AMH Level Indicating Menopause
The AMH level indicating menopause is less than 0.05 ng/mL. 1
Understanding AMH and Menopause
Anti-Müllerian Hormone (AMH) is a protein produced by pre-antral and small antral ovarian follicles that serves as a marker of ovarian reserve. AMH levels naturally decline with age, particularly from the third decade of life until they become undetectable at menopause.
AMH Levels Across the Reproductive Lifespan:
- Normal reproductive years: Varies by age, but generally higher than 1.0 ng/mL
- Perimenopause: Declining levels, typically below 0.5 ng/mL
- At menopause: Approximately 0.05 ng/mL (0.05 ± 0.06 ng/mL) 2
- Post-menopause: Undetectable or extremely low levels
Clinical Significance of AMH Measurements
AMH has emerged as a valuable predictor of menopause timing:
- A single AMH measurement in late reproductive-aged women can predict menopause with high accuracy (area under ROC curve of 0.88) 3
- AMH threshold of 0.39 ng/mL has optimal sensitivity and specificity for predicting menopause within 6 years 3
- Women with AMH levels greater than 0.39 ng/mL have only a 10% chance of reaching menopause within 6 years 3
Diagnostic Thresholds
The most reliable threshold values for menopause determination include:
- Menopause: AMH ≤ 0.05 ng/mL 2
- Diminished ovarian reserve: AMH < 0.7 ng/mL 1
- Extreme diminished ovarian reserve: AMH < 0.015 ng/mL 1
Clinical Applications
AMH measurement is particularly useful in:
Predicting time to menopause: Lower AMH levels strongly correlate with shorter time to menopause, with highest effectiveness in short-term (up to 3 years) prediction 4
Diagnosing menopause: Undetectable AMH has equivalent diagnostic accuracy to elevated FSH (>22.3 mIU/mL) for confirming menopause 5
Early detection of premature ovarian insufficiency (POI): Very low AMH in young women can indicate increased risk of POI 5
Limitations and Considerations
- AMH prediction accuracy increases with age as the interval to menopause shortens 5
- Individual AMH trajectories vary significantly between women, necessitating personalized evaluation 2
- Technical issues with assays can lead to heterogeneity in results; newer automated platform assays are more reliable 6
- Age-specific reference ranges are vital as AMH levels naturally decline with age 6
Answer to Multiple Choice Question
Based on the evidence presented, the correct answer is:
C. Less than 1 ng/mL
While the exact threshold is closer to 0.05 ng/mL at actual menopause, among the given options, "less than 1" is the most accurate choice, as levels below 1 ng/mL are consistent with approaching menopause, especially in women over 40.