Low AMH After Birth Control (Episode 463)

Full Podcast Transcript: Episode 463

Lisa: Welcome to the Fertility Friday Podcast, your source for information about the fertility awareness method and all things fertility. I’m your host Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Charting Workbook. I’m a certified fertility awareness educator and holistic reproductive health practitioner with over 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormone health, and optimizing the menstrual cycle without hormones.

Lisa: Today I’m sharing a brand new episode in my Pill Reality series. I’m sharing a fascinating interview with Amanda. She is a member of the Fertility Friday community, and she reached out to me several months ago to share her experience coming off the pill. What was really interesting about her message is that she had a series of tests done because she came off the pill to try to conceive. She was testing her ovarian reserve parameters, including AMH and FSH, one month after coming off the pill, and then again a few months later, all the way up to a year out. I’m really excited to be here today with Amanda. Your email really stood out to me, and you shared your experience coming off the pill, including how your AMH changed from when you first came off to a year later. This episode puts a very practical face to a lot of the data and research I’ve talked about over the years. So welcome to the show, Amanda.

Amanda: Thank you. I’m glad to be here.

Lisa: I’d love for you to start by leading us into your story. How old were you when you had your first period? When did you go on the pill, and what led you to where you are now?

Amanda: Sure. I think my period started when I was 13. I didn’t go on the pill right away, but I went on it a few years later primarily because of acne. My mom had been on the pill before, my older sister had been on the pill, and when I had quite a lot of acne as a teenager, going on the pill was sort of a natural step. A lot of women are recommended to take that step. I wanted to go on Accutane, which is a major acne medication, but my mom refused. At the time I was frustrated, but now I’m thankful. After that, I was kind of on and off birth control for many years. Perhaps close to 20 years. I’m 39 now. I went off the pill at 38 to try to get pregnant.

Lisa: That’s really interesting. Many women are put on the pill for acne, and it becomes normalized very young.

Amanda: I did have better skin when I was on birth control, but by the time I finally went off at 38, my skin was great anyway. I didn’t need to be on it for that for many years. I also wasn’t sexually active until well into my 20s, so going on birth control as a teenager was unnecessary for me. It taught me very young that the pill was the only way to prevent pregnancy.

Lisa: While you were on the pill over those years, did you notice any side effects or issues?

Amanda: I actually did not notice too many obvious problematic side effects. The longest stretch I was on it was probably seven years. Other than that, I would be on it for acne, then come off, then go back on if I was going to be sexually active again. I’m willing to admit I probably experienced side effects that I just wasn’t aware of at the time. In the past couple of months, being off the pill, I noticed my hair is growing more, like an advancing hairline. I don’t know for sure, but I wonder if that has something to do with being off the pill for over a year.

Lisa: That’s interesting. Were there any other changes you noticed?

Amanda: One major thing is that I had been diagnosed with HPV and had it for about two and a half years, until I went off the pill. After coming off hormonal birth control, I had more testing done, and suddenly it was gone. It was actually your podcast that taught me there is a link between coming off hormonal birth control and clearing HPV. Beyond fertility, I think women need to know that, because HPV can lead to cervical cancer.

Lisa: Yes, the pill doesn’t cause HPV, but long-term use is associated with persistent infection, likely through nutrient depletion like folate and immune effects. Going back to your cycles—when you came off the pill in the past, did your cycle return normally?

Amanda: Yes. My cycles came back normally every time. The last time I came off to try to conceive, I think I ovulated immediately. About a month after stopping, I started tracking basal body temperature, and by the second month off birth control, my BBT confirmed ovulation. I understand many women don’t get ovulation back immediately, so I’m thankful mine returned quickly.
Lisa: So you came off the pill specifically to try to conceive. Take us through what your experience was like at the beginning.

Amanda: One of the first things I did when my husband and I decided to try for a baby was I went to the doctor for a preconception checkup, which I now realize is a total joke for someone coming off birth control. In my experience, the results are not based in reality or based in your actual natural hormonal production. I started doing hormone tests as part of that preconception checkup, and it set me on a path of anxiety and fear, expecting that I would not be able to get pregnant. One of the first data points was FSH, and my very first FSH number was 20.03. Doctors tend to say anything over 10 is unlikely to become pregnant naturally. My doctor looked at that result and said, “You’re probably going to need donor eggs.” So that’s how I started trying to get pregnant—being told I would probably need donor eggs.

Lisa: I want to put this into context. This was one month off birth control, meaning you were still in the post-pill transition phase. FSH is follicle stimulating hormone. It’s released from the pituitary gland at the beginning of the menstrual cycle and helps nudge the ovaries toward ovulation. Coming off the pill, the ovaries are not always as receptive right away, so a high FSH one month off birth control does not mean the same thing as high FSH in a different context. They also tested your AMH. What was that number at one month?

Amanda: At the one month mark, my AMH was 0.13, which was practically undetectable. They say over one is the preferred number to try to get pregnant naturally or using IVF, so that number was extremely low.

Lisa: AMH is anti-Müllerian hormone. It’s produced by developing follicles, and it’s often used as part of ovarian reserve testing. But it’s not a direct measure of fertility potential. It’s an indirect estimate, and it’s often treated in practice as though it’s set in stone. The pill suppresses ovarian function, so if you test AMH while on the pill or shortly after, it will often appear lower. In fact, ovarian volume can be about 50% lower on the pill. It’s not permanent, but it is well documented.

Amanda: When I asked my doctor if being only one month off birth control could explain the FSH result, she said, “We couldn’t possibly know.” She told me I’d have to test again later, and she also said FSH cannot be changed and that it’s determined by your maternal grandmother. At the time, I was floored and terrified.

Lisa: What’s really interesting is that you continued testing at multiple points: one month, three months, nine months, and twelve months. And by twelve months, your results were completely different. There’s a fertility preservation study I referenced in The Fifth Vital Sign. Women who wanted to freeze their eggs came off birth control, and researchers tested ovarian reserve parameters right away, then monthly. What they found was that right off the pill, ovarian reserve markers were suppressed. Over six to seven months, they rebounded and stabilized. The researchers concluded that women planning egg freezing should come off the pill early, because AMH is most useful for predicting IVF stimulation success. The irony is that women trying to conceive naturally are rarely counseled this way, even though the same rebound process applies.

Amanda: Yes. It’s amazing to think that I spent nearly 20 years terrified that if I missed a single day of the pill I would get pregnant immediately.

Lisa: It’s such an important conversation. Women deserve to know what the pill is doing, so they can make informed decisions.

Amanda: And like you said, at the end of twelve months coming off birth control, my AMH was up to 1.25. That’s not an amazing number, but it’s a pretty good number, and it’s high enough to qualify for IVF in a lot of cases. My FSH transformation was even more extraordinary. After twelve months off, my number was 5.9. The best data I could find online suggested that 5.9 is better than the average for a woman much younger than me. To go from “You’re going to need donor eggs” to having an FSH better than a woman in her early 30s was unbelievable.

Lisa: Not every woman will have such a stark transformation, but your story shows why these hormone test results right after stopping birth control should not be treated as permanent. For women coming off the pill, those numbers are not useful until they’ve been off for at least six months, because the body is still in transition.

Amanda: It has been a really traumatic year. I’m now about one year into trying to conceive. I keep trying to remind myself that I’m in a better situation hormonally than I was a year ago, even though I’m a year older. Another factor is that I had polyps removed in October 2022, almost exactly a year after coming off birth control. Between the polyps and the hormones changing rapidly, it’s been really hard, but I do believe I’m in a better position now.

Lisa: I can appreciate how emotionally devastating it is to receive those kinds of diagnoses, especially when AMH is not actually useful for predicting whether a woman can conceive naturally. AMH is most effective at predicting IVF stimulation success, but it is often used incorrectly as a fertility “death sentence,” which is not supported by the research. If you could go back and talk to your younger self, what would you want her to know?

Amanda: I would tell her to get off birth control right away.

Lisa: For the woman listening who feels terrified about getting pregnant right now, what would you say?

Amanda: I’ve thought about this a lot. Assuming I’m able to have a baby, what would I do afterwards? I feel like the only thing that makes sense is fertility awareness charting. I don’t know how I could go back to hormonal methods, and I don’t feel comfortable with physical insertions that could cause damage. I don’t see what else there is other than awareness charting.

Lisa: It’s such a nuanced conversation. Every woman is doing the best she can with what she knows. But my opinion is that when women get into their late 20s and early 30s, it’s worth asking: is this birth control method still serving me? We aren’t told about the temporary delay in fertility after coming off the pill, or that ovarian reserve markers are suppressed for months. When you’re over 35, you have two things happening: natural age-related decline, plus the post-pill transition delay. That’s why, if possible, switching to non-hormonal options earlier can give the body time to normalize.

Amanda: Another thing I really wanted to add was that I did not get any fertile-quality cervical mucus until almost exactly a full year off birth control. I had been listening to people talk about egg-white cervical mucus, and I couldn’t imagine what that meant because I only had watery mucus around ovulation up until a year after stopping the pill. Then, two weeks short of a full year off, it finally showed up, and I was shocked. The first month it came, it was there for six days. The next month, it was there for nine days.

I remember reading that at my age you might expect only one or two days, but when it first came back, it was much more than that. I hope that offers hope to someone listening who feels like they have no fertile cervical mucus. I tried grapefruit juice, Mucinex, and evening primrose oil, and none of those actually turned watery mucus into proper fertile cervical mucus. It really corresponded to what you’ve said—that it takes about a year for things to return to where they should be. I even went to my doctor and asked about fertility-friendly lubricant because I felt like I had no fertile mucus. She told me cervical mucus wasn’t that important and that it was a secondary fertility sign, and I was amazed by that. To me, it showed that hormones were not where they needed to be for conception.

Lisa: Your experience doesn’t surprise me. It’s very typical for mucus to be limited for a while after long-term birth control use. Doctors are not trained in fertility awareness charting, so many don’t understand the role of cervical mucus. But mucus is a primary fertility sign, and it matters. Amanda, this has been such an informative conversation. I’m really thankful that we had this time together. I know this episode is going to be powerful for women listening, especially anyone who has been given that low AMH “sentence” and told they can’t conceive naturally. Thank you so much. It’s been great talking to you.