Anti-Müllerian Hormone a Potential Biomarker for Menstrual Disturbance in PCOS

Findings show that anti-Müllerian hormone (AMH) is a strong predictor for menstrual disturbance due to PCOS and that the risk for menstrual disturbance was increased with the degree of elevation of AMH.

Serum anti-Müllerian hormone (AMH) may serve as a useful biomarker in the diagnosis of polycystic ovarian syndrome (PCOS), according to study results published in Frontiers in Endocrinology.

The diagnosis of PCOS is complicated by the heterogeneity of disease presentation. Recent guideline updates have revised the criteria for diagnosis to at least 20 follicle number per ovary as detected by ultrasound. Serum AMH has been shown to correlate with follicle number, and researchers sought to explore the utility of serum AMH level as a biomarker for diagnosis of PCOS.

Data were obtained from women screened for participation in a clinical trial of in vitro fertilization treatment conducted between 2013 and 2016 ( Identifier: NCT01667406). A total of 187 women were included in the study, aged 18 to 35 years with serum AMH level >1.4 ng/mL. Researchers analyzed the relationship between serum AMH levels and characteristic features of PCOS, including menstrual disturbance, total antral follicle count, and serum gonadotropin and androgen levels. Menstrual disturbance was defined by the presence of oligomenorrhea (menstrual cycle intervals ≥35 days, 4-8 periods a year) or amenorrhea (≤3 periods per year).

Among women with serum AMH levels >8.4 ng/mL, the odds for menstrual disturbance were increased 28.5-fold (95% CI, 3.6-227.3) compared with those who had serum AMH levels <2.1 ng/mL. In addition, median serum AMH levels were significantly higher among women with menstrual disturbance compared with women with regular menstrual cycles (9.18 vs 4.87 ng/mL; P <.0001) and were higher among women with all 3 characteristic features of PCOS (menstrual disturbance, polycystic ovarian morphology, and hypoandrogenism) compared with those who exhibited none of the features (9.18 vs 2.04 ng/mL; P <.0001).

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Serum AMH levels also discriminated women with menstrual disturbance from those with regular cycles better than antral follicle count (0.77 vs 0.67 area under receiver operating characteristic [ROC] curve), although the combination of the 2 performed better than either marker alone (0.83 area under ROC curve; 95% CI, 0.77-0.89). A combination of serum AMH and testosterone levels was also found to identify the diagnosis of PCOS using updated clinical guidelines with an area under the ROC curve of 0.77 (95% CI, 0.67-0.85).

The authors noted that the women included in the study were young women seeking fertility treatment, which may limit generalizability, as women over 35 years of age with low serum AMH levels or who were obese were not included.

“[O]ur data suggests that AMH is a strong predictor for menstrual disturbance due to PCOS and that the risk of menstrual disturbance was increased with the degree of elevation of AMH,” the researchers concluded. “AMH is a promising marker for the identification of menstrual disturbance due to PCOS.”

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Abbara A, Eng PC, Phylactou M, et al. Anti-Müllerian hormone (AMH) in the diagnosis of menstrual disturbance due to polycystic ovarian syndrome. Front Endocrinol. 2019;10:656.