Anti-Mullerian hormone: correlation with testosterone and oligo- or amenorrhoea in female adolescence in a population-based cohort study

Abstract

STUDY QUESTIONSCan serum anti-Müllerian hormone (AMH) levels measured in female adolescents predict polycystic ovary syndrome (PCOS)-associated features in adolescence and early adulthood?SUMMARY ANSWERAMH levels associated well with PCOS-associated features (such as testosterone levels and oligoamenorrhoea) in adolescence, but was not an ideal marker to predict PCOS-associated features in early adulthood.WHAT IS KNOWN ALREADYSeveral studies have reported that there is a strong correlation between antral follicle count and serum AMH levels and that women with PCOS/PCO have significantly higher serum AMH levels than women with normal ovaries. Other studies have reported an association between AMH serum levels and hyperandrogenism in adolescence, but none has prospectively assessed AMH as a risk predictor for developing features of PCOS during adulthood.STUDY DESIGN, SIZE, DURATIONA subset of 400 girls was selected from the prospective population-based Northern Finland Birth Cohort 1986 (n = 4567 at age 16 and n = 4503 at age 26). The population has been followed from 1986 to the present.PARTICIPANTS/MATERIAL, SETTING, METHODSAt age 16, 400 girls (100 from each testosterone quartile: 50 with oligo- or amenorrhoea and 50 with a normal menstrual cycle) were selected at random from the cohort for AMH measurement. Metabolic parameters were also assessed at age 16 in all participants. Postal questionnaires enquired about oligo- or amenorrhoea, hirsutism, contraceptive use and reproductive health at ages 16 and 26.MAIN RESULTS AND ROLE OF CHANCEThere was a significant correlation between AMH and testosterone at age 16 (r = 0.36, P < 0.001). AMH levels at age 16 were significantly higher among girls with oligo- or amenorrhoea compared with girls with normal menstrual cycles (35.9 pmol/l [95% CI: 33.2;38.6] versus 27.7 pmol/l [95% CI: 25.0;30.4], P < 0.001). AMH at age 16 was higher in girls who developed hirsutism at age 26 compared with the non-hirsute group (31.4 pmol/l [95% CI 27.1;36.5] versus 25.8 pmol/l [95% CI 23.3;28.6], P = 0.036). AMH at age 16 was also higher in women with PCOS at age 26 compared with the non-PCOS subjects (38.1 pmol/l [95% CI 29.1;48.4] versus 30.2 pmol/l [95% CI 27.9;32.4], P = 0.044). The sensitivity and specificity of the AMH (cut-off 22.5 pmol/l) for predicting PCOS at age 26 was 85.7 and 37.5%, respectively. The addition of testosterone did not significantly improve the accuracy of the test. There was no significant correlation between AMH levels and metabolic indices at age 16.IMPLICATIONS, REASONS FOR CAUTIONAMH is related to oligo- or amenorrhoea in adolescence, but it is not a good marker for metabolic factors. The relatively low rate of participation in the questionnaire at age 26 may also have affected the results. AMH was measured in a subset of the whole cohort. AMH measurement is lacking international standardization and therefore the concentrations and cut-off points are method dependent.WIDER IMPLICATIONS FOR THE FINDINGSUsing a high enough cut-off value of AMH to predict which...

Anti-Müllerian Hormone as a marker of ovarian reserve in relation to cardio-metabolic health: A narrative review

“…[37,40,42,43] pooled the results of all study subjects for the correlation of AMH with metabolic indices, which may have diluted any observed effect inherently related to the pathophysiology of PCOS. In all mentioned studies, AMH was shown to be elevated in women with PCOS compared to healthy controls [31,32,37,38], in correspondence with other literature [21].…”

“…This was supported by another study among adolescents [31], including subjects with a diagnosis of PCOS (5.3%). In this study, AMH was not related to any metabolic parameters [31]. When researching the degree of insulin resistance or level of fasting insulin alone in relation to AMH, a significant correlation was found by two studies [32,33], whereas another study was not able to confirm this correlation [34].…”

“…In cross-sectional research conducted in a large cohort of adolescent females, AMH quintile was not associated with lipid and blood glucose levels and insulin resistance, nor with C-reactive protein (CRP) levels [30]. This was supported by another study among adolescents [31], including subjects with a diagnosis of PCOS (5.3%). In this study, AMH was not related to any metabolic parameters [31].…”

Anti-Müllerian Hormone and Inhibin-A, but not Inhibin-B or Insulin-Like Peptide-3, may be Used as Surrogates in the Diagnosis of Polycystic Ovary Syndrome in Adolescents: Preliminary Results

“…Some studies have shown that AMH closely correlated especially with testosterone (43,46), and others have shown that it correlated with D4-A and FAI (47). In our study, AMH was found to significantly correlate with androgens such as DHEAS, fT, D4-A.…”

Anti-Müllerian Hormone Concentrations in Premenopausal Women and Breast Cancer Risk

“…Testosterone concentrations are also positively correlated with AMH levels (31, 32) and were controlled for in the current analysis. We did not measure estradiol levels since the blood draw was not timed to the menstrual cycle and premenopausal estradiol has a weaker association with breast cancer risk compared to postmenopausal levels (30, 33, 34).…”