PGR and obesity due to melanocortin 4 receptor deficiency: For patients who are progesterone-resistant/ineffective (SD, PR-negative, relapse) or those unsuitable for progesterone therapy due to factors like obesity, abnormal liver/renal function, hypercoagulable states, thromboembolic lesions, other pharmacological therapies, such as LNG-IUS and GnRH-a, should be considered.