Bernardi Lia A, Weiss Marissa Steinberg, Waldo Anne, Harmon Quaker, Carnethon Mercedes R, Baird Donna D, Wise Lauren A, Marsh Erica E
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
Fertil Steril. 2021 Jul;116(1):208-217. doi: 10.1016/j.fertnstert.2021.02.007. Epub 2021 Mar 19.
To assess whether the duration, recency, or type of hormonal contraceptive used is associated with antimüllerian hormone (AMH) levels, given that the existing literature regarding the association between hormonal contraceptive use and AMH levels is inconsistent.
Cross-sectional study.
Baseline data from the Study of the Environment, Lifestyle and Fibroids Study, a 5-year longitudinal study of African American women.
PATIENT(S): The patients were 1,643 African American women aged 23-35 years at the time of blood drawing (2010-2012).
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Serum AMH level was measured by an ultrasensitive enzyme-linked immunosorbent assay. Linear regression models were used to estimate percent differences in mean AMH levels and 95% confidence intervals (CIs) according to use of hormonal contraceptives, with adjustment for potential confounders.
RESULT(S): In multivariable-adjusted analyses, current users of hormonal contraceptives had 25.2% lower mean AMH levels than non-users of hormonal contraceptives (95% CI: -35.3%, -13.6%). There was little difference in AMH levels between former users and non-users of hormonal contraceptives (-4.4%; 95% CI: -16.3%, 9.0%). AMH levels were not appreciably associated with cumulative duration of use among former users or time since last use among non-current users. Current users of combined oral contraceptives (-24.0%; 95% CI: -36.6%, -8.9%), vaginal ring (-64.8%; 95% CI: -75.4%, -49.6%), and depot medroxyprogesterone acetate (-26.7%; 95% CI: -41.0%, -8.9%) had lower mean AMH levels than non-users.
CONCLUSION(S): The present data suggest that AMH levels are significantly lower among current users of most forms of hormonal contraceptives, but that the suppressive effect of hormonal contraceptives on AMH levels is reversible.
鉴于现有关于激素避孕药使用与抗苗勒管激素（AMH）水平之间关联的文献不一致，评估使用激素避孕药的持续时间、近期使用情况或类型是否与AMH水平相关。
横断面研究。
来自环境、生活方式与子宫肌瘤研究的基线数据，这是一项针对非裔美国女性的为期5年的纵向研究。
患者为1643名在采血时（2010 - 2012年）年龄在23 - 35岁的非裔美国女性。
无。
采用超灵敏酶联免疫吸附测定法测量血清AMH水平。使用线性回归模型根据激素避孕药的使用情况估计平均AMH水平的百分比差异和95%置信区间（CI），并对潜在混杂因素进行调整。
在多变量调整分析中，当前使用激素避孕药的女性平均AMH水平比未使用激素避孕药的女性低25.2%（95%CI：-35.3%，-13.6%）。曾经使用激素避孕药者与未使用者的AMH水平差异不大（-4.4%；95%CI：-16.3%，9.0%）。AMH水平与曾经使用者的累积使用时间或非当前使用者自上次使用以来的时间没有明显关联。当前使用复方口服避孕药（-24.0%；95%CI：-36.6%，-8.9%）、阴道环（-64.8%；95%CI：-75.4%，-49.6%）和醋酸甲羟孕酮长效避孕针（-26.7%；95%CI：-41.0%，-8.9%）的女性平均AMH水平低于未使用者。
目前的数据表明，大多数形式的激素避孕药当前使用者的AMH水平显著较低，但激素避孕药对AMH水平的抑制作用是可逆的。
