Does Birth Control Affect AMH Levels and Ovarian Health?

Is there a relationship between AMH and birth control pills? Do birth control pills have a protective effect on the ovaries?

Dear Dr.
Tsao,
I would like to inquire about the significance of some laboratory test results.
I recently had my AMH tested, and the value was 1.18.
My vitamin D level was low at 8.96.
All other values, such as insulin, FSH, AFP, CEA, CA-125, P4, T4, and TSH, were normal.
Due to the popularity of the physician I consulted, I didn't have enough time to ask all my questions before I was asked to leave.

My questions are as follows:
1) Could my AMH level be lower because I had just completed a month of birth control pills (Diane, 21 days) and had the test done on the third day of my menstrual cycle?
2) Since my AMH is low, the doctor mentioned that I might experience premature ovarian failure and an earlier onset of menopause.
Is there any way to slow down this condition, such as taking birth control pills (which I have heard can protect the ovaries, but I haven't researched this in depth)?
3) After finishing the birth control pills, my menstrual flow was very light.
During the heaviest days, a tampon was only half full, and I changed it about three times a day.
However, the duration of my period was longer, with small blood spots appearing on the panty liner.
In the past, when I wasn't on birth control, my periods lasted about 5 to 6 days, but this time it lasted around seven to eight days (with small blood spots).
Is this normal?
4) My birth control pills were prescribed by my family physician to treat acne, and since starting them, I have had fewer deep acne breakouts.
Given my current situation, should I return to my family physician to discuss the acne and AMH issues, or should I see a gynecologist or a fertility specialist? Should I consult both, one for acne and the other for premature ovarian failure? I had the AMH test done based on my family physician's recommendation to understand my basic health status before discussing whether to take Accutane for acne, especially considering my reproductive age and uncertainty about having children.

Thank you very much, Dr.
Tsao!
Best regards,
Da Yu

Da Yu, 30~39 year old female. Ask Date: 2023/11/08

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, with low AMH, we can only observe.
Birth control pills are generally used to regulate menstruation and treat acne.
It's advisable to take birth control pills for a while to see if the acne improves.
Wishing you good health.

Reply Date: 2023/11/08

More Info

Hello, thank you for your detailed questions regarding AMH levels, birth control, and ovarian health. Let's address your concerns one by one.

1. Impact of Birth Control on AMH Levels: AMH (Anti-Müllerian Hormone) is a marker of ovarian reserve, which reflects the number of remaining eggs in the ovaries. Birth control pills, such as the one you mentioned (Diane), can influence hormone levels in the body, but they typically do not have a long-term effect on AMH levels. However, if you tested your AMH shortly after starting the pill, it is possible that the hormonal changes induced by the contraceptive could temporarily affect the measurement. It is generally recommended to wait a few months after stopping birth control before testing AMH to get a more accurate reflection of your ovarian reserve.

2. Ovarian Health and Early Menopause: A low AMH level, such as 1.18 ng/mL, can indicate diminished ovarian reserve, which may be associated with an earlier onset of menopause. While some studies suggest that hormonal contraceptives can help preserve ovarian function by preventing premature ovulation, they do not reverse or significantly alter the underlying ovarian reserve. If you are concerned about early menopause, it is essential to discuss this with your healthcare provider. They may recommend lifestyle changes, dietary adjustments, or specific supplements that could support ovarian health.

3. Changes in Menstrual Cycle After Birth Control: It is not uncommon for menstrual cycles to change after starting or stopping birth control pills. The changes you described—reduced menstrual flow and prolonged duration—can occur as your body adjusts to the hormonal fluctuations. If you notice significant changes or if the bleeding is concerning, it would be wise to consult your healthcare provider for further evaluation. They can help determine if these changes are within normal limits or if further investigation is needed.

4. Consulting Healthcare Providers: Given your situation, it may be beneficial to consult both a gynecologist and a dermatologist. The gynecologist can provide insights into your AMH levels, ovarian health, and any concerns regarding fertility, while the dermatologist can address your acne treatment options, including the use of oral retinoids like Accutane. It is essential to have a comprehensive approach to your health, especially since you are considering your reproductive options.

In summary, while birth control can temporarily influence hormone levels, it is unlikely to have a lasting impact on AMH levels. If you have concerns about your ovarian reserve and potential early menopause, discussing these with a gynecologist is crucial. Additionally, managing your acne with the help of a dermatologist can ensure that both your skin and reproductive health are addressed effectively. It is always best to have open and thorough discussions with your healthcare providers to tailor a plan that suits your individual needs. Thank you for your questions, and I wish you the best in your health journey!

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