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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]

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.

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

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.

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.

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