How well can a hormone test predict the menopause?
A US study of 1537 women aged 42 to 52 years claims that a highly sensitive blood test for an ovarian hormone, anti-Mūllerian hormone (AMH), can predict the timing of a woman’s last menstrual period.
AMH is produced by follicles containing developing eggs in the ovaries. As women age the number of follicles produced decreases, causing the blood AMH concentration to fall to undetectable levels after the menopause. The highly sensitive AMH test used in this study can measure concentrations much lower than those measurable by older tests.
To assess the ability of hormones to predict the menopause, US researchers investigated participants in the Study of Women's Health Across the Nation in their own communities. They tested 1537 multi-ethnic women aged 42 to 52 years who had had at least one menstrual period in the previous three months and who were not taking hormone replacement therapy. A fasting blood sample was taken at 8-10am on day 2-5 of menstruation for the measurement of highly sensitive AMH and follicle stimulating hormone (FSH). Sampling was repeated at follow-up visits at least yearly where possible. These continued until periods had stopped for at least 12 months. The final menstrual period (FMP) was taken as the start of the menopause.
Changes in both AMH and FSH over time have been used in schemes to anticipate the menopause. The researchers found, as expected, highly sensitive AMH concentrations fell and FSH concentrations rose as the menopause approached. They used complex statistical models of AMH and FSH concentrations according to age to calculate the probability that the FMP would occur within the next 12, 24 or 36 months. They found a small but significant advantage of AMH over FSH at 24 and 36 months.
For women with the lowest AMH concentrations (<10 pg/mL), the probability of experiencing their final menstrual period in the next 12 months was 51% for women aged 42 to 47, 63% for those aged 48 to 50 and 79% for those aged 51 and 52. When extended to 36 months, these predictions in the three age groups increased to 78%, 89% and 97%. A high AMH is good at excluding an imminent FMP. High concentrations (>100 pg/mL) gave probabilities of women not having their FMP in the next 12 months of 97%, 96% and 90% in the three age groups.
The researchers concluded that AMH measurement helps estimate when a woman will undergo her final menstrual period and, in general, does so better than FSH. In a News Release, co-senior author Dr Joel Finkelstein of Massachusetts General Hospital, Boston said "Researchers have long thought AMH would be a superior marker of the time to menopause, but tests haven't been sensitive enough to detect the very, very low levels that occur in the year or two leading up to menopause. It took a cohort like the Study of Women's Health Across the Nation, which followed the same women year after year from well before menopause until well after, to get the kind of data necessary to be able to demonstrate the predictive value of AMH.”
The study was funded by the US National Institutes of Health and was published online in the Journal of Clinical Endocrinology & Metabolism on 22 January 2020.