AMH Test and Perimenopause: What It Tells You About Ovarian Reserve
Understand what the AMH test measures, how it relates to perimenopause, what your result means, and how to use it to plan ahead.
What Is AMH and What Does the Test Measure?
AMH stands for anti-Mullerian hormone. It is produced by the small follicles in your ovaries and reflects how many eggs remain in your ovarian reserve. Unlike FSH, which fluctuates throughout the cycle, AMH is relatively stable and can be measured at any point in the month. A declining AMH signals that the pool of available follicles is shrinking. This makes it one of the most reliable single markers for assessing where you are in the journey toward menopause.
Why AMH Is Relevant in Perimenopause
AMH falls gradually from around age 30, and by early perimenopause it is often already quite low. A very low AMH indicates limited ovarian reserve and predicts that menopause may arrive sooner rather than later. This matters for women still considering fertility, but it also gives women who are not trying to conceive a clearer sense of their hormonal timeline. Knowing that ovarian reserve is significantly reduced can help you make informed decisions about HRT timing and long-term bone and cardiovascular protection.
What AMH Levels to Expect at Different Life Stages
In your late 20s, AMH might be around 15 to 40 pmol/L. By your late 30s, 5 to 15 pmol/L is common. In early perimenopause, many women see levels below 5 pmol/L, and in late perimenopause the level is often undetectable or close to zero. These are general ranges and vary between individuals. Some women with low AMH still have regular periods; others with moderate AMH experience significant symptoms. AMH tells you about egg quantity, not the quality of your symptoms.
How to Get an AMH Test
AMH testing is not routinely offered on the NHS for perimenopause assessment. It is more commonly used in fertility clinics. However, many private clinics and online hormone testing services offer it as part of hormonal health panels. The blood draw can be done at any time in your cycle, which makes it more convenient than cycle-dependent tests like day-two FSH. Some GPs will order it if you have a clear clinical reason, such as early-onset symptoms or family history of early menopause.
Understanding Your AMH Result
An AMH below 5 pmol/L is generally considered low for reproductive purposes and indicates reduced ovarian reserve. Below 2 pmol/L is very low, and an undetectable AMH suggests ovarian reserve is essentially depleted. Interpreting the result depends on your age: a low AMH at 35 is more significant than a low AMH at 48, when a decline is expected. Your result needs to be read alongside your symptoms and menstrual history to have clinical meaning.
What to Do With the Information
A low AMH confirms that perimenopause is progressing and can strengthen the case for proactive health planning. If you are not yet on HRT and have a low AMH alongside symptoms, this is worth discussing with your doctor as a factor in the conversation about treatment timing. If fertility is still a consideration, a very low AMH warrants urgent discussion with a reproductive specialist. For most women in perimenopause, a low AMH is reassurance that their symptoms are real and hormonally driven, not imagined.
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