Editors' ChoiceMenopause

A Snooze Button for the Biological Clock

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Science Translational Medicine  17 Aug 2011:
Vol. 3, Issue 96, pp. 96ec131
DOI: 10.1126/scitranslmed.3003033

The feminist movement of the last three decades has proven without a doubt that women can “have it all” —education, career, and family. While struggling to fit “it all” into our 20s and early 30s however, the incessant tick-tock-tick-tock of our proverbial biological clocks can be deafening for many. Now, Broer and colleagues have developed a nomogram based on serum anti-Müllerian hormone (AMH) concentrations that is highly predictive for the timing of menopause. This new tool offers some women the option of hitting the snooze button on their biological clock.

AMH is a hormone that is secreted by ovarian granulosa cells and plays a critical role in the embryonic development of the female reproductive tract. In the adult, serum AMH concentrations are strongly associated with the number of ovarian follicles, which is directly related to fertility. Follicular development and ovulation are also closely regulated by the pituitary hormone follicle-stimulating hormone (FSH). Rising serum concentrations of FSH signal the transition to reduced fertility and menopause.

The authors followed three cohorts of normally ovulating women in a prospective observational study. At the time of entry into the study, the participants had their serum concentrations of AMH and FSH measured and underwent transvaginal ultrasound to count the number of follicles in both ovaries. The study volunteers were followed for an average of 11 years and then queried about the regularity of their menstrual cycles. Of the three tests, serum AMH concentrations at the time of entry into the study was the single best predictor of a participant’s time of entry into menopause.

Broer and colleagues used the data from these cohorts to develop a nomogram that correlates age-specific AMH concentrations with a predicted age of menopause. For example, a 27-year-old woman with a serum AMH level in the lowest fifth percentile has a median predicted age of menopause of 48.8 years, whereas a 27-year-old woman whose serum AMH is in the 80th percentile has a predicted age of menopause of 54.2 years.

Although this study bears repeating in larger populations of participants from different ethnic groups, the nomogram is likely to prove useful in family planning strategies and the prevention of age-related infertility. Similarly, these findings may also help in the anticipatory management of conditions such as osteoporosis, breast cancer, and endometrial cancer, which are often related to either early or late onset of menopause.

S. L. Broer et al., Anti-Müllerian hormone predicts menopause: A long-term follow-up study in normoovulatory women. J. Clin. Endocrinol. Metab. 96, 2532–2539 (2011). [PubMed]

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