Abstract P2-06-20: Hormonal Criteria for Assessment of Menopause: Role of Anti-Mullerian Hormone

Abstract

Abstract Introduction: The difficulty in establishing the time of menopause poses a problem in many breast cancer research studies. We sought to determine the value of adding anti-mullerian hormone (AMH) to the accuracy of designating hormonal signs of menopause in 179 women who were recruited for a case-control study of nipple aspirate fluid (NAF) biomarkers. Methods: A questionnaire was administered to obtain medical and reproductive history, self-reported menstrual cycle length, last menstrual period and age. Serum estradiol, progesterone, FSH, and AMH were measured in a blood sample obtained on the day of the study encounter. Criteria for premenopause were: serum FSH <30 mIU/ml, AMH >0.08 ng/ml, estradiol (E2) >30 pg/ml, and menstrual periods of 25 to 35 days. For postmenopause the inverse of the hormone levels and no menstrual periods for >12 mo and age >52 years was used. Serum progesterone (P4) concentration of <3 ng/ml provided confirmation of postmenopause. Results: The age range was from 35 to 69 years (median 51). By self-report (amenorrhea >12 mo and age) 76 subjects were premenopausal; 70 were postmenopausal and 33 subjects were perimenopausal. Table: Designation of menopausal state based on hormonal criteria: Concordance of individual measures with the designation based on all criteria (percentages). Table FSH was found to be discordant in 1 (1.1%) of premenopausal subjects and in 5 (5.3%) of postmenopausal subjects. AMH was found to be discordant in 21 (24.7%) of premenopausal subjects and 6 (6.4%) of postmenopausal subjects. Estradiol was discordant in 13 (15.3%) of premenopausal subjects and in 7 (7.4%) of postmenopausal subjects. Progesterone was <3 ng/ml in all of the postmenopausal subjects. The combination of FSH and AMH predicted 100% of the grouping based on all measures; FSH and E2 predicted 99.9%. The absence of progesterone is a certain criterion for postmenopause but adds nothing to the designation of premenopause. Comment: An accurate determination of the hormonal and reproductive status of women is critically important in studies relating hormones to breast cancer risk. The loss of ovarian hormones has long-term implications, and the menopausal status at the time of sampling determines the recent and current hormonal exposure. Using the hormonal criteria, all women in this study could be classified as pre-or postmenopausal. Adding AMH to the usual hormones did not improve the designation based on the other criteria. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-06-20.