Multiple measurements of anti-müllerian hormone (AMH) and calculating the AMH decline rate over time do not improve the prediction of menopause and early menopause occurrence, according to study results publish in The Journal of Clinical Endocrinology & Metabolism.
In light of the limitations of using a single AMH measurement in menopause prediction, the investigators aimed to assess the use of multiple AMH measurements and the AMH decline pattern in predicting menopause occurrence.
In this study, the researchers used data from the female participants of the Doetinchem Cohort Study. After exclusion of women without an available blood sample, cases of bilateral oophorectomy or hysterectomy, and women with an unknown menopausal status, the study cohort included 2434 premenopausal women. The participants were invited for follow-up every 5 years, during which they completed a questionnaire, had anthropometric measurements recorded, and underwent a blood withdrawal. The study included data following 5 visits, resulting in a follow-up time of approximately 20 years.
A total of 1298 women (53%) reached menopause during the follow-up period (median age at menopause, 51), including 96 women (7.4%) who reached menopause by age 45.
In a 20-year-old participant, lower AMH levels were associated with lower chance of becoming postmenopausal during the follow-up. However, this association reversed from age 25 on. The probability of correctly discriminating occurrence of menopause or early menopause by measurements of AMH at age 20 was equal to tossing a coin (C-statistics, 0.62; 95% CI, 0.60-0.64; and C-statistics, 0.47; 95% CI, 0.40-0.53, respectively).
At age 25, the AMH slope during the previous 5 years predicted the occurrence of menopause better than a single AMH measurement (C-statistics, 0.69; 95% CI, 0.67-0.70 vs C-statistics, 0.64; 95% CI, 0.62-0.66). However, there was no difference between serial or single AMH measurements in predicting early menopause (both C-statistics, 0.73; 95% CI, 0.67-0.80).
In participants older than 25, multiple AMH measurements were not superior to a single measurement for the prediction of menopause occurrence. Furthermore, the model using AMH levels at age 25 and 30 was associated with underestimation of the risk for menopause before the age of 45.
The researchers acknowledged some possible limitations of the study, including the long time interval of 5 years between AMH measurements, use of questionnaires to assess age at menopause, and lack of data on pregnancies and conception rates.
“Our results are an addition to an increasing volume of evidence suggesting that it is unlikely for women seeking advice on family planning to benefit from screening their AMH levels, be it on a single or serial basis,” concluded the investigators.
De Kat AC, van der Schouw YT, Eijekmans MJC, Broer SL, Verschuren WMM, Broekmans FJM. Can menopause prediction be improved with multiple AMH measurements? Results from the prospective Doetinchem Cohort Study [published online April 22, 2019]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-02607