LONGITUDINAL EXAMINATION OF THE ASSOCIATION BETWEEN HORMONAL CONTRACEPTIVE USE AND ANTI-MÜLLERIAN HORMONE (AMH) LEVELS IN REPRODUCTIVE-AGED AFRICAN-AMERICAN WOMEN

Abstract

To determine the impact of hormonal contraceptive (HC) use on trends in AMH levels in a longitudinal cohort of reproductive-aged African American women (AAW). This study used an established cohort of AAW from Detroit, MI aged 25 to 35 years, who were recruited as a part of the Study of the Environment, Lifestyle and Fibroids. Anthropometric measurements, self-reported health history, and serum AMH levels (picoAMH assay, Ansh Labs, Webster, TX) were collected from participants at 4 visits over 5 years. All types of HC were included. Percent changes in AMH levels were calculated from baseline to final visit and compared across groups with different patterns of HC use using linear regression models, adjusting for age, BMI, history of abnormal menstrual bleeding, thyroid disorder, and a history of infertility. The effect of starting, continuing, or stopping HC on rate of change in AMH for all follow up visits was also assessed using linear mixed models adjusted for age. A total of 1531 women were included with a mean age of 29.2 ± 3.4 years and a median AMH of 4.07 (IQR 2.29 - 6.70) ng/mL at baseline. At the final follow-up visit, mean age was 34.1 ± 3.4 years and median AMH was 2.97 (IQR 1.52 - 5.15) ng/mL, with a 19.8% average decline in AMH. Women who started and continued HC during the study period had significantly greater % decrease in AMH levels (-23.1%, 95% CI -40.3%, -5.9%) compared with women who never used HC. When compared with women who never used HC, the % change in AMH levels among women who started and stopped HC during the study was -14.4% (95% CI -29.3%, 0.5%), among women who only used HC prior to the study was -13.5%, (95% CI -26.9%, -0.1%) , and among long-term users of HC (on HC before and throughout study period) was -8.7% (95% CI -24.6%, 7.2%). We next sought to determine whether the rate of decline in AMH was impacted by the recency of HC start or discontinuation. Women who started HC between study visits had a faster rate of decline in AMH levels compared with women not on HC at their previous or current visit, (-11.9%; 95% CI -15.5%, -8.0%), while women who used HC at a previous visit but discontinued prior to the most recent visit had a slower rate of decline in AMH (10.7% 95% CI 6.7%, 15.0%). There was no difference in rate of decline among women who continued HC between visits (2.3%, 95% CI -0.6%, 5.7%) compared to those who were not on HC between visits. In this study, the % decline in AMH levels with age was greatest among those who started and continued HC during the study period. This finding, along with the non-significant difference in % decrease with age in AMH levels among long-term HC users, suggests that the impact of HC use on AMH may be most significant after initiation with recovery of AMH following stoppage of HC suggested by the smaller decline with age in this subset of women. Thus, the impact of HC on AMH levels appears reversible. In addition, being on HC neither increases nor protects against the age related rate of decline.