发性痛经症状。虽然两种治疗方式的远期疗效相当，但其作用机制、起效时间及不良反应特征存在显著差异。临床医师应结合患者个体化需求（如症状特点、治疗偏好及耐受性等因素）制定治疗方案。

Background: Menstrual disorders caused by ovarian dysfunction are important health issues affecting the quality of life of women of childbearing age. The menstrual cycle, duration and menstrual symptoms can all have a significant impact on a woman's life. Polycystic ovary syndrome (PCOS) and primary dysmenorrhea (PD), respectively, as representative diseases with abnormal menstrual cycles and obvious discomfort symptoms during menstruation, have made significant progress in their pathogenesis in recent years. However, there is still a lack of treatment methods with definite efficacy and no side effects. This study focuses on clinical issues and, in combination with the background of hierarchical medical treatment in China, intends to explore the understanding of the medical community regarding the diagnosis and treatment of PCOS and discover effective methods for treating PD, hoping to find a treatment model with better efficacy and fewer side effects.

Method: The first chapter of this study is an analysis of the current situation under a cross-sectional study, with obstetricians and gynecologists from primary, secondary and tertiary hospitals participating in the survey. Obstetricians and gynecologists come from different subspecialties, including gynecologists, obstetricians and gynecological endocrinologists. Chapter Two: Multicenter, randomized, parallel controlled study. Eligible participants were randomly assigned to three groups, namely the placebo group, the oral contraceptive (Marvelon) group and the photodynamic therapy group. Participants received treatment for three consecutive menstrual cycles and were followed up for two cycles after the treatment ended. We recorded the Visual Analogue Scale (VAS) scores, SF-MPQ-2 scores, CMSS scores and the concentrations of pain-related small molecules in the blood of patients in each group before and after treatment to evaluate the therapeutic effects of different treatment methods. The provided and collected data were analyzed using various statistical techniques such as chi-square test, Fisher's exact test and multivariate logistic regression.

Result:

A total of 2,298 questionnaires were received in the cross-sectional survey, among which 13.1% were from primary hospitals, 52.4% from secondary hospitals, and 34.5% from tertiary hospitals. With the improvement of hospital grades, more participants will pay attention to inquiring about the adverse pregnancy history of patients. The higher the grade of the hospital, the more participants will choose AMH and androgen-related evaluations. The higher the hospital grade is, the more participants will choose the oral glucose tolerance test (OGTT) to diagnose insulin resistance, select the Asian BMI standard to diagnose obesity, and evaluate blood lipids at the same time. Participants in primary hospitals (OR = 0.383, 95%CI 0.282-0.520) and secondary hospitals (OR = 0.607, 95%CI 0.481-0.765) were significantly less likely to choose OGTT than those in tertiary hospitals. In contrast, the number of people choosing to undergo lipid profile testing in primary hospitals was significantly lower than that in tertiary hospitals (OR 0.689, 95% CI 0.523-0.909). With the improvement of the hospital level, the participants' understanding of the various therapeutic effects and dosage options of metformin has increased, and the probability of choosing letrozole and assisted reproduction has also increased accordingly.

Compared with the placebo group, both Marvelon and PDT were effective in the treatment of primary dysmenorrhea (VAS scale P < 0.05). The effect of marvelon appears rapidly and can significantly relieve symptoms at the initiation of treatment, while the effect of PDT is relatively slow, showing a significant downward trend approximately in the first two cycles of treatment. There was no significant difference in the final effect between the two during the 2-cycle follow-up after the end of the treatment. Before and after the treatment, the SF-MPQ-2 scores and CMSS scores of all three groups decreased, but there was no significant statistical significance among the three groups. The mechanism for alleviating dysmenorrhea symptoms may be by reducing the concentrations of prostaglandin 2 (PGE2) and endothelin (ET) in the blood (P < 0.05).

Conclusion: This study reveals the differences in endocrine assessment, metabolic screening and management of patients with polycystic ovary syndrome in the obstetrics and gynecology departments of different hospitals. Meanwhile, it emphasizes the need to improve the hierarchical medical system and narrow the knowledge gap among hospitals. Marvelon and PDT therapy are effective methods for treating primary dysmenorrhea. The long-term therapeutic effects of the two are similar, but their treatment characteristics and side effects are different. Patients can choose the appropriate treatment method according to their personal needs.