In the JournalsPerspective

Blood test can predict final menstrual period

Nanette Santoro

The amount of anti-Müllerian hormone in the blood can be used to estimate when a woman will undergo her final menstrual period and, in general, does so better than measuring follicle-stimulating hormone, according to an analysis of the Study of Women’s Health Across the Nation.

The ability to accurately and precisely predict the final menstrual period has long been a “holy grail” of menopause research, Nanette Santoro, MD, professor and E. Stewart Taylor Chair of Obstetrics and Gynecology at the University of Colorado School of Medicine in Aurora, and colleagues wrote. However, menstrual bleeding patterns, serum follicle-stimulating hormone (FSH) levels or previous anti-Müllerian hormone (AMH) assays could predict the final menstrual period only within a window of 4 years, which is not clinically useful.

“There are two messages: One is the scientific, physiologic one that tells us that AMH is sufficiently reflective of ovarian reserve, that its measurement can predict follicle loss more precisely than ever before,” Santoro told Healio. “Then there is the clinical message that there is now a blood test that can predict the final menstrual period.”

In a prospective, longitudinal study, Santoro and colleagues analyzed AMH and FSH data from 1,537 pre- or early perimenopausal women participating in the Study of Women’s Health Across the Nation (SWAN), a community-based study of the menopause transition (mean age at baseline, 48 years; 761 white). Hormone measurements took place at baseline and yearly until 12 months of amenorrhea occurred (mean time to final menstrual period, 57 months). AMH was measured using a two-site, enzyme-linked immunoassay (MenoCheck picoAMH ELISA, Ansh Labs) with a detection limit of 1.85 pg/mL.

 
The amount of anti-Müllerian hormone in the blood can be used to estimate when a woman will undergo her final menstrual period and, in general, does so better than measuring follicle-stimulating hormone.
Source: Shutterstock

Primary outcomes were area under the receiver operating characteristic curve for AMH-based and FSH-based predictions of time to final menstrual period, stratified by age. Probabilities that women would undergo their final menstrual period during the next 12, 24 or 36 months across a range of AMH values were assessed.

Researchers found that AUCs for predicting that the final menstrual period will occur within the next 24 months were greater for AMH-based vs. FSH-based models. The AUC for predicting the final menstrual period within 24 months was 0.891 for AMH (95% CI, 0.084-0.9) and 0.877 for FSH (95% CI, 0.869-0.885).

The probability that a woman with an AMH level of less than 10 pg/mL would experience her final menstrual period within the next 12 months ranged from 51% at age 48 years or younger to 79% when aged at least 51 years. The probability that a woman with an AMH level of at least 100 pg/mL would not undergo her final menstrual period within the next 12 months ranged from 97% in women aged 48 years or younger to 90% in women aged at least 51 years.

“Women who wish to have a clearer idea of when their last menstrual period will occur can use this test to help make decisions,” Santoro said. “It is not for everyone. Women on hormonal contraception may have falsely low AMH levels and women with certain medical conditions may also have falsely low AMH, and in those cases, it won’t be reliable.”

Santoro added that such a test may be beneficial for women who want to know how much longer they will need contraception, who are considering surgery for gynecologic problems, or who are considering medication for menopausal symptoms.

“These findings are encouraging, and we would like to see if we can define AMH profiles over time and whether they enhance prediction models,” Santoro said. “For example, a woman who has a very steeply dropping AMH may be more likely to have menopause sooner, so more than 1 AMH level taken over a few years may wind up being even more precise. It is also possible that a more sensitive test will be even better.” – by Regina Schaffer

For more information:

Nanette Santoro, MD, can be reached at the University of Colorado School of Medicine, 12631 E. 17th Ave., Room 4004, Mail Stop B-198, Aurora, CO 80045; email: Nanette.santoro@cuanschutz.edu.

Disclosures: One of the study authors reports he is an employee of Ansh Labs. Another author was an employee of Ansh Labs at the time the study began; he reports he is now an employee of Motive Biosciences.

Nanette Santoro

The amount of anti-Müllerian hormone in the blood can be used to estimate when a woman will undergo her final menstrual period and, in general, does so better than measuring follicle-stimulating hormone, according to an analysis of the Study of Women’s Health Across the Nation.

The ability to accurately and precisely predict the final menstrual period has long been a “holy grail” of menopause research, Nanette Santoro, MD, professor and E. Stewart Taylor Chair of Obstetrics and Gynecology at the University of Colorado School of Medicine in Aurora, and colleagues wrote. However, menstrual bleeding patterns, serum follicle-stimulating hormone (FSH) levels or previous anti-Müllerian hormone (AMH) assays could predict the final menstrual period only within a window of 4 years, which is not clinically useful.

“There are two messages: One is the scientific, physiologic one that tells us that AMH is sufficiently reflective of ovarian reserve, that its measurement can predict follicle loss more precisely than ever before,” Santoro told Healio. “Then there is the clinical message that there is now a blood test that can predict the final menstrual period.”

In a prospective, longitudinal study, Santoro and colleagues analyzed AMH and FSH data from 1,537 pre- or early perimenopausal women participating in the Study of Women’s Health Across the Nation (SWAN), a community-based study of the menopause transition (mean age at baseline, 48 years; 761 white). Hormone measurements took place at baseline and yearly until 12 months of amenorrhea occurred (mean time to final menstrual period, 57 months). AMH was measured using a two-site, enzyme-linked immunoassay (MenoCheck picoAMH ELISA, Ansh Labs) with a detection limit of 1.85 pg/mL.

 
The amount of anti-Müllerian hormone in the blood can be used to estimate when a woman will undergo her final menstrual period and, in general, does so better than measuring follicle-stimulating hormone.
Source: Shutterstock

Primary outcomes were area under the receiver operating characteristic curve for AMH-based and FSH-based predictions of time to final menstrual period, stratified by age. Probabilities that women would undergo their final menstrual period during the next 12, 24 or 36 months across a range of AMH values were assessed.

Researchers found that AUCs for predicting that the final menstrual period will occur within the next 24 months were greater for AMH-based vs. FSH-based models. The AUC for predicting the final menstrual period within 24 months was 0.891 for AMH (95% CI, 0.084-0.9) and 0.877 for FSH (95% CI, 0.869-0.885).

The probability that a woman with an AMH level of less than 10 pg/mL would experience her final menstrual period within the next 12 months ranged from 51% at age 48 years or younger to 79% when aged at least 51 years. The probability that a woman with an AMH level of at least 100 pg/mL would not undergo her final menstrual period within the next 12 months ranged from 97% in women aged 48 years or younger to 90% in women aged at least 51 years.

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“Women who wish to have a clearer idea of when their last menstrual period will occur can use this test to help make decisions,” Santoro said. “It is not for everyone. Women on hormonal contraception may have falsely low AMH levels and women with certain medical conditions may also have falsely low AMH, and in those cases, it won’t be reliable.”

Santoro added that such a test may be beneficial for women who want to know how much longer they will need contraception, who are considering surgery for gynecologic problems, or who are considering medication for menopausal symptoms.

“These findings are encouraging, and we would like to see if we can define AMH profiles over time and whether they enhance prediction models,” Santoro said. “For example, a woman who has a very steeply dropping AMH may be more likely to have menopause sooner, so more than 1 AMH level taken over a few years may wind up being even more precise. It is also possible that a more sensitive test will be even better.” – by Regina Schaffer

For more information:

Nanette Santoro, MD, can be reached at the University of Colorado School of Medicine, 12631 E. 17th Ave., Room 4004, Mail Stop B-198, Aurora, CO 80045; email: Nanette.santoro@cuanschutz.edu.

Disclosures: One of the study authors reports he is an employee of Ansh Labs. Another author was an employee of Ansh Labs at the time the study began; he reports he is now an employee of Motive Biosciences.

    Perspective
    Andrea Dunaif

    Andrea Dunaif

    This is a nice proof-of-concept study demonstrating that AMH level correlates with the number of follicles, which can be predictive of menopause. The predictive value of 97% for women younger than 48 years is quite good and could be useful for counseling women. There are women who certainly want to have some idea of when their menses are going to stop. The question I get even more with my patients is they will report symptoms that are not classic menopausal symptoms and ask if they are reflective of the menopause transition. This test could help a clinician confirm that.

    The problem is that you need a good AMH assay. Not all AMH assays are the same, and accessibility of the right one is key. This will require education.

    Levels can be helpful, but people don’t always appreciate that there is a lot of variability among assays. One cannot simply translate values from a clinical article into practice.

    • Andrea Dunaif, MD
    • Endocrine Today Editorial Board Member
      Professor of molecular medicine and system chief of the division of endocrinology, diabetes and bone disease
      Icahn School of Medicine
      Mount Sinai Health System

    Disclosures: Dunaif reports no relevant financial disclosures.