Ultrasensitive AMH testing offers new insights into midlife ovarian reserve

In women's lifelong health management, the years from 35 to 55 form a critical transition period. During this period, many women face a triple challenge: declining fertility, bothersome perimenopausal symptoms, and delayed or delays in recognizing or confirming menopause. 

Anti-Müllerian hormone (AMH) is widely used in clinical practice as a marker of ovarian reserve. However, its clinical usefulness in midlife women is still constrained. For example, most existing AMH reference ranges are based on women of reproductive age, for women over 35, and especially those in the menopausal transition, precise age-specific reference ranges are often lacking. On top of that, conventional assays may have insufficient sensitivity at very low AMH concentrations, making it difficult to detect subtle changes during the late reproductive and perimenopause stages. 

Recently, a research team led by Professor Yingying Qin (Shandong University, China) in collaboration with Professor Ruimin Zheng (National Center for Women and Children's Health, China) constructed an age-specific AMH reference table for Chinese women aged 35–55 based on a large nationwide cohort. Using an ultrasensitive AMH assay, the investigators were able to measure AMH more precisely in the age range where levels often approach very low values-particularly among women aged 44–49, a period often described as an AMH "near-depletion" phase. With this age-calibrated "coordinate map," clinicians can now use a woman's exact age and locate her AMH value on this "coordinate chart" to see whether her ovarian reserve is "well ahead of" or "lagging behind" that of her peers. The study was made available online on August 17, 2026, in the Chinese Medical Journal. 

The team also evaluated the clinical utility of this reference framework in a hospital-based care cohort. Among women aged 35–40 who still plan to conceive, they found that those with a baseline AMH level below the 10th percentile (P10) for their age had a much higher risk of progressing to severely diminished ovarian reserve (<0.25 ng/mL) than women in the normal percentile range. This finding may offer practical support for fertility counseling and planning among women attempting pregnancy at later reproductive ages. Beyond fertility-related assessment, AMH percentile strata may also relate to symptoms that are often under-recognized in routine care. The study suggests that, in women aged 35–55, lower AMH levels are associated with a greater likelihood of more severe perimenopausal symptoms, particularly vasomotor symptoms (e.g., hot flashes and sweating). This raises the possibility that AMH could serve as an objective biomarker to complement symptom questionnaires and help clinicians tailor more individualized approaches to symptom management, including consideration of hormone replacement therapy (HRT) when clinically appropriate. The team also examined whether ultra-sensitive AMH testing could help with menopausal status assessment. Comparing AMH levels in premenopausal and postmenopausal women, they observed a clear "cliff-like drop" (0.187 vs 0.043 ng/mL). The ability of AMH alone to distinguish menopausal status was moderate, with an overall discriminative performance around 0.7 (AUC). In other words, AMH by itself is not sufficient as a stand-alone diagnostic test for menopause, but extremely low AMH values may still provide useful supportive information-especially in clinically challenging situations where hormones such as FSH and estradiol can fluctuate. 

In summary, this new ultrasensitive AMH-based, age-specific reference scale aims to address practical clinical gaps across both the late reproductive and perimenopausal stages, supporting more integrated women's health care by enabling: 

1. Earlier identification: Recognizing women at higher risk of low ovarian reserve earlier, providing quantitative support for fertility planning in later reproductive age. 

1. Better management: Combining AMH profiling with symptom assessment to support more precise management of perimenopausal symptoms and improve quality of life in midlife. 

1. Supportive diagnosis: While AMH alone is not an ideal test for diagnosing menopause, very low AMH levels-measured with an ultrasensitive assay-may assist clinicians in assessing menopausal status, particularly in complex cases where other reproductive hormones are difficult to interpret.