From the Research
Anticoagulation therapy does not have a direct effect on follicle-stimulating hormone (FSH) levels or function. FSH is a gonadotropin hormone produced by the anterior pituitary gland that regulates reproductive processes, while anticoagulants like warfarin, heparin, direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, and dabigatran work on the coagulation cascade to prevent blood clot formation. These medications do not interact with the hypothalamic-pituitary-gonadal axis that controls FSH production and release.
When monitoring patients on anticoagulation therapy, there is no need to adjust FSH testing protocols or interpretation of results based on anticoagulant use. If a patient requires both anticoagulation and fertility treatment or hormone replacement involving FSH, these treatments can generally be administered concurrently without dose adjustments. The physiological separation between the coagulation system and the endocrine pathways governing FSH explains this lack of interaction. However, patients with certain underlying conditions requiring anticoagulation, such as antiphospholipid syndrome, may have reproductive implications independent of the anticoagulant medication itself.
Some studies have evaluated the effects of anticoagulation on various outcomes, such as thromboembolic events and bleeding risks, but none of these studies have investigated the effect of anticoagulation on FSH levels or function 1, 2, 3, 4, 5. The most recent and highest quality study, which compared direct oral anticoagulants with low-molecular-weight heparin for the treatment of cancer-associated thrombosis, did not mention FSH levels or function as an outcome of interest 5.
Key points to consider:
- Anticoagulation therapy and FSH have distinct mechanisms of action and do not interact directly.
- Patients on anticoagulation therapy can undergo FSH testing and fertility treatment without needing to adjust their anticoagulant regimen.
- Certain underlying conditions, such as antiphospholipid syndrome, may have reproductive implications independent of anticoagulant use.
- The current evidence base does not support a direct effect of anticoagulation on FSH levels or function.