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Test could predict menopause PDF Print Email
A number of newspapers have covered the story of a new blood test to predict when the menopause will occur which “could close the baby gap” by telling women how long they will remain fertile for.
They reported on the hormone-based menopause test, saying that home testing kits could be available in a few years.
The news is based on a study that has been presented at fertility conference, although because it is unpublished it is difficult to assess the methods and quality of the research.
It is important to stress that a woman’s fertility level and ability to conceive start to decline long before her periods stop and, therefore, a test predicting menopause may be of limited value in this area. Also, fertility levels are affected by other factors, such as blocked ovarian tubes or the quality of a man’s sperm.  The limited information available suggests further testing will be needed and although the test may have a role in predicting early menopause, further results are needed to confirm this. The reports are based on a press release and conference abstract presented at the 2010 conference of the European Society of Human Reproduction and Embryology. Only limited details of the study carried out by researchers from Shaheed Beheshti University of Medical Sciences in Iran were presented.  No information is available as to if or when the research may be published in a peer-reviewed journal, or about how the research was funded. Most papers also published comments from independent experts, who set the research in context and addressed the fact that such a test is only of limited use to most women because fertility levels start to fall well before the menopause occurs.  A home testing kit may be on sale within three years. It was not reported in any of the stories that the information was based on a conference abstract and press release and that the full results have not yet been published.
This research aimed to test a statistical model developed to predict the age at which the menopause would occur.  The model is based on assessing levels of a hormone called anti-mullerian hormone (AMH), which is produced by the ovaries.  AMH controls the development of ovarian follicles from which eggs develop, and some experts have suggested it could be a marker for ovarian function. The researchers wanted to test whether measuring AMH at various ages could predict when women would reach the menopause.
Only limited information is available on the methods used in this research.  However according to the abstract and press release, the researchers took blood samples to measure blood levels of AMH in 266 women, aged 20-49, randomly selected from a larger, prospective cohort study called the Tehran Lipid and Glucose Study.  This ongoing study was looking at cardiovascular risk factors among the Iranian population.
In this smaller study, the researchers measured AMH levels twice more, at three-yearly intervals. They also collected information on the women’s reproductive background and reproductive history. They then developed and tested a statistical model for estimating the women’s age at menopause using a single measurement of AMH in blood samples.
The researchers say they found a “high degree of correlation” between the estimated ages at menopause provided by their formula model and the actual age at menopause seen in a subgroup of 63 women who reached menopause during the study.  The average difference between the predicted age using the model and the women’s actual age was only a third of a year and the maximum margin of error of three to four years.
Using this statistical model, the researchers say they were able to identify the specific AMH levels at different ages (20, 25 and 30 years) that would predict if women were likely to have an early menopause (before 45) or reach menopause over 50 years.  Among the group studied, the average age at the menopause was 52 years.
Conclusion
As the research has not yet been published and subjected to peer review and with the lack of  sufficient details it must be treated with caution.  This was a small study carried out over a limited period (about six years), which tested whether levels of AMH in women of reproductive age could be used to predict the age they will reach the menopause.  It seems to have been designed with a reasonable cut-off point set for the test, the first step in preparing a potential test for clinical use.
If validated by further studies, such a test could be particularly useful in predicting early menopause, giving women who may experience it time to plan their future and balance careers with family.
The fact that so far only 63 women actually reached menopause in the study and only three of them were under 45, means the mathematical formula has only undergone limited testing. It should be stressed that until there are larger studies following women from the age of 20 to the age they actually reach menopause, the method the researchers used has not been proven.
It will be important to follow up this initial study with others, setting a cut-off point that can establish the sensitivity and specificity of the test. What is needed are statistical measures that relate to the number of women correctly identified by the test as going on to an early menopause (or late menopause) and also the number of women incorrectly identified or predicted as heading for early or late menopause when they do not. These results, when published, will help decide the true value of the test.
Links to the research