Medically reviewed by Dr. Taylor Sittler
Whether you reach menopause organically, or it’s foisted upon you surgically due to hysterectomy/oophorectomy, your body will feel the impact. Menopause symptoms themselves can range (and change) from occasionally bothersome to relentlessly disruptive throughout your transition and beyond.
The hormone changes that accompany menopause also increase your risk for chronic conditions later in life, including osteoporosis1, cardiovascular disease2,3, and type 2 diabetes4,5. Researchers are even looking into the link between menopause and higher rates of Alzheimer’s disease6,7 in older women. So again, knowing where you are in your transition can help you be proactive about your overall health. Treatments ranging from lifestyle changes and natural supplements to hormone therapy (HRT) and other prescription meds can help keep your body in balance for the long haul.
As a woman, you’re likely to spend a third to a half of your life in menopause. The more you understand about this phase, the more agency you have over it and your body. But so much about women’s health in general, and women’s health in midlife in particular, has not received the attention and research it deserves.
In 2018, the FDA approved a highly sensitive hormone test that helps predict when women will reach menopause8. This past January, researchers published a study9 showing that when the test results are paired with additional health data, that prediction becomes much more accurate—a welcome development for a lot of women in the throes of perimenopause. When you’re up to your eyeballs in hot flashes, mood swings, and wildly irregular periods, a little light at the end of the tunnel is appreciated. Menopause, for many women, is the sweet reward for having made it through the previous 6-10 years.
But knowing when you’ll reach this milestone is just one benefit of the test. That knowledge can also help you and your doctor plan for a smoother transition and a healthier second half of life.
Historically, hormone tests to predict menopause looked at levels of estrogen, luteinizing hormone (LH), and follicle stimulating hormone (FSH). As you probably know, estrogen is that wonder hormone that keeps every system in women’s bodies operating at peak performance during the first half of our lives. When those levels become erratic in perimenopause, we can start to experience a slew of symptoms ranging from hot flashes, mood swings, and irregular periods, to vaginal dryness, weight gain, and loss of libido (there are actually more than 20 symptoms associated with the menopause transition).
The problem with these tests is that the levels of both of these hormones fluctuate throughout each menstrual cycle—particularly in perimenopause—and from one cycle to the next. This has led to doctors trying to get women to take these tests at particular times in the menstrual cycle, hoping to catch these hormones at a very specific point. Additionally, they vary tremendously with birth control and in a number of other situations. Since there is so much variability in these hormones during perimenopause, these tests by themselves are often not reliable.
Did that stop companies from offering them? Or doctors from prescribing them? It did not. So a lot of women have paid a lot of money to have their saliva, urine, or blood analyzed as a way to predict when they would reach menopause. But all they got in return was a loose estimate based on unreliable results.
Adding a hormone called Anti-Mullerian Hormone (AMH) to the mix changed things. When we’re fetuses, AMH helps determine our gender. Once that’s set, in females it helps select the best follicles for egg production. This hormone doesn’t fluctuate during the menstrual cycle. Instead, it gradually dissipates as you blow through your eggs, finally bottoming out when you reach menopause.
That said, by the time you reach perimenopause, your AMH levels are already very low, “even below detectable limits” in the last five years of perimenopause. So traditional AMH tests weren’t really useful in predicting menopause. But the new AMH test that the FDA approved—the picoAMH test—is sensitive enough to detect these very low levels. And those results, in combination with a woman’s age, health history, and existing menopause symptoms, can help doctors with menopause expertise predict a woman’s final period. And you don’t have to wait until perimenopause to take the test. It can predict menopause starting at age 42, and the test in combination with a clinical evaluation of your symptoms can be helpful even earlier.
"Testing AMH, LH, and FSH, paired with other health data, provides our clinicians with the foundation for understanding when the transition to menopause and midlife will begin,” explains Dr. Taylor Sittler, Founder and CEO of The Cusp. “With that knowledge, we can develop personalized treatment plans that care for the whole woman, help her feel better, and optimize her health and wellbeing.”
At The Cusp, we welcome all of the new peer-reviewed research and vetted tools that help women gain knowledge about their health. If you’re interested in learning where you are on your menopause journey, we’re now offering the new picoAMH test, which you can take at home. Visit our site to learn more!
2. Zhu D, Chung H-F, Dobson AJ, Pandeya N, Giles GG, Bruinsma F, et al. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. Lancet Public Health. 2019;4: e553–e564. doi:10.1016/S2468-2667(19)30155-0
6. Scheyer O, Rahman A, Hristov H, Berkowitz C, Isaacson RS, Diaz Brinton R, et al. Female Sex and Alzheimer’s Risk: The Menopause Connection. J Prev Alzheimers Dis. 2018;5: 225–230. doi:10.14283/jpad.2018.34
7. Candeias E, Duarte AI, Sebastião I, Fernandes MA, Plácido AI, Carvalho C, et al. Middle-Aged Diabetic Females and Males Present Distinct Susceptibility to Alzheimer Disease-like Pathology. Mol Neurobiol. 2017;54: 6471–6489. doi:10.1007/s12035-016-0155-1
9. Finkelstein JS, Lee H, Karlamangla A, Neer RM, Sluss PM, Burnett-Bowie S-AM, et al. Anti-Mullerian Hormone and Impending Menopause in Late Reproductive Age: The Study of Women’s Health Across the Nation. J Clin Endocrinol Metab. 2020. doi:10.1210/clinem/dgz283