AMH: new diagnostic tool for PCOS
AMH: new diagnostic tool for PCOS
What is AMH?
Hi there,
How are things going?
New guidelines for the management of PCOS were introduced last year, the last one being in 2018. The guideline is called the International Evidence-Based Guideline for the assessment and management of polycystic ovary syndrome.
It included 77 evidence-based recommendations and 54 consensus recommendations. The detailed report is about 6,000 pages, but you can get a summary here.
One of the most exciting decisions in this report is the ability to use AMH as a new diagnostic tool instead of ultrasound. As a reminder, to be diagnosed with PCOS, you need to have at least 2 out of the following 3:
Signs of excess testosterone (either on a blood test or symptoms)
Irregular periods
Polycystic ovaries on ultrasound or/and increased AMH levels
You might wonder, what about insulin resistance? Whilst recognised as a critical feature of PCOS, the available measurements of insulin resistance are still inaccurate and unreliable.
Back to AMH.
What is AMH?
Anti-Müllerian Hormone (AMH) is a protein hormone that had a huge role when we were in our mother's womb.
In the early stages of fetal life, the gonads (future sex organs) are undifferentiated until about the sixth week. The genetic sex of the fetus, determined by the sex chromosomes (XX for females and XY for males), directs how these gonads will develop. On these chromosomes, there is a specific region that determines if it produces testosterone and AMH. If it does, it develops into testes. If AMH is not produced early, the organs grow into ovaries. The ovaries only start producing AMH for us women around week 36th of pregnancy. HOW COOL?
Now, in adulthood, it plays a significant role in evaluating our fertility and reproductive health.
AMH levels are used to:
Understanding your fertility: how many eggs do you still have
AMH is widely used as a biomarker to assess ovarian reserve, representing the quantity and quality of eggs remaining in the ovaries.
Help our follicle develop (if this topic is confusing to you, please have a read/listen to my article on ovulation)
It can inhibit the initial recruitment of follicles and reduce the sensitivity of follicles to FSH ( follicle-stimulating hormone)
The second point is where it becomes relevant for PCOS.
AMH and PCOS
PCOS is characterised by too many small follicles. The ovary puts forward more follicles for ovulation, but none make it to ovulation. This is revised in my ovulation article and video. I would give this a read if this part is not clear.
Given that these follicles produce AMH, our levels are elevated. Unfortunately, this is no longer a reliable measure of fertility for us.
There is a positive correlation between AMH levels and hyperandrogenism (elevated levels of male hormones), which is another key feature of PCOS. Higher AMH levels are often found in women with PCOS who have high testosterone and irregular periods.
In addition, studies have indicated a relationship between AMH levels and insulin resistance. For example, AMH levels are often higher in PCOS patients with insulin resistance compared to those without. This suggests that AMH might be involved in the metabolic aspects of PCOS.
The guidelines in the UK
The NICE guidelines for the diagnosis of PCOS seem to have been updated in April 2024 to follow the International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome 2023. However, AMH is not mentioned fully as a diagnostic criteria. It’s only mentioned in the small print. I am only letting you know so you are not surprised if this is not offered.
The guidelines have been updated with more recommendations. These include mental health considerations, dissatisfaction with care, and weight stigma. I will break some of them out in the follow-up newsletters.
Our Genetics-based PCOS program is open. We are only accepting seven people into the programme, and spaces are filling up. If you are ready to understand your PCOS in depth and have a personalised management plan, join here.
See you next Sunday,
Francesca
References
International, P. (2023). International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome 2023.
Sivanandy, M. S., & Ha, S. K. (2023). The role of serum anti-Mullerian hormone measurement in the diagnosis of polycystic ovary syndrome. Diagnostics (Basel, Switzerland), 13(5), 907. https://doi.org/10.3390/diagnostics13050907
Teede, H. J., Tay, C. T., Laven, J., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., Joham, A. E., & International PCOS Network. (2023). Recommendations from the 2023 International Evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction (Oxford, England), 38(9), 1655–1679. https://doi.org/10.1093/humrep/dead156