Anti-Mullerian hormone: correlation with testosterone and oligo- or amenorrhoea in female adolescence in a population-based cohort study
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STUDY QUESTIONS: Can serum anti-Müllerian hormone (AMH) levels measured in female adolescents predict polycystic ovary syndrome (PCOS)-associated features in adolescence and early adulthood? SUMMARY ANSWER: AMH levels associated well with PCOS-associated features (such as testosterone levels and oligoamenorrhoea) in adolescence, but was not an ideal marker to predict PCOS-associated features in early adulthood. WHAT IS KNOWN ALREADY: Several studies have reported that there is a strong correlation between antral follicle count and serum AMH levels and that women with PCOS/PCO have significantly higher serum AMH levels than women with normal ovaries. Other studies have reported an association between AMH serum levels and hyperandrogenism in adolescence, but none has prospectively assessed AMH as a risk predictor for developing features of PCOS during adulthood. STUDY DESIGN, SIZE, DURATION: A subset of 400 girls was selected from the prospective population-based Northern Finland Birth Cohort 1986 (n = 4567 at age 16 and n = 4503 at age 26). The population has been followed from 1986 to the present. PARTICIPANTS/MATERIAL, SETTING, METHODS: At age 16, 400 girls (100 from each testosterone quartile: 50 with oligo- or amenorrhoea and 50 with a normal menstrual cycle) were selected at random from the cohort for AMH measurement. Metabolic parameters were also assessed at age 16 in all participants. Postal questionnaires enquired about oligo- or amenorrhoea, hirsutism, contraceptive use and reproductive health at ages 16 and 26. MAIN RESULTS AND ROLE OF CHANCE: There was a significant correlation between AMH and testosterone at age 16 (r = 0.36, P < 0.001). AMH levels at age 16 were significantly higher among girls with oligo- or amenorrhoea compared with girls with normal menstrual cycles (35.9 pmol/l [95% CI: 33.2;38.6] versus 27.7 pmol/l [95% CI: 25.0;30.4], P < 0.001). AMH at age 16 was higher in girls who developed hirsutism at age 26 compared with the non-hirsute group (31.4 pmol/l [95% CI 27.1;36.5] versus 25.8 pmol/l [95% CI 23.3;28.6], P = 0.036). AMH at age 16 was also higher in women with PCOS at age 26 compared with the non-PCOS subjects (38.1 pmol/l [95% CI 29.1;48.4] versus 30.2 pmol/l [95% CI 27.9;32.4], P = 0.044). The sensitivity and specificity of the AMH (cut-off 22.5 pmol/l) for predicting PCOS at age 26 was 85.7 and 37.5%, respectively. The addition of testosterone did not significantly improve the accuracy of the test. There was no significant correlation between AMH levels and metabolic indices at age 16. IMPLICATIONS, REASONS FOR CAUTION: AMH is related to oligo- or amenorrhoea in adolescence, but it is not a good marker for metabolic factors. The relatively low rate of participation in the questionnaire at age 26 may also have affected the results. AMH was measured in a subset of the whole cohort. AMH measurement is lacking international standardization and therefore the concentrations and cut-off points are method dependent. WIDER IMPLICATIONS FOR THE FINDINGS: Using a high enough cut-off value of AMH to predict which adolescents are likely to develop PCOS in adulthood could help to manage the condition from an early age due to a good sensitivity. However, because of its low specificity, it is not an ideal diagnostic marker, and its routine use in clinical practice cannot, at present, be recommended. STUDY FUNDINGS AND COMPETING INTERESTS: The study was funded by a grant from Wellcome Trust (089549/Z/09/Z) to H.L., S.F. and M.-R.J. Study funding was also received from Oulu University Hospital Research Funds, Sigrid Juselius Foundation and the Academy of Finland. None of the authors have any competing interest to declare.
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AMH levels are positively correlated with serum testosterone among reproductive-age women.
“AMH levels are also positively correlated with serum testosterone among reproductive-age women,39,40”
From Prenatal Origins of Endometriosis Pathology and Pain: Reviewing the Evidence of a Role for Low Testosterone (2023) · cites this paper as [39]
The Results (AMH and testosterone) report a significant positive correlation between serum AMH and testosterone at age 16 (r = 0.36). The study measured that correlation in adolescent girls, not across reproductive-age women generally, so the claim extends beyond the population directly studied. (LLM, conf=0.86)
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- Authors
- Pinola, P., Morin-Papunen, L. C., Bloigu, A., Puukka, K., Ruokonen, A., Jarvelin, M. R., Franks, S., Tapanainen, J. S., & Lashen, H.
- Affiliations
- Oulu University Hospital (FI)
- Imperial College London (GB)
- University of Helsinki (FI)
- University of Sheffield (GB)
- Corresponding author
- Morin-Papunen, L. C.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-07-23
- Volume
- 29
- Issue
- 10
- Pages
- 2317-2325
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- PMC
- PMC4164146
- OpenAlex
- W2122478596
- Cited by
- 41
- References
- 46
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 3 · 2022: 6 · 2021: 4 · 2020: 6 · 2019: 4 · 2018: 1 · 2017: 1 · 2016: 6 · 2015: 6
- FWCI
- 5.25
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Human Reproduction (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- WOS
- Funders
- Wellcome Trust (089549/Z/09/Z)
- Academy of Finland
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- anti-Müllerian hormone, polycystic ovary syndrome, hyperandrogenism, testosterone, hirsutism, female adolescence, early adulthood, risk prediction, antral follicle count, Northern Finland Birth Cohort 1986, menstrual cycle, reproductive health, contraceptive use
- MeSH terms
- Adolescent, Adult, Amenorrhea, Female, Finland, Humans, Polycystic Ovary Syndrome, Prospective Studies, Testosterone, Cohort Studies, Biomarkers, Adolescent Development, Anti-Mullerian Hormone
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