Korean J Obstet Gynecol.  2012 Feb;55(2):89-97. 10.5468/KJOG.2012.55.2.89.

Anti-Mullerian hormone, follicle-stimulating hormone, antral follicle count, and clinical findings as predictive markers of menopause in late reproductive-aged women

• Kim SM
• Kim SH
• Lee JR
• Jee BC
• Suh CS
• Lee JY
• Kim KC
• Hwang DY
• Kim JG
• Moon SY

• KMID: 2078120
• DOI: http://doi.org/10.5468/KJOG.2012.55.2.89

Abstract

OBJECTIVE
To assess the efficiency of anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol, antral follicle count (AFC), endometrial thickness (EMT), and clinical findings as predictive markers of menopause in late reproductive-aged Korean women.
METHODS
A cohort of 104 women, aged 45 to 55 years in their menopausal transition were selected. The participants were assessed twice (T1 and T2) at a mean interval of 13.1 months. At each time, their menstrual history was determined; pelvic ultrasonography was performed to evaluate AFC and EMT; blood sampling was done. A logistic regression analysis using the SPSS ver. 17.0 was performed, with the outcome measure of menopause at T2.
RESULTS
Of the 104 participants, 33 were postmenopausal based on their menstrual history at T2. Compared with women who stayed in the menopausal transition period, those who became postmenopausal at T2 differed significantly with regard to the following factors at T1: FSH, estradiol, EMT, AFC, days from the last menstrual cycle, and interval between the last 2 cycles. However, AMH levels were not different between the groups. Of all the parameters, a longer number of days from the last menstrual cycle and time interval between the last 2 cycles were significantly associated with the occurrence of menopause.
CONCLUSION
This study indicates that AMH is not a predictive marker of menopause in late reproductive-aged women over a relatively short timeframe (range, 0.5 to 2.5 years). Time since the last menstruation at T1 was a better predictor of menopause.

Keyword

Menopausal transition period; Anti-Mullerian hormone; Follicle stimulating hormone; Antral follicle count; Last menstrual period

MeSH Terms

Aged
Anti-Mullerian Hormone
Carbamates
Cohort Studies
Estradiol
Female
Follicle Stimulating Hormone
Humans
Logistic Models
Menopause
Menstrual Cycle
Menstruation
Organometallic Compounds
Outcome Assessment (Health Care)
Anti-Mullerian Hormone
Carbamates
Estradiol
Follicle Stimulating Hormone
Organometallic Compounds

Figure

• 

  Fig. 1 Receiver operating characteristic (ROC) curves of selected markers after multiple logistic regression analysis for predicting menopause at T2. MCD, menstrual cycle day; LMP, last menstrual period; PMP, previous menstrual period.

Reference

1. Treloar AE. Menstrual cyclicity and the pre-menopause. Maturitas. 1981. 3:249–264.

2. Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W, et al. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Fertil Steril. 2001. 76:874–878.

3. Grodstein F, Manson JE, Stampfer MJ. Hormone therapy and coronary heart disease: the role of time since menopause and age at hormone initiation. J Womens Health (Larchmt). 2006. 15:35–44.

4. Rossouw JE, Prentice RL, Manson JE, Wu L, Barad D, Barnabei VM, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. 2007. 297:1465–1477.

5. Salpeter SR, Walsh JM, Greyber E, Ormiston TM, Salpeter EE. Mortality associated with hormone replacement therapy in younger and older women: a meta-analysis. J Gen Intern Med. 2004. 19:791–804.

6. Burger HG, Hale GE, Robertson DM, Dennerstein L. A review of hormonal changes during the menopausal transition: focus on findings from the Melbourne Women's Midlife Health Project. Hum Reprod Update. 2007. 13:559–565.

7. Hale GE, Zhao X, Hughes CL, Burger HG, Robertson DM, Fraser IS. Endocrine features of menstrual cycles in middle and late reproductive age and the menopausal transition classified according to the Staging of Reproductive Aging Workshop (STRAW) staging system. J Clin Endocrinol Metab. 2007. 92:3060–3067.

8. Rigon C, Andrisani A, Forzan M, D'Antona D, Bruson A, Cosmi E, et al. Association study of AMH and AMHRII polymorphisms with unexplained infertility. Fertil Steril. 2010. 94:1244–1248.

9. Lee JR, Kim SH, Kim SM, Jee BC, Ku SY, Suh CS, et al. Follicular fluid anti-Mullerian hormone and inhibin B concentrations: comparison between gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist cycles. Fertil Steril. 2008. 89:860–867.

10. Fanchin R, Mendez Lozano DH, Frydman N, Gougeon A, di Clemente N, Frydman R, et al. Anti-Mullerian hormone concentrations in the follicular fluid of the preovulatory follicle are predictive of the implantation potential of the ensuing embryo obtained by in vitro fertilization. J Clin Endocrinol Metab. 2007. 92:1796–1802.

11. Shin SY, Lee JR, Noh GW, Kim HJ, Kang WJ, Kim SH, et al. Analysis of serum levels of anti-Mullerian hormone, inhibin B, insulin-like growth factor-I, insulin-like growth factor binding protein-3, and follicle-stimulating hormone with respect to age and menopausal status. J Korean Med Sci. 2008. 23:104–110.

12. Sowers MR, Eyvazzadeh AD, McConnell D, Yosef M, Jannausch ML, Zhang D, et al. Anti-mullerian hormone and inhibin B in the definition of ovarian aging and the menopause transition. J Clin Endocrinol Metab. 2008. 93:3478–3483.

13. La Marca A, De Leo V, Giulini S, Orvieto R, Malmusi S, Giannella L, et al. Anti-Mullerian hormone in premenopausal women and after spontaneous or surgically induced menopause. J Soc Gynecol Investig. 2005. 12:545–548.

14. van Rooij IA, Tonkelaar I, Broekmans FJ, Looman CW, Scheffer GJ, de Jong FH, et al. Anti-mullerian hormone is a promising predictor for the occurrence of the menopausal transition. Menopause. 2004. 11:601–606.

15. Tehrani FR, Solaymani-Dodaran M, Azizi F. A single test of antimullerian hormone in late reproductive-aged women is a good predictor of menopause. Menopause. 2009. 16:797–802.

16. van Disseldorp J, Faddy MJ, Themmen AP, de Jong FH, Peeters PH, van der Schouw YT, et al. Relationship of serum antimullerian hormone concentration to age at menopause. J Clin Endocrinol Metab. 2008. 93:2129–2134.

17. Flaws JA, Langenberg P, Babus JK, Hirshfield AN, Sharara FI. Ovarian volume and antral follicle counts as indicators of menopausal status. Menopause. 2001. 8:175–180.

18. Giacobbe M, Mendes Pinto-Neto A, Simões Costa-Paiva LH, Martinez EZ. The usefulness of ovarian volume, antral follicle count and age as predictors of menopausal status. Climacteric. 2004. 7:255–260.

19. Broer SL, Eijkemans MJ, Scheffer GJ, van Rooij IA, de Vet A, Themmen AP, et al. Anti-mullerian hormone predicts menopause: a long-term follow-up study in normoovulatory women. J Clin Endocrinol Metab. 2011. 96:2532–2539.

20. Flaws JA, Rhodes JC, Langenberg P, Hirshfield AN, Kjerulff K, Sharara FI. Ovarian volume and menopausal status. Menopause. 2000. 7:53–61.

21. Scheffer GJ, Broekmans FJ, Looman CW, Blankenstein M, Fauser BC, teJong FH, et al. The number of antral follicles in normal women with proven fertility is the best reflection of reproductive age. Hum Reprod. 2003. 18:700–706.

22. Yang YS, Hur MH, Kim SY, Young K. Correlation between sonographic and endocrine markers of ovarian aging as predictors for late menopausal transition. Menopause. 2011. 18:138–145.

23. Irmak MK. Self-fertilization in human: having a male embryo without a father. Med Hypotheses. 2010. 75:448–451.

24. Rashidi BH, Abediasl Z, Tehraninejad ES, Shariat M, Mahdavi A. Menstrual cycle length in relation to antimullerian hormone and follicle-stimulating hormone. J Reprod Med. 2009. 54:315–318.

25. Tsepelidis S, Devreker F, Demeestere I, Flahaut A, Gervy C, Englert Y. Stable serum levels of anti-Mullerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women. Hum Reprod. 2007. 22:1837–1840.

26. La Marca A, Stabile G, Artenisio AC, Volpe A. Serum anti-Mullerian hormone throughout the human menstrual cycle. Hum Reprod. 2006. 21:3103–3107.

27. La Marca A, Giulini S, Tirelli A, Bertucci E, Marsella T, Xella S, et al. Anti-Mullerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology. Hum Reprod. 2007. 22:766–771.

28. Hehenkamp WJ, Looman CW, Themmen AP, de Jong FH, Te Velde ER, Broekmans FJ. Anti-Mullerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation. J Clin Endocrinol Metab. 2006. 91:4057–4063.

29. Robertson DM, Hale GE, Fraser IS, Hughes CL, Burger HG. Changes in serum antimullerian hormone levels across the ovulatory menstrual cycle in late reproductive age. Menopause. 2011. 18:521–524.

30. Weghofer A, Dietrich W, Barad DH, Gleicher N. Live birth chances in women with extremely low-serum anti-Mullerian hormone levels. Hum Reprod. 2011. 26:1905–1909.