Researchers Say Anti-Mullerian Hormone Levels May Be Accurate Predictor of Menopause Age
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If early findings are confirmed, researchers say anti-Mullerian hormone (AMH) levels may predict age at menopause within one or two years in women as young as age 30.
Researcher Jeroem van Disseldorp, MD, tells WebMD that the early study shows the hormone to be a more sensitive predictor of age at menopause than chronological age alone.
Van Disseldorp and colleagues from University Medical Center Utrecht in the Netherlands developed a predictive model based on AMH levels in fertile women.
The next step is to see if the women actually reach menopause when the model says they will.
"Right now it looks like AMH is quite sensitive for determining a woman's age at menopause within one or two years," van Disseldorp says. "But we can't say this with certainty yet."
AMH and Menopause
Anti-Mullerian hormone is undetectable in girls until they reach puberty, and after that levels of the hormone appear to increase until around the age of 30.
AMH levels in the blood reflect the number of small follicles present in a woman's ovaries. These follicles enable reproduction by ensuring monthly ovulation.
Low levels of AMH in the blood are indicative of poor ovarian reserve. Because of this, AMH measurement is increasingly being done in women seeking medical treatment for infertility.
The hormone may prove to be an even more useful marker of fertility in this setting than the most widely used assessment, follicle-stimulating hormone (FSH), because unlike FSH, AMH levels do not appear to fluctuate with the menstrual cycle.
In an effort to examine the hormone's potential as an early predictor of menopause, van Disseldorp and colleagues measured AMH levels in 144 healthy, fertile women between the ages of 25 and 45, and the researchers used this information to estimate the change in mean levels of the hormone with age.
Based on these findings, the researchers then estimated the distribution of the age at menopause in a group of 3,384 postmenopausal women between the ages of 50 and 70.
These data were used to develop a model which showed AMH to be a sensitive predictor of menopause for women in their 30s and older, with the possible exception of women who experience menopause much earlier (age 41 or younger) or later (age 57 or older) than normal.
The researchers plan to follow the older, but still fertile women in the study to see if their predicted and actual ages at menopause are the same.
Understanding a Woman's Biological Clock
If the model proves accurate, AMH may one day help women as young as their early 30s better understand their personal biological clocks.
"This would be a better indicator than chronological age, which is what we use now," van Disseldorp says.
But Columbia University menopause researcher Michelle Warren, MD, remains skeptical about the hormone's potential for predicting age at menopause in young women.
Warren is director of the Columbia University Center for Menopause, Hormonal Disorders and Women's Health.
"That remains to be seen," she says. "AMH is finding a place in the evaluation of women seeking treatment for infertility, but we can't say much more than that until more research is done."
SOURCES: van Disseldorp, J. Journal of Clinical Endocrinology & Metabolism, online edition released April 29, 2008. Jeroem van Disseldorp, MD, department of reproductive medicine and gynecology, University Medical Center Utrecht, Netherlands. Michelle Warren, MD, director, Center for Menopause Hormonal Disorders and Women's Health, Columbia University Medical Center, New York City.
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