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New hormone data can predict menopause within one year
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Changes in anti-Mullerian hormone and inhibin B concentrations may predict time to menopause, according to data from two new studies.
“We finally have numbers from enough women evaluated over a long time period to describe the reproductive aging process. It begins to give women and clinicians an expanded way to look at menses and endocrine events in terms of reproductive progression,” MaryFran R. Sowers, PhD, professor, Department of Epidemiology, University of Michigan School of Public Health, said in a press release.
In one study published in the Journal of Clinical Endocrinology & Metabolism, Sowers and colleagues examined the naturally occurring changes in two different biomarkers — anti-Mullerian hormone and inhibin B — in 50 women with six consecutive annual visits during pre- and perimenopause.
They found that anti-Mullerian hormone declined to a very low or non-measurable level five years prior to the final menstrual period. This decline pinpoints a critical juncture in which a woman probably has so few follicles that her fertility becomes increasingly questionable, according to Sowers. The researchers concluded that changes in anti-Mullerian hormone and inhibin B concentrations were predictive of time of menopause; however, low inhibin B levels observed four to five years prior to final menstrual period were less predictive of time or age to final menstrual period.
The researchers conducted a second study, also published in the Journal of Clinical Endocrinology and Metabolism, and examined follicle-stimulating hormone and rate of change in defining menopause transition stages in 629 women aged 22 to 44 years. They obtained 5,757 annual follicle-stimulating hormone data points during 14 years.
Based on a woman’s age and level of follicle-stimulating hormone, the researchers described four different stages that occur for women from their late reproductive period to the time of their final menstrual period. In stage 1 (mean chronologic age, 40 to 43.6 years), the rate of follicle-stimulating hormone change increased up to seven years before the final menstrual period; stage 2 (43.6 to 47.6 years), seven to two years prior to final menstrual period; stage 3 (47.6 to 51 years), two years prior to one year after the final menstrual period (average follicle-stimulating hormone, 34 mIU/mL); stage 4 (older than 51 years), one year after the final menstrual period (average follicle-stimulating hormone, 54 mIU/mL).
In addition, they identified eight epochs in chronological aging from age 28 to 60 years that were defined by changes of follicle-stimulating hormone trajectory accelerations or decelerations and rate of change.
While clinicians have the ability to measure these hormones now, they haven’t had the kind of information about anti-Mullerian hormone, inhibin B or follicle-stimulating hormone collected on a large group of women over time to know how to relate levels or changes in the levels to fertility or to a menopause endpoint.
“This information provides a roadmap as to how fast women are progressing through the different elements of their reproductive life. People really want information about how long do I have and when will I have my final menstrual period. Now we are beginning to say, ‘If you have a specific follicle-stimulating hormone level combined with your age, this is the likelihood that you are in this reproductive stage,” said Sowers.
According to the researchers, additional study results have been submitted to describe the amount of bone loss that occurs at the different follicle-stimulating hormone stages. If women and clinicians know where women are in the various reproductive stages, it will further their understanding of the likely health implications associated with each stage, they said. – by Katie Kalvaitis
J Clin Endocrinol Metab. 2008;93:3478-3483.
J Clin Endocrinol Metab. 2008;93:3958-3964.
The measurement of migration inhibitory factor is another measure of ovarian aging, which may be helpful in combination with other measures. However, there is too much overlap for this to be helpful and accurately predict ovarian failure precisely. We need more clinical data — so the jury is still out.
– Michelle P. Warren, MD
Endocrine Today Editorial Board member