From the Guidelines
Oral contraceptive pills (OCPs) can decrease Anti-Müllerian Hormone (AMH) levels by 17-23%, but this change is not typically clinically significant, making AMH a relatively reliable marker of ovarian reserve even in women taking hormonal contraception. The effect of OCPs on AMH levels has been studied, with recent findings indicating a decline in AMH levels during the use of combined oral contraception 1. This decrease is thought to be due to the suppression of FSH and LH levels, which can affect follicle growth and AMH production. However, the impact of OCPs on AMH production is minimal compared to their effect on preventing ovulation, and AMH testing can still provide valuable information about ovarian reserve without requiring discontinuation of contraception.
Some studies have shown that the use of OCPs can decrease the follicle count by 30-40%, but this decrease does not necessarily affect the diagnostic accuracy of AMH testing 1. The relationship between OCP use and AMH levels is complex, and more research is needed to fully understand the effects of hormonal contraception on ovarian reserve. However, based on current evidence, AMH testing can be performed at any time during the menstrual cycle and even while on hormonal contraception, providing a relatively reliable estimate of ovarian reserve. If comprehensive fertility testing is required, a healthcare provider may recommend stopping OCPs for 2-3 months before testing to get a more complete picture of the natural hormonal state, as OCPs can mask other important hormonal parameters like FSH and estradiol 1.
Key points to consider:
- OCPs can decrease AMH levels by 17-23% 1
- The decrease in AMH levels is not typically clinically significant
- AMH testing can be performed at any time during the menstrual cycle and even while on hormonal contraception
- OCPs can mask other important hormonal parameters like FSH and estradiol
- Stopping OCPs for 2-3 months before comprehensive fertility testing may be recommended to get a more complete picture of the natural hormonal state 1
From the Research
Effect of Oral Contraceptive Pills on Anti-Müllerian Hormone Levels
- The relationship between Oral Contraceptive Pills (OCP) and Anti-Müllerian Hormone (AMH) levels is complex, with varying effects reported in different studies 2, 3, 4, 5, 6.
- Some studies suggest that OCP use can suppress pituitary gonadotropins and antral follicle development, but may not significantly affect AMH levels 2.
- However, other studies have found that OCP use can lead to decreased AMH levels, with a significant negative influence on AMH observed in some cases 4, 5, 6.
- A cross-sectional study of 27,125 individuals found that current hormonal contraceptive use, including OCP, was associated with lower mean AMH levels compared to non-users, with variability in the percent difference across contraceptive methods 6.
Factors Influencing the Effect of OCP on AMH Levels
- The duration of OCP use may impact AMH levels, with some studies suggesting a positive association between duration of use and AMH levels, although this effect may be small and not clinically meaningful 6.
- The type of contraceptive used may also influence AMH levels, with different methods (e.g. combined oral contraceptive pill, vaginal ring, hormonal intrauterine device) associated with varying degrees of decrease in AMH levels 6.
- Individual factors, such as age, body mass index, and smoking status, may also impact AMH levels and should be considered when interpreting the effects of OCP use on AMH 6.
Clinical Implications
- Clinicians should be aware of the potential impact of OCP use on AMH levels when interpreting results and counseling patients on their fertility status and reproductive lifespan 5, 6.
- The use of OCP may affect ovarian reserve parameters, including AMH, antral follicle count, and ovarian volume, which should be considered when assessing fertility potential 5.