The prospect of a blood test that can predict when a woman will reach menopause has moved closer following new research by Iranian scientists.
Measurements of a reproductive hormone in the blood could provide a reasonably reliable assessment of a woman’s likely age at menopause, a 12-year study of 266 women has suggested.
The findings indicate that testing women for anti-Mullerian hormone (AMH), which is produced by the ovaries, could predict when they can expect to go through the menopause, giving them valuable information they could use to plan when they should begin trying to start a family.
Such a test would be particularly valuable for women at risk of having an early menopause, in their 20s or 30s. It would allow them either to try for a baby straight away, or to have eggs frozen for later use while still fertile.
Independent scientists said the research, which will be presented tomorrow at the European Society of Human Reproduction and Embryology conference in Rome, provided the most robust evidence yet that hormone levels can predict menopause age. They cautioned that further research would be needed to confirm the findings: so far, only 63 of the women in the study have reached menopause, and only three of these had an early menopause, below the age of 45.
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Experts also pointed out that as fertility declines for several years before menopause, it would be wrong to place too much value on the results of any test.
Stuart Lavery, director of IVF at Hammersmith Hospital and a spokesman for the British Fertility Society, said: “This is an important piece of work. AMH probably represents the best thing we have at the moment [for predicting menopause age], but we have always struggled to get an accurate picture. This prospective study provides useful evidence.
“I would be concerned, though, if women were too reassured by this, and thought that because they have a certain AMH level at 25 they don’t need to be concerned about their fertility. People should be very cautious about making judgments about their reproductive potential based on the currently available tests.”
Clare Lewis-Jones, of the patient charity Infertility Network UK, said: “Although further research is needed, finding an accurate way to predict the age at which a woman will reach the menopause will be extremely helpful to those considering when to have children.
“Many women now leave this decision until they are in their 30s, and to then discover that they are approaching an early menopause and will have problems conceiving can be devastating for them.
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“However, it is important that women are also made aware that other factors can affect their chances of conceiving such as blocked fallopian tubes. Although test results could point to a potential problem with egg reserves and perhaps lead women to seek advice early, a normal result could lull a woman into a false sense of security about her future fertility.”
The research, led by Fahimeh Ramezani Tehrani, of the Shaheed Beheshti University of Medical Sciences in Tehran, began in 1998 when she recruited 266 volunteers, then aged between 20 and 49, who were taking part in a separate study of blood fat and sugar. Levels of AMH in women’s blood were monitored at intervals of three years. A statistical model was used to predict age at menopause.
This technique produced remarkably accurate predictions for the 63 women in the study who have already reached menopause. On average, the predictions were correct to within four months, and the maximum error was four years. The average age at menopause was 52.
“The results from our study could enable us to make a more realistic assessment of a woman’s reproductive status many years before she reaches menopause,” Dr Ramezani said. “To the best of our knowledge this is the first prediction of age at menopause that has resulted from a population-based cohort study.
“We believe that our estimates of ages at menopause based on AMH levels are of sufficient validity to guide medical practitioners in their day-to-day practice, so they can help women with their family planning.
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“Considering that this is a small study that has looked at women over a period of time, larger studies starting with women in their 20s and following them for several years are needed to validate accuracy for prediction of menopause in young women.”
Dagan Wells, senior scientific leader at the Nuffield Department of Obstetrics and Gynaecology at the University of Oxford, said: “It would also be dangerous to take this as an absolute. Even if this turns out to be a very good test, fertility will be dramatically reduced in the years leading up to the menopause.
“The main way it would be useful is to help women who are unaware they are likely to experience a premature menopause. It could give women a better idea of just how much time they have left on that biological clock. Most people don’t think about egg-freezing until well past the time when their best chance of fertility is over.”
Several tests based on hormones, including AMH, are already used by doctors to get a rough guide to women’s future reproductive potential, though they are wary of making precise predictions about the age of menopause.