Correlation between sonographic and endocrine markers of ovarian aging as predictors for late menopausal transition

Abstract

Recent studies suggest that ovarian volume and antral follicle counts (AFCs) may be useful indicators of menopause status. In this study, we examined several sonographic and endocrine markers of ovarian aging for their ability to discriminate between premenopausal and late menopausal transition (LMT) status. A total of 40 women aged 40 to 55 years were enrolled in this cross-sectional study. Premenopausal women (n = 21) were required to have regular menstrual cycles (24 to 35 days), and women in LMT (n = 19) must have experienced 3 to 11 months of amenorrhea. Participants underwent a transvaginal ultrasound to determine ovarian volume and AFCs; provided blood for the measurement of antimüllerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone, and estradiol; and completed a questionnaire. The correlation between ovarian aging markers and AFCs was investigated. The area under the receiver operating characteristic curve (ROC AUC) was calculated as a measure of diagnostic accuracy. Serum AMH levels were more strongly correlated with AFCs than were serum levels of FSH, luteinizing hormone, and estradiol. Serum levels of AMH and FSH had the highest diagnostic accuracy (ROC AUC, 0.893 and 0.890, respectively) for LMT. The inclusion of FSH to AMH in a multivariable model improved the diagnostic accuracy (ROC AUC, 0.932); however, FSH did not have a statistically significant relationship with LMT, whereas AMH tended to be significant (P = 0.017). The ROC curves for sonographic makers (AFC and ovarian volume) and AMH in determining LMT differed significantly (z = 1.76, P G 0.05; z = 1.86, P G 0.05, respectively). AMH alone or in combination with FSH may be a useful indicator of LMT. These data suggest that sonographic markers cannot be substituted for AMH in determining LMT. However, we cannot definitively say that endocrine markers (especially AMH as a single indicator) are better than sonographic markers for determining LMT because serum AMH levels have a strong correlation with AFCs.