Antimüllerian hormone levels decrease in women using combined contraception independently of administration route

Capsule:
In young healthy, normal weight women, continuous use of combined contraception leads to a decrease in serum AMH levels independently of administration route.

Authors:
Sanna Kallio, M.D., Johanna Puurunen, M.D., Aimo Ruokonen, M.D., Ph.D., Tommi Vaskivuo, M.D., Ph.D., Terhi Piltonen, M.D., Ph.D., Juha S. Tapanainen, M.D., Ph.D.

Volume 99, Issue 5, Pages 1305-1310, April 2013

Abstract:

Objective:
To compare the effects of continuous use of oral, transdermal and vaginal combined contraceptives (CCs) on the pituitary-ovarian axis and inhibition of follicular development.

Design:
Spin-off study of a prospective, randomized trial.

Setting:
University clinic.

Patients:
Forty-two of 54 healthy women completed the study.

Interventions:
Treatment with combined oral contraceptives (ethinyl estradiol [EE] and desogestrel), transdermal patches (EE and norelgestromin) or vaginal rings (EE and etonogestrel) for 9 weeks continuously. Blood sampling was performed before and at 5 and 9 weeks of treatment.

Main Outcome Measures:
Changes in serum hormone levels induced by CCs.

Results:
Serum AMH, FSH, inhibin B, LH and estradiol (E2) levels had decreased significantly in all study groups after 9 weeks of treatment. Significant declines were already detected after 5 weeks’ use of CCs as regards all hormone levels apart from those of serum AMH, where the decrease between baseline and 5 weeks was only moderate. Between groups, serum levels of AMH, inhibin B, LH, and E2 were comparable at baseline and after 5 and 9 weeks of treatment.

Conclusions:
The decrease of serum AMH levels during the use of all CCs indicates that folliculogenesis is arrested independently of administration route.

Trial Registration Number:
NCT01087879

  • laurenwroth

    This provides interesting information to the growing literature regarding AMH. I agree with previous commenter that information on return to baseline values would be really interesting. Using prolonged continuous OCPs should be investigated as a method to decrease OHSS in those at risk in preparation for IVF (especially women with PCOS).

  • j.utah

    Thank you for this interesting article characterizing changes in pituitary ovarian axis regulation with various routes of continuously administered combined contraceptive methods. A question for the authors, did you collect any samples after the nine week time point to follow the return to baseline in AMH values?

    It was interesting to note the markedly reduced levels of AMH after just 9 weeks of continuous combined contraceptive use. It would be interesting to investigate how the long term use of continuous oral contraceptive pills prior to a long agonist protocol affects ovarian response for our endometriosis patients on similar regimens prior to their IVF cycles.

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