The impact of oral contraceptives and metformin on anti-Müllerian hormone serum levels in women with polycystic ovary syndrome and biochemical hyperandrogenemia

Abstract

Objective. To assess the impact of metformin and of two different oral contraceptives (OCs) containing cyproterone acetate and drospirenone, on serum anti-Müllerian hormone (AMH) levels, in a cohort of women with polycystic ovary syndrome (PCOS) with hyperandrogenism.

Design. Prospective randomised study.

Setting. Division of Endocrinology and Human Reproduction, Aristotle University of Thessaloniki.

Patients. Forty-five (45) women with PCOS diagnosed according to the criteria proposed in 1990 by the NIH.

Interventions. Women with PCOS were randomised into three groups, all treated for 6 months: Group A received an OC containing 35 μg ethinylestradiol plus 2 mg cyproterone acetate, Group B received an OC containing 30 μg ethinylestradiol plus 3 mg drospirenone and Group C received metformin 850 mg × 2.

Main outcome measure(s). Anti-Müllerian hormone levels were measured by a specific ELISA.

Results. AMH was significantly decreased under treatment with 35 μg ethinylestradiol plus 2 mg cyproterone acetate (p = 0.002 at 3 months and p < 0.001 at 6 months). Treatment with 30 μg ethinylestradiol plus 3 mg drospirenone, and treatment with metformin 850 mg × 2 did not significantly affect serum AMH levels. AMH was significantly decreased under OCs treatment compared to metformin 850 mg × 2 (p = 0.005).

Conclusion(s). AMH serum levels were significantly decreased under treatment with 35 μg ethinylestradiol plus 2 mg cyproterone acetate, due to decrease in androgens and suppression of gonadotropins.

Keywords:

• Polycystic ovary syndrome
• hyperandrogenism
• anti-Müllerian Hormone
• oral contraceptives
• metformin

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.