Better test to predict menopause on the horizon

By Dr. Ananya Mandal, MDJun 28 2010

Dr Ananya Mandal, MD

With more and more women delaying when they have a baby until they are older researchers are developing a test that can now tell a woman in her twenties how long she has left to start a family. This test kit could come into the market in another three years and can predict the onset of menopause for women with an accuracy of four months. This also means that a woman knows how much time she has to get pregnant or even plan to freeze her eggs for use at a later date to make babies using artificial means. Existing kits cost between £15 and £180, but are less accurate.

According to researcher Fahimeh Ramezani Tehrani from Shahid Beheshti University of Medical Sciences in Tehran, “In modern society women try to finish their education, get a job and take good opportunities and postpone pregnancy until later…Every day, I have women asking me if they are at risk of early menopause. At the moment, we don't have an answer to this question. Maybe this study can provide an answer.”

Dr. Tehrani studied the blood of 266 women volunteers aged between 20 and 49 for levels of Anti-Müllerian hormone*, or AMH that acts as a chemical signal for maturation of eggs in the ovaries. He also assessed the medical history and lifestyles of these women. He used the hormone levels to predict the onset of menopause. Higher levels of the hormone predicted later menopause than low levels. Of these women 63 have reached their menopause and the predictions have been fairly accurate to within 4 months on an average with worst predictions off by three to four years. The doctors presented their findings at the European Society of Human Reproduction and Embryology's conference.

Expert speak

London's Hammersmith Hospital consultant gynecologist and director of IVF, Stuart Lavery said, “Contraception has given women control over when not to have kids…This new technology is giving control in a more positive aspect, in terms of keeping options open to have children.” However he pointed out that pregnancy may not result if there are other problems in the uterus or with the partner’s fertility. Dr Dagan Wells, of the Nuffield Department of Obstetrics and Gynecology at the University of Oxford also said that this breakthrough was “very exciting” but added, “Even if it does turn out to be a very good estimate of the age of menopause, fertility is dramatically reduced in the years leading up to that…If menopause occurs at 50 or 52, fertility is really going to be over five years before that.” The test many experts feel will be most helpful for the small proportion of women who go through an early menopause — around 1% under the age of 40 and 5% to 10% under the age of 45.

Nick Macklon, professor of obstetrics and gynecology at Southampton University said, “It [AMH] can give us a reasonable idea of when the menopause may happen, but more importantly when women's fertility may fall and they can't have a spontaneous conception…What is lacking are the prospective long-term studies which correlate the predicted time on menopause with the actual time of menopause.”

Dr. Tehrani also said, “Larger studies, starting with women in their 20s and following them for several years are needed to validate the accuracy of serum AMH concentration for the prediction of menopause in young women.”

*Anti-Müllerian hormone is a protein that, in humans, is encoded by the AMH gene. It inhibits the development of the Müllerian ducts (paramesonephric ducts) in the male embryo. It has also been called Müllerian inhibiting factor (MIF), Müllerian inhibiting hormone (MIH), and Müllerian inhibiting substance (MIS). It is named after Johannes Peter Müller.