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Improving prediction of age at menopause using multiple Anti Mullerian Hormone measurements; Tehran Lipid-Glucose Study

Ramezani Tehrani F1, Bidhendi Yarandi R1, Solaymani-Dodaran M2,3, Tohidi M4, Firouzi F1, Azizi F5.

J Clin Endocrinol Metab. 2020 Feb 28. pii: dgaa083. doi: 10.1210/clinem/dgaa083. [Epub ahead of print]

Abstract
CONTEXT:
Several statistical models were introduced for prediction of age at menopause using a single measurement of Anti Mullerian Hormone (AMH), however individual prediction is challenging and need to be improved.

OBJECTIVE:
Whether multiple AMH measurements can improve the prediction of age at menopause.

DESIGN:
All eligible reproductive aged women (n=959) were selected from the Tehran Lipid and Glucose Study. The serum concentration of AMH was measured at the time of recruitment and twice after that with on average 6 years interval. An accelerated failure time model with Weibull distribution was used to predict age at menopause, using a single AMH value versus model included annual AMH decline rate. The adequacy of these models was assessed using C-statistics.

RESULTS:
The median follow-up period was 14 years and 529 women reached menopause. Adding the annual decline rate to the model included single AMH, improved the model discrimination’s adequacy from 70% (95% CI: 67% to 71%) to 78% (95%CI: 75% to 80%) in terms of c-statistic. The median of differences between actual and predicted age at menopause for the first model was -0.48 years and decreased to -0.21in model including decline rate. The predicted age at menopause for women with the same amount of age-specific AMH, but annual AMH decline rate of 95 percentiles was about one decade lower than those with decline rate of 5 percentiles.

CONCLUSION:
Prediction of age at menopause could be improved by multiple AMH measurements, it will be useful in identifying women at risk of early menopause.