Menopause is the cessation of menstrual cycling and fertility. Clinically it is recognized by a cessation of menstrual bleeding; menopause is a woman’s status after her final menstrual period (FMP). Menstrual cycling and bleeding are driven by the dynamics of ovarian follicle maturation. Because a woman is born with a limited number of follicles (non-growing “primodial” follicles) that cannot be replaced and are slowly consumed by the monthly maturation of smaller groups of follicles (primary, secondary and antral growing follicles), the natural cause of menopause is the absence of follicles. However, many natural (e.g., certain diseases, starvation, etc.) or interventional processes (chemotherapy, surgical removal of the uterus, ovaries, or pituitary gland, etc.) can cause a cessation of menses that can be either irreversible (e.g., functionally the same as menopause) or reversible. Diagnosing menopause (e.g. the FMP) currently is only done unequivocally after cessation of menses for 12 months in a previously cycling woman.

Naturally occurring (i.e., as a result of aging) menopause is referred to as “spontaneous” and, on average, occurs at the age of 51 years, but there is a very large variance of approximately +/- 10 years with respect to the occurrence of menopause in healthy women. Ovarian function deteriorates gradually leading up to menopause and contributes to the variance observed among women with respect to menopausal status. Ovarian function affects, primarily via the steroid hormones produced by growing follicles, virtually every organ in a woman’s body. Physiological responses to the gradual or abrupt loss of ovarian function include a multitude of menopausal “symptoms” and consequences that affect a woman’s health and quality of life. 1,2

During several years leading up to the FMP and several years immediately following the FMP is a time called the climacteric or menopausal transition, when a woman transitions from the reproductive to a non-reproductive state. The transition is highly variable among women with respect to duration and intensity of associated physiological changes, which affect her well being and level of disease risk. Thus, determining where a woman is in this process must be individualized and is clinically important, particularly during the menopausal transition and the 12 months following the FMP. Quantitative measurement of blood levels of Anti-Müllerian Hormone using the picoAMH assay can aid in determining a woman’s menopausal status during the menopausal transition.

Blood levels of AMH represent one of the markers available to clinicians to determine where a woman is in her menopausal transition. Other clinical tests relevant in this context are estradiol which is produced only by follicles in their final stages of maturation, and thus only indirectly reflects the total number of follicles in the ovary, and FSH which reflects the negative feedback by estradiol on pituitary gland secretion (i.e., also an indirect marker of ovarian follicular pool based on large follicle function). In contrast AMH is produced by the majority of ovarian follicles (primary, secondary and antral).

Blood levels of AMH have been shown to be highly correlated with the number of primordial follicles in an ovary (i.e., true ovarian reserve).3 The picoAMH assay was developed to allow more sensitive measurements. AMH measured using the picoAMH assay provides a significant new parameter to aid physicians in determining the status of women during the menopausal transition.

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2. Su HI, Freeman EW 2009 Hormone changes associated with the menopausal transition. Minerva Ginecol 61:483-489

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