I am 35 and have severely low anti-Mullerian hormone (AMH). I first discovered my situation as a single 30-year-old pursuing egg freezing. After my initial consultation, I had the prerequisite blood draw to assess my hormones. It was discovered that my AMH was abnormally low for my age. I was told I am not a candidate for egg freezing but that my AMH may or may not make it difficult to get pregnant. I was lucky to conceive two children and we don’t plan to have any more, but now it feels as though menopause is on the horizon. Except I don’t know how true that is, because I can’t get a clear answer. Does low AMH predict early menopause?
—Anonymous
As more and more women have access to fertility preservation such as egg freezing, more women are undergoing testing to assess ovarian reserve, and, not surprisingly, many more women are identified as having diminished ovarian reserve.
There are a few ways to diagnose low ovarian reserve, but checking anti-Mullerian hormone (AMH) levels in the blood is a quick and easy way to get a sense of it. AMH is actually made by immature follicles in the ovary.
There is some variability in AMH from one cycle to another, and recent birth control use, a diagnosis of polycystic ovary syndrome (PCOS), and several other factors can affect AMH levels. So a single low measurement may not be indicative of anything, but several low measurements over time may be meaningful. Diminished ovarian reserve can be “overt” — the patient is having irregular periods consistent with perimenopause — or “biochemical,” in which periods are regular.
A review study of the role of AMH in predicting fertility and age at menopause found that the hormone can be a reliable predictor of age at menopause, particularly in younger women before age 40 at risk of primary ovarian insufficiency — that is, menopause before age 40 — or early menopause, defined as menopause before age 45.
Mathematical modeling using AMH to predict age at menopause has been done, but the windows given are so large as to be unhelpful. For example, a 30-year-old woman with an AMH of 1.1 nanograms/milliliter has a mean predicted age of 45 but with a window of anywhere from 37 to 50. A 13-year-window is not so helpful.
What we can say with certainty is that in a woman of any age, an AMH of 0.1 ng/ml means menopause is imminent.
Ultimately, we need more research to determine how best to use AMH as an indicator of age at menopause, but very low levels at any age suggest that a woman will experience menopause very soon.
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“has a mean predicted age of 45 but with a window of anywhere from 37 to 50. A 13-year-window is not so helpful.” – couldn’t find a link to the mathematical modeling referred here. When you say window, did they not have standard deviation or any other way to quantify the spread? Of course there will be a mean and a range/window. I hold this newsletter to a bar that will link references and state meaningful statistics. Hoping to see rigor in future articles. Thank you!