ABSTRACT
Background: Anti-Mullerian hormone (AMH) is secreted by small antral follicles and is elevated in PCOS. Unlike serum total testosterone, its value remains constant irrespective of the phase of menstrual cycle. Serum AMH could prove to be a promising marker of disease activity and response to therapy. Combined estrogen-progestin (CEP) pills are considered treatment of choice in PCOS, but their effect on serum AMH has not been widely studied. Objective: To study the effect of six months of CEP pills on serum AMH and testosterone in PCOS patients. Methods: 55 consecutive females, above 18 years and diagnosed with PCOSby Rotterdam Criteria, who attended our outpatient clinic from July 2020 to April 2021, were enrolled. Hirsutism was assessed by modified Ferriman-Gallwey Scoring (mFGS). Serum AMH and total testosterone were measured at baseline, and all the patients were initiated on combination of ethinyl estradiol (35 mcg) with cyproterone acetate (2 mg), to be taken orally for 21 days every month for a period of 6 months. Serum AMH and total testosterone were reassessed again after 6 months of CEP therapy. Out of total 55 patients, 14 were lost to follow up due to Covid-19 pandemic. A total of 24 patients completed 6 months of CEP therapy, while remaining discontinued the treatment after a mean period of 2 months because of perceived adverse effects. Results: Mean age of study population was 22.8 ± 4.4 years. At baseline, hyperandrogenic features like acne, hirsutism and hair fall were present in 41 (74.5%), 35 (63.6%) and 42 (76.4%) females, respectively. Mean mFGS was 5.6 ± 2.8. Oligomenorrhoea was reported by38 (69.1%) females. Mean AMH levels and testosterone were 12.1 ± 7.1 ng/ml and 46.6 ± 20.1 ng/dl, respectively. There were 17 (30.9%) patients who had testosterone 360 ng/dl, while 42 females (76.3%) had high AMH levels (36.8 ng/ml). Baseline AMH positively correlated with BMI and serum LH level. Post-treatment, there was significant decrease inacne, hirsutism and hair fall (P < 0.001 for all). Mean mFGS (5.6 ± 2.8 vs 4.2 ± 2, P < 0.001) and mean serum AMH levels (12.1 ± 7.1 ng/ml vs 10.4 ± 7 ng/ml, P = 0.002) demonstrated a significant improvement. Serum testosterone levels decreased post therapy (46.6 ± 20.1 vs 42.3 ± 17.4 ng/dl, P = 0.08), but did not reach statistical significance (table 1). Testosterone and AMH levels did not show any correlation (R = 0.054, P = 0.7). Conclusions: AMH levels show a significant decline after 6 months of treatment, corresponding to improvement in hyperandrogenic symptoms and mFGS. AMH can prove to be a promising marker of disease activity in PCOS. The major limitation of the study was its small sample size, and more robust studies are needed.