Changes in anti-mullerian hormone levels after recovery from functional hypothalamic amenorrhea: a retrospective cohort study about women with and without polycystic ovarian morphology.
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BACKGROUND: Almost half of patients with functional hypothalamic amenorrhea (FHA) show polycystic ovarian morphology (PCOM) on the ultrasound, which leads to a diagnostic confusion. Although FHA and polycystic ovarian syndrome (PCOS) have been thought to co-exist and some FHA-patients seem to have had PCOS before developing FHA, respectively, once hypothalamic inhibition proceeds, the FHA phenotype predominates over the PCOS features, except from PCOM. This connection has never been shown longitudinally. Furthermore, it is still not clear if FHA-PCOM is actually related to preexisting PCOS or if these women constitute their very own heterogeneous subgroup. Thus, the aims of this study were to evaluate changes in hormonal parameters and PCOM after remission and to provide further insight into pathophysiological processes of PCOM in FHA. METHODS: Monocentric retrospective cohort study. Sixty women with FHA in remission were included. While anti-mullerian hormone (AMH) was the main outcome parameter, we also analyzed total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), sex hormone-binding globulin (SHBG) and dehydroepiandrosterone sulfate (DHEAS). PCOM was diagnosed using ultrasound. RESULTS: At baseline, FHA-PCOM patients revealed higher baseline prolactin (p = 0.029) and AMH levels (p < 0.001). At follow-up, compared to women without PCOM, these women had higher PCOM prevalence (48.1% versus 0%, p < 0.001), higher AMH levels (median 6.49 ng/mL, IQR 4.74-7.95 versus median 2.25 ng/mL, IQR 2.0-2.71; p < 0.001) and higher PCOS prevalence (22.2% versus 0%, p = 0.006). While overall median AMH levels increased significantly, FHA-PCOM patients revealed a significant median decrease in AMH levels (median AMH dynamics - 0.82 ng/mL, IQR - 2.30 - -0.16; p < 0.001). CONCLUSIONS: Our data support the hypothesis that relative FSH deficiency in hypothalamic dysfunction can lead to lower AMH levels. In contrast, the decline in AMH levels and the resolution of PCOM in the FHA-PCOM group may indicate a reversible state of ovarian hyperactivation during FHA. TRIAL REGISTRATION: Not applicable.