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

Objective. To assess the impact of metformin and of two different oral contraceptives (OCs) containing cyproterone acetate and drospirenone, on serum anti-Mullerian 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 mg ethinylestradiol plus 2 mg cyproterone acetate, Group B received an OC containing 30 mg ethinylestradiol plus 3 mg drospirenone and Group C received metformin 850 mg x 2. Main outcome measure(s). Anti-Mullerian hormone levels were measured by a specific ELISA. Results. AMH was significantly decreased under treatment with 35 mu g ethinylestradiol plus 2 mg cyproterone acetate (p = 0.002 at 3 months and p < 0.001 at 6 months). Treatment with 30 mu g ethinylestradiol plus 3 mg drospirenone, and treatment with metformin 850 mg x 2 did not significantly affect serum AMH levels. AMH was significantly decreased under OCs treatment compared to metformin 850 mg x 2 (p = 0.005). Conclusion(s). AMH serum levels were significantly decreased under treatment with 35 mu g ethinylestradiol plus 2 mg cyproterone acetate, due to decrease in androgens and suppression of gonadotropins.