Anti-Müllerian Hormone Trajectories Across the Menopause Transition

OBJECTIVE: To analyze the trajectory of anti-müllerian hormone (AMH) decline leading to the final menstrual period, identify distinct AMH patterns, and assess their association with unique participant characteristics. METHODS: SWAN (Study of Women's Health Across the Nation), a multisite, multiethnic perimenopausal cohort, was analyzed. Included participants had an observed final menstrual period and three or more measurements of AMH levels taken during perimenopause. Statistical modeling was used to identify AMH trajectory classes; participants were placed into predicted class based on best fit. Differences in baseline demographic and health characteristics were assessed by analysis of variance or χ2. Generalized estimating equation models were used to estimate the association between AMH trajectory class and outcomes, accounting for repeated measures. RESULTS: A total of 1,131 women had at least three AMH measurements and an observed final menstrual period. Two AMH trajectory classes were observed: 448 participants (39.6%) with lower initial AMH and slower decline (low/slow [LS] group) and 683 participants (60.4%) with higher AMH and steeper decline (high/fast [HF] group). Participants in the LS group had a median AMH decline of 1.2 pg/mL/month; those in the HF group had a decline of 6.7 pg/mL/month. The LS classification was associated with baseline older age, higher body mass index (BMI), and non-White race and ethnicity. Trajectory classes did not differ by history of oligomenorrhea, presumptive polycystic ovarian syndrome, or smoking status. Participants in the LS group had worse postmenopausal cardiovascular risk profiles and were less likely to report frequent vasomotor symptoms after the final menstrual period. CONCLUSION: Two different AMH trajectories to the final menstrual period were observed in a subsample of SWAN participants. Independent of a participant's premenopausal cardiovascular risk factors, lower starting AMH and slower decline were associated with higher postmenopausal cardiovascular risk.