How Anti-Mullerian Hormone Can Help Diagnose PCOS?
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Introduction
Hormones control several body functions and also influence our lives in a myriad number of ways. While hormones like insulin, thyroid, oestrogen, progesterone, and testosterone receive ample attention, there is an equally important one- the anti-Mullerian hormone (AMH) that can shed light on ample conditions like PCOS. Let’s understand more about what are AMH levels and how they can help diagnose PCOS.
What is the Anti-Mullerian Hormone (AMH)?
The anti-mullerian hormone is a hormone that is produced by the testes in males and ovaries in females. This hormone plays a different role in both sexes. The levels of AMH vary depending on the gender and age of an individual. They provide a deeper insight into many reproductive health conditions, including PCOS.
Did you know AMH is also produced in unborn babies?
Yes, you read that right! AMH in unborn babies helps in the formation and development of reproductive hormones. AMH, along with other hormones, are responsible for this. Unborn female babies have low levels of AMH, which allows the various reproductive structures to develop.
Why are AMH Levels Important?
AMH is secreted by an ovarian follicle that is ready to release an egg during the menstrual cycle. The hormone is also called a Mullerian-inhibiting substance. AMH levels are directly related to the number of small follicles in the ovary every month. Each month, the follicles grow and, towards the end of development, mature.
One mature follicle releases an egg each month through the process of ovulation. The more follicles a female has, the higher will be her AMH levels. So, doctors use a female’s AMH level reading to predict the number of follicles she has, called the ovarian reserves. Knowing AMH levels can help doctors determine if infertility treatments like IVF can be successful.
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How to Test for AMH Levels?
This test measures the amount of anti-mullerian hormone in your blood.
When is an AMH Test Prescribed?
An AMH test is usually recommended under the following conditions:
In females,
- When there is a fertility-related issue
- When you need to undergo an IUI or IVF treatment
- When you have symptoms of PCOS such as acne, menstrual irregularities, weight gain, excessive hair growth on the face, chest, stomach and thighs
- When you are undergoing treatment for ovarian cancer, an AMH test can show if your treatment is working. It can also indicate if your cancer has returned after completion.
Other indications of an AMH Test:
- A male baby who does not have testicles in the scrotum may need an AMH to determine if there are healthy testicles in the body
- A baby with genitals that are not clearly male or female may require an AMH to diagnose the cause of the condition and confirm the sex.
What happens during an AMH Test?
A healthcare professional will collect a blood sample from a vein in your arm. The test usually takes less than five minutes.
What are the Normal AMH Levels?
AMH levels are determined using a blood test. An AMH test can:
- Check how many eggs you have left in your ovaries (called the ovarian reserve)
- Help determine how well you respond to fertility medicine
- Help determine if you are close to menopause
- Help diagnose or monitor problems with the ovaries like PCOS or certain types of cancer
The AMH levels stay low in female children and begin to increase as they reach puberty. After this, they begin to decline. Normal AMH levels in females are usually determined by age:
| Age | AMH Level |
| 20-25 years | 4.23 ng/dL |
| 26-30 years | 3.48 ng/dL |
| 31- 35 years | 2.43 ng/dL |
| 36 to 40 years | 1.28 ng/dL |
| 41- 44 years | 0.52 ng/dL |
AMH levels under 1 ng/dL are considered low, according to the American College of Obstetricians and Gynaecologists (ACOG).
A Brief About PCOS
Polycystic ovarian syndrome, or PCOS, is a common endocrine disorder in females of reproductive age. It is a multifactorial condition characterised by a wide range of clinical symptoms and delayed complications like type 2 diabetes mellitus, metabolic syndrome, cardiovascular diseases and endometrial cancer.
PCOS is caused by an imbalance in female sex hormones which leads to irregular menstrual cycle, lack of ovulation, and infertility.
According to the Rotterdam criteria, you are said to have PCOS if you have at least two or more of the following features:
- Oligo or amenorrhoea (Irregular periods)
- Hpyergonadisum
- The polycystic appearance of the ovary on the ultrasound (the ovaries become enlarged and contain fluid-filled sacs around the follicles
A few common symptoms that females with PCOS may experience are:
- Irregular or no periods
- Difficulty in getting pregnant
- Excessive hair growth on the face or body
- Weight gain
- Oily skin and acne
Causes of PCOS
The exact cause of PCOS is unknown but is said to run in families. While it is characterised by abnormal hormone levels in the body, the same abnormal hormone in the body, like high insulin levels, is said to cause this condition. It has been found that females with PCOS are resistant to the action of insulin in the body and produce higher insulin levels to overcome this. This results in the overproduction of androgens (male sex hormones), including testosterone. Being overweight or obese can also increase the risk of both hormonal imbalance and PCOS.
To know more about PCOS and its effect on health, check out our blog here!
How Does AMH Help in Diagnosing PCOS?
Though existing studies show AMH levels were significantly higher in females with PCOS, it is an independent marker. AMH levels must be used as an adjunct to the Rotterdam criteria for the confirmed diagnosis of PCOS.
Females with PCOS have excessive amounts of antral follicles, producing a larger quantity of PCOS. So, higher AMH levels may suggest PCOS in females who may not show signs and symptoms of the condition.
In a normal healthy ovary, AMH levels keep the follicles from developing too early. When this happens, the ovaries will release an egg that is not yet ready (or is immature). When AMH levels are high, it can prevent ovulation.
Having too much AMH can stop ovulation from happening. In a normal ovary, AMH keeps the follicles from developing too early. If this happened, they would release an egg that isn’t ready yet. However, high AMH levels do not always mean the individual has PCOS.
AMH, PCOS and Diabetes Mellitus
So far, we have understood the association between AMH and PCOS and how they are a marker for reproductive ageing. There is limited research on reproductive ageing and increased risk of type 2 diabetes mellitus. Just like AMH is related to an increase in androgens and insulin resistance, these are also characteristic features of PCOS.
FitterTake
The anti-mullerian hormone plays a vital role at different times in the life of an individual. In females, the role of this hormone is paramount as it gives deeper information about their reproductive health and fertility. AMH level is an important parameter in diagnosing PCOS, a condition that significantly impacts the health and well-being of women affected by it.
If you suspect you are showing signs of PCOS, visit your doctor today! PCOS increases the risk of type 2 diabetes. Over 50% of women with this condition go on to develop type 2 diabetes by age 40. Living with PCOS and type 2 diabetes? Learn more about Fitterfly’s Diabetes Care Program has been curated by expert diabetologists.
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Frequently Answered Questions
Q1) Does PCOS affect AMH levels?
The levels of AMH are 2-3 times higher in women with PCOS. This is due to the increased number of cyst-like follicles seen in PCOS.
Q2) Can eating a healthy diet improve my AMH levels?
If your abnormal AMH levels are due to an underlying condition like PCOS, treating it may help bring your AMH levels within the normal range. Healthy lifestyle changes like achieving and maintaining optimum weight, stress management and eating a healthy diet can influence your overall AMH levels.
Q3) Can stress affect AMH levels?
Women who are constantly under stress and mental pressure tend to have lower AMH levels, which has a direct effect on their fertility.
Q4) What are the signs and symptoms of low AMH?
Low AMH levels do not usually cause any specific signs or symptoms. However, you may experience irregular periods, shorter menstrual cycles or premature menopause.
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