How AMH falls before the final period tracked later cardiovascular risk

Design

Longitudinal cohort analysis with trajectory modelling (SWAN)

Population

1,131 US women with three or more perimenopausal AMH measurements and a known final period

Primary outcome

AMH trajectory class and postmenopausal cardiovascular risk profile

Effect

Two classes: low/slow (39.6%, median decline 1.2 pg/mL/month) and high/fast (60.4%, 6.7 pg/mL/month); low/slow had worse risk profiles

In the US SWAN cohort, 1,131 women had at least three anti-Müllerian hormone (AMH) measurements during perimenopause and an observed final menstrual period. Statistical modelling sorted them into two patterns: about 40% started with lower AMH and declined slowly, and about 60% started higher and fell steeply.

The low-and-slow group was older at baseline, had a higher body mass index and was more often from a non-White background. After the final period these women had worse cardiovascular risk profiles and were less likely to report frequent hot flushes, an association that held after accounting for premenopausal cardiovascular risk factors.

This is a description of patterns in a cohort, not a test. AMH is not validated for predicting cardiovascular risk, and repeated AMH measurement in perimenopause is not routine care.

The clinical value is a reminder: the menopause transition is a good time to review blood pressure, lipids, glucose and weight, and the women with fewer vasomotor symptoms may be the ones whose cardiovascular risk is quietly higher.

• Use perimenopausal visits to check blood pressure, lipids, glucose and weight.
• Do not use AMH to estimate cardiovascular risk; it has not been validated for that.
• Do not assume that few hot flushes means a low-risk transition.
• Consider cardiovascular risk assessment for women with a higher body mass index at menopause.

Why it matters

It links ovarian ageing with cardiovascular risk and hints that the quieter transition is not necessarily the healthier one.

Don't overread it

This was an observational pattern analysis; it does not support ordering AMH to stratify heart risk.

The statistics, in plain English

The two groups were found by a statistical method that sorts women by the shape of their AMH curve. The differences between groups are associations; they do not show that the pace of ovarian ageing causes cardiovascular risk.

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