EXECUTIVE SUMMARY

Results of a new study established that levels of anti-Müllerian hormone (AMH) can predict when a woman’s final menstrual period will occur. By measuring AMH levels, clinicians have an indicator of how many eggs a woman has remaining. Women are born with a finite supply of eggs that diminishes as menopause is approached.

• The results of the research were part of the scientific evidence presented to the FDA for the 2018 approval of MenoCheck, an assay kit used to determine menopausal status in women ages 42-62 years.


More than 50 million U.S. women this year will be older than 51.1 Since menopause occurs at an average age of 52 years, how can clinicians help women better determine their final menstrual period?

Results of a new study established that levels of anti-Müllerian hormone (AMH) can predict when a woman’s final menstrual period will occur.2 By measuring AMH levels, clinicians have an indicator of how many eggs a woman has remaining. Women are born with a finite supply of eggs that diminishes as menopause is approached.

Data come from a prospective longitudinal cohort study conducted as part of the Study of Women’s Health Across the Nation (SWAN). Scientists examined blood tests from 1,537 women ages 42-63 years. While the long-term SWAN study monitored women’s health changes as they moved through the menopausal transition, for the current study, participants’ blood samples were tested for AMH levels as well as follicle-stimulating hormone.

To measure the participants’ AMH levels, scientists used a more sensitive test than what previously had been available. With the enhanced sensitivity, scientists predicted the final menstrual period timing within 12 to 24 months in women in their late 40s and early 50s.2

The results were part of the scientific evidence presented to the FDA for the 2018 approval of MenoCheck, an assay kit used to determine menopausal status in women ages 42-62. The assay offers adequate sensitivity to measure declining AMH concentrations in women who are entering menopause.

Which women may benefit from knowing their menopausal status? While it may not be necessary to test all women, there are several instances where it can be helpful for a woman and her healthcare provider to forecast her final menstrual period with greater precision, says Nanette Santoro, MD, professor and E. Stewart Taylor Chair of Obstetrics and Gynecology at the University of Colorado School of Medicine.

For example, a woman who does not experience gynecological problems, is in a monogamous relationship with a sterile man, and notes a late onset of her menopause with minimal symptoms will not be motivated to answer this question in advance, notes Santoro. However, Santoro, who served as co-lead author of the study, lists several conditions where testing may be advantageous:

• Contraceptive decisions. Santoro offers the example of a 50-year-old woman with a levonorgestrel intrauterine device (IUD) who is looking to replace it in two years. With AMH testing, she may determine that she is highly likely to experience her final menses before then and will not need to replace the IUD, based on a very low AMH level. Conversely, a 48-year-old woman who has a very high AMH, but the same IUD and timing issues would be unlikely to experience her final menses, and should continue her IUD.

“Because both [levonorgestrel] IUD and implant methods do not appreciably suppress the production of follicle-stimulating hormone [FSH] and luteinizing hormone [LH], but may change the menstrual pattern, these women cannot rely on menstrual patterns to make this prediction. An AMH is helpful,” says Santoro.

Clinicians should remember an important caveat: Since FSH, LH, and AMH are suppressed in women taking combined hormonal contraception, the test will not be predictive. It cannot be used to answer the question, “When can I stop my birth control pills?,” but it can be used with these other methods, Santoro advises.

• Surgical decisions. A woman with heavy menstrual bleeding from fibroids, adenomyosis, or idiopathic origin stands to benefit from knowing how much longer she has to deal with her symptoms, says Santoro.

“If she is 50, with a very low AMH, she may just want to temporize with medical management to get to menopause,” Santoro explains. “However, if she is 48 with a high AMH, she will know that she is facing years more of disruptive menstrual periods and may opt for surgery — hysterectomy, myomectomy, or endometrial ablation, depending on the exact problem.”

• Accurate diagnosis. Not all cases of amenorrhea in women in their 40s and 50s are due to menopause, says Santoro. Some cases are from pituitary tumors and other rare conditions. If the signs and symptoms are atypical, an AMH level can help to distinguish between menopause and other causes, she states.

REFERENCES

  1. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015;100:3975-4011.
  2. Finkelstein JS, Lee H, Karlamangla A, et al. Anti-Müllerian hormone and impending menopause in late reproductive age: The Study of Women’s Health Across the Nation. J Clin Endocrinol Metab 2020; doi: 10.1210/clinem/dgz283.