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Could a new blood test predict when menopause will start?

Thursday 23 January 2020

"New blood test can predict when women will hit the menopause two years in advance, scientists claim," reports The Sun.

Researchers in the US tested the ability of a blood test for anti-mullerian hormone (AMH) to predict when a woman would have her final period. AMH is released from a woman's ovaries. When levels drop very low, it suggests her ovaries have almost run out of functional eggs and her periods will soon stop.

Older tests were not accurate enough to detect very low levels of AMH, so they could not be used to accurately predict when a woman's periods would stop. The researchers tried a new type of AMH test to see if it was better.

Researchers tested 1,537 women aged 42 to 52 who had not gone through the menopause. They were tested until after their last period. The new AMH test was used, as well as the more commonly used follicle stimulating hormone (FSH) test. Testing FSH levels has been used to roughly predict menopause, but as it varies a lot through the menstrual cycle the results have been harder to interpret.

The AMH test was more accurate than FSH and was most accurate for estimating if menopause would happen in the next 2 to 3 years in women aged 52 and older. Being able to predict menopause can be helpful. For example, it can help women with heavy periods decide if they should have surgery to treat them.

Find out more about the menopause.

Where did the story come from?

The researchers who carried out the study were from several US institutions including University of Michigan, Rush University, Massachusetts General Hospital,
University of California, Albert Einstein College of Medicine, New Jersey Medical School and University of Pittsburgh.

The study was funded by the US National Institutes of Health and published in the peer-reviewed Journal of Clinical Endocrinology and Metabolism (JCEM). It's available on an open-access basis and is free to view online.

You can read the study on the JCEM website.

The UK media coverage said that the test could predict the menopause 2 years in advance, which could be misunderstood. While the test can predict the likelihood for women of different ages going through menopause in the next 1 to 3 years, it cannot say exactly when it will happen.

What kind of research was this?

This was a cohort study. Cohort studies are a good way to look at patterns of data, to spot how factors, such as AMH levels, are linked to outcomes, such as menopause.

What did the research involve?

Researchers recruited 1,537 women aged 42 to 52 (average age 47.5) between 1996 and 1998. All the women were pre-menopausal or early perimenopausal. Women gave information about their health, menstrual patterns, had their weight and height measured, and gave blood samples.

The researchers continued to take blood samples until the women had reached 12 months since their last period (the usual point at which a woman is presumed to be post-menopausal and to have had her final period). The researchers do not report how frequently blood samples were taken but said annual tests were done when possible.

They analysed 7,407 blood samples from women who had experienced their final period but had given at least 1 sample before going through the menopause. They looked at levels of FSH and AMH. They wanted to see if AMH levels of less than 10pg/ml would predict that a woman was about to go through the menopause, and if AMH levels of more than 100pg/ml would predict that a woman was not about to go through the menopause.

They checked whether factors such as smoking and body mass index (BMI) were linked to AMH levels and menopause, but found only age made a difference in predicting menopause. They therefore reported their results by age ranges:

  • under 48
  • 48 to under 52
  • 52 and over

What were the basic results?

As expected, AMH levels got lower and FSH levels got higher as the participants got closer to their final period.

Statistical tests showed that AMH was more accurate than FSH at predicting a final period, although the difference was small.

Low AMH levels (less than 10pg/ml) predicted the approach of the final period. Women with this level of AMH had:

  • a 51% chance of having their final period in the next year, for women under 48
  • a 63% chance of having their final period in the next year, for women 48 to 51
  • a 79% chance of having their final period in the next year, for women 52 and over

By contrast, a high AMH (more than 100pg/ml) predicted that a woman would not have her final period in the next year. Women who had a test showing this level of AMH had:

  • A 97% chance of not having their last period in the next year, if they were under 48
  • A 96% chance of not having their last period in the next year, if they were 48 to 51
  • A 90% chance of not having their last period in the next year, if they were 52 and over

The results were more accurate when assessing if a woman would have her last period in the next 3 years.

How did the researchers interpret the results?

The researchers said: "it is now possible to predict the FMP [final menstrual period] within a window of 12 to 24 months in late-reproductive aged women, a marked improvement compared with less sensitive AMH assays [tests], serum FSH levels, or menstrual bleeding patterns."

They added: "AMH measurements may help women predict when vasomotor symptoms [such as hot flushes] are likely to begin, or when heavy menstrual bleeding is likely to end." They suggest this "may help women to decide whether to undergo a hysterectomy".

Conclusion

It is not easy to predict when a woman will go through the menopause. Menstrual periods can be irregular, especially as menopause approaches. Previous measures, such as FSH, must be taken at the same time in each menstrual cycle, which makes them hard to interpret, especially when menstrual cycles are irregular.

This new test gives a more accurate prediction of menopause, within 1 to 3 years, although it still cannot say exactly when it will happen.

For some women, the timing of menopause is not particularly important. However, for women trying to decide, for example, whether to have surgery to treat heavy periods, knowing that their periods are likely to stop within a year could be helpful. They might decide to delay surgery if the chances of periods stopping are high, or go ahead if the chances are low.

There are some limitations to the study which mean we need to be cautious about the results. We do not know how frequently women were tested for AMH, or how many tests each woman took. The tables which report the AMH levels and chances of menopause for different age groups use slightly different levels of AMH, so it's difficult to make direct comparisons between age groups.

We should also remember that the results do not apply to women who are younger than 42, as the women in the study were all 42 or older. We therefore do not know if AMH levels is a useful way to predict the onset of early menopause.

Find out more about the menopause and heavy periods.

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Blood test can predict when the menopause is approaching two years in advance, study finds

Mail Online, 22 January 2020

Blood test to predict menopause

The Times, 23 January 2020

Fertility Alert: New blood test can predict when women will hit the menopause two years in advance, scientists claim

The Sun, 23 January 2020

Blood test to predict menopause developed by scientists

The Telegraph, 22 January 2020

Links to the science

Finkelstein JS, Lee H, Karlamangla A, et al.

Anti-Mullerian Hormone and Impending Menopause in Late Reproductive Age: The Study of Women's Health Across the Nation

Journal of Clinical Endocrinology and Metabolism. Published online 22 January 2020