Healthcare provider in office explaining what AMH is to female patient

What Is AMH (Anti-Müllerian Hormone)?

Written on January 24, 2024 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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If you are considering pregnancy or are struggling to get pregnant, you may be wondering about the many hormones involved in the reproductive process. When you think about reproductive hormones, you probably think about estrogen and progesterone, but the reproductive process is complex.

One of the many hormones that may be assessed in a fertility evaluation is anti-Müllerian hormone (AMH), but what is AMH? AHM is a hormone that plays a role in development and reproduction throughout most of the life cycle.

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The Origin of AMH

AMH is a hormone that is present in both males and females. It is present from the initial stages of embryological development.[1] While babies are developing in the uterus, AMH helps with the development of the reproductive tract. Prior to the development of the reproductive tract, both male and female babies have tubes called Müllerian ducts.

If the developing baby has XY chromosomes, they will make AMH in their testicular tissue. This will cause the Müllerian ducts to shrink and the male reproductive organs to develop. Levels of AMH will stay high until puberty and then decrease.

If the developing baby has XX chromosomes, the levels of AMH will remain low, and the Müllerian ducts will develop into the female reproductive organs — the uterus, fallopian tubes, and top part of the vagina. AMH levels will stay low until puberty, when follicles inside the ovaries will take over the development of AMH.

The Role of AMH After Puberty

As mentioned before, in females and people assigned female at birth (AFAB), AMH will be produced by the follicles very early in their transition to eggs. As the egg matures, the hormone levels decrease.[2] AMH levels usually peak at around age 25 and then will start to decline until menopause.

AMH is believed to play a role in the development of the follicle until a dominant egg is chosen for ovulation. This process is influenced by other reproductive hormones, such as follicle-stimulating hormone (FSH).[3] Since AMH levels are involved in follicle development and decline with age, testing AMH levels can be a marker of ovarian function and reserve.

AMH and Functional Ovarian Reserve

AMH may play many roles in reproductive development, but testing for AMH levels is primarily used as a means of evaluating the functional ovarian reserve. Functional ovarian reserve is an indirect marker of fertility.[4] There is not an international assay standard for AMH, so the routine use of this test is somewhat limited.[4,5] The American College of Obstetricians and Gynecologists (ACOG) recommends against the routine use of AMH for the purpose of counseling about reproductive status and future fertility potential.[5]

AMH levels may help predict how the ovaries will respond to fertility medications in women and people AFAB who are using fertility medications to induce ovulation. However, AMH levels do not predict pregnancy rates after in vitro fertilization or the chances of a live birth.[4,8]

Limitations of AMH testing

As mentioned, there is no international standard assay for AMH testing, which makes it more difficult to use this test for routine testing. Because there is no standard assay, it is difficult to determine whether levels naturally vary between different ethnic groups. The rate of decline between the peak in the mid-20s and menopause may also vary between ethnic groups. Studies have also shown that levels of AMH fluctuate naturally throughout the menstrual cycle, but the variation can range from 28% to 163% depending on which assay is used to measure the rates.[6] This may mean that a single AMH measurement may not be fully accurate in evaluating functional ovarian reserve.

There may also be changes in AMH levels related to certain autoimmune diseases, such as autoimmune thyroid disease and type 1 diabetes. AMH levels may be less beneficial for testing in this subset of patients.[4]

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AMH Levels and Menopause

Menopause is defined as the absence of menstrual periods for at least a year without another explanation, such as pregnancy.[7] Menopause is more common in women and AFAB in their 40s and 50s. Menopause can cause irregular periods, vaginal dryness, hot flashes, chills, night sweats, difficulty sleeping, mood changes, and changes in the metabolism. Since AMH levels decrease to undetectable as you approach menopause, AMH levels have been evaluated as a possible predictor of menopause.[10]

Studies have mixed results when it comes to whether they would be beneficial for predicting time to menopause.[8-10] A recent review of the available literature suggests that AMH does show promise as an indicator of menopause because AMH levels decline prior to the increase in hormones such as FSH or luteinizing hormone (LH).[10] At this time, ACOG does not recommend routine testing of AMH for menopause.[5]

AMH Levels and Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a condition that results from many small follicles in the ovaries. The follicles have a cystic appearance on ultrasound. PCOS is a common cause of irregular menses in women who are of childbearing age.[11] While AMH levels may be abnormal in people with PCOS, it is not currently recommended to routinely check levels for diagnostic purposes. AMH levels are not part of the diagnostic criteria for this condition.[5]

Learn More About Your Hormones With Everlywell

If you have questions or are concerned about your hormone levels or your fertility, the first step is to discuss your concerns with a healthcare provider. You may also consider getting a women’s health consult with one of our virtual consultants. Everlywell also provides access to fertility testing that can provide more information about your hormone levels and fertility. Take control of your reproductive health with Everlywell’s variety of health services.

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References

  1. Anti-Müllerian Hormone Test. Medline Plus. https://medlineplus.gov/lab-tests/anti-Müllerian-hormone-test/. Accessed January 16, 2024.
  2. Rosewell KL, Curry Jr TE. Reproductive senescence in the female. Encyclopedia of Reproduction (Second Edition) Volume 2, 2018:250-254. https://www.sciencedirect.com/science/article/abs/pii/B9780128012383646494. Accessed January 16, 2024.
  3. Bedenk J, Vrtacnik-Bokal E, Virant-Klun I. The role of anti-Müllerian hormone (AMH) in ovarian disease and infertility. J Assist Reprod Genet. 2020;37(1):89-100. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000586/.
  4. Moolhuijsen LME, Visser JA. Anti-Müllerian hormone and ovarian reserve: Update on assessing ovarian function. J Clin Endocrinol Metab. 2020; 105(11):2261-3373. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486884/
  5. The Use of AntiMüllerian Hormone in Women Not Seeking Fertility Care. Committee on Gynecologic Practice. ACOG Committee Opinion. Number 772. https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2019/04/the-use-of-antiMüllerian-hormone-in-women-not-seeking-fertility-care.pdf.
  6. Overbeek A, Broekmans FJ, Hehenkamp WJ, et al. Intra-cycle fluctuations of anti-Müllerian hormone in normal women with a regular cycle: a re-analysis. Reproductive BioMedicine Online. 2012; 24(6):664-669. https://www.sciencedirect.com/science/article/abs/pii/S1472648312001472
  7. Menopause. Cleveland Clinic. Updated May 24, 2023. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397. Accessed January 16, 2024.
  8. Broer SL, Eijkemans MJ, Scheffer GJ, et al. Anti-Müllerian hormone predicts menopause: a long-term follow-up study in normoovulatory women. J Clin Endocrinol Metab 2011;96:2532-2539. https://pubmed.ncbi.nlm.nih.gov/21613357/.
  9. Depmann M, Broer SL, Eijkemans MJC. Et al. Anti-Müllerian Hormone does not predict time to pregnancy: results of a prospective cohort study. Gynecol Endocrinol 2017;33:644-668. https://pubmed.ncbi.nlm.nih.gov/28393651/.
  10. Nelson SM, Davis SR, Kalantaridou S, et al. Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systemic review. Hum Reprod Update. 2023;29(3): 327-346. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10152172/.
  11. Polycystic ovary syndrome (PCOS). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439. Published September 8, 2022. Accessed January 16, 2024.

Jillian Foglesong Stabile, MD, FAAFP is a board-certified Family Physician. Since completing her residency training in 2010, she’s been practicing full-scope family medicine in a rural setting. Dr. Foglesong Stabile’s practice includes caring for patients of all ages for preventative care as well as chronic disease management. She also provides prenatal care and delivers babies. Dr. Foglesong Stabile completed a teaching fellowship in 2020 and teaches the family medicine clerkship for one of her local medical schools. Dr. Foglesong Stabile’s favorite thing about family medicine is the variety of patients she sees in her clinical practice.

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