Association between anti-Mullerian hormone levels and age in women with endometriosis: insights from a population-based study

Background While previous studies have shown an association between anti-Mullerian hormone (AMH) levels and endometriosis, there are limited data on the relationship between AMH levels and age among women with endometriosis.Objectives The present study aimed to investigate the associations between a...

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Main Authors: Fereidoun Azizi, Fahimeh Ramezani Tehrani, Samira Behboudi-Gandevani, Maryam Mousavi, Shahla Noori Ardebili, Marzieh Saei Ghare Naz
Format: Article
Language:English
Published: BMJ Publishing Group 2025-07-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/15/7/e102774.full
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author Fereidoun Azizi
Fahimeh Ramezani Tehrani
Samira Behboudi-Gandevani
Maryam Mousavi
Shahla Noori Ardebili
Marzieh Saei Ghare Naz
author_facet Fereidoun Azizi
Fahimeh Ramezani Tehrani
Samira Behboudi-Gandevani
Maryam Mousavi
Shahla Noori Ardebili
Marzieh Saei Ghare Naz
author_sort Fereidoun Azizi
collection DOAJ
description Background While previous studies have shown an association between anti-Mullerian hormone (AMH) levels and endometriosis, there are limited data on the relationship between AMH levels and age among women with endometriosis.Objectives The present study aimed to investigate the associations between age and AMH levels in women with and without endometriosis.Design and setting A cross-sectional, population-based study using data from the ongoing Tehran Lipid and Glucose Study.Participants A total of 1005 eligible reproductive-age women were selected. These participants were categorised into two groups: women with confirmed endometriosis (n=305) and controls (n=700).Interventions None.Outcome measures Association between AMH levels and age among women with endometriosis and healthy controls, using linear, quadratic and segmented regression analyses.Results A total of 1005 women aged 18–48 years participated in the study, including 305 (30.3%) with endometriosis and 700 (69.7%) healthy controls. Women with endometriosis had significantly lower AMH levels compared with healthy controls (1.99±1.42 vs 2.30±1.61 ng/mL; p=0.029). In healthy controls, an increase of 1 year was associated with −0.15 ng/mL of AMH (95% CI: −0.17 to −0.14). Segmented regression identified a threshold at 27 years (1.92), with a sharper decline below this age (slope: −0.35, 95% CI: −0.47 to −0.23; p<0.001) and a more gradual decline beyond it (slope: −0.12, 95% CI: −0.14 to −0.10; p<0.001). In women with endometriosis, AMH levels also declined with age (slope: −0.16, 95% CI: −0.17 to −0.14; p<0.001), with no significant threshold observed.Conclusion Our study showed that women with endometriosis had significantly lower AMH levels compared with healthy controls and did not demonstrate the age-related threshold observed in the control group, where AMH levels declined more sharply before 27 years of age. These findings suggest that endometriosis may alter the typical pattern of AMH, indicating that clinicians should interpret AMH levels with caution in this population. Further research is needed to validate these results in other populations and explore alternative biomarkers or strategies for more accurately assessing ovarian reserve in women with endometriosis.
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spelling doaj-art-4d0b2fcddc3349e6a3cc9131243e547a2025-08-20T02:42:39ZengBMJ Publishing GroupBMJ Open2044-60552025-07-0115710.1136/bmjopen-2025-102774Association between anti-Mullerian hormone levels and age in women with endometriosis: insights from a population-based studyFereidoun Azizi0Fahimeh Ramezani Tehrani1Samira Behboudi-Gandevani2Maryam Mousavi3Shahla Noori Ardebili4Marzieh Saei Ghare Naz5Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehra, IranReproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranFaculty of Nursing and Health Sciences, Nord Universitet, Bodø, NorwayReproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranReproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranReproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranBackground While previous studies have shown an association between anti-Mullerian hormone (AMH) levels and endometriosis, there are limited data on the relationship between AMH levels and age among women with endometriosis.Objectives The present study aimed to investigate the associations between age and AMH levels in women with and without endometriosis.Design and setting A cross-sectional, population-based study using data from the ongoing Tehran Lipid and Glucose Study.Participants A total of 1005 eligible reproductive-age women were selected. These participants were categorised into two groups: women with confirmed endometriosis (n=305) and controls (n=700).Interventions None.Outcome measures Association between AMH levels and age among women with endometriosis and healthy controls, using linear, quadratic and segmented regression analyses.Results A total of 1005 women aged 18–48 years participated in the study, including 305 (30.3%) with endometriosis and 700 (69.7%) healthy controls. Women with endometriosis had significantly lower AMH levels compared with healthy controls (1.99±1.42 vs 2.30±1.61 ng/mL; p=0.029). In healthy controls, an increase of 1 year was associated with −0.15 ng/mL of AMH (95% CI: −0.17 to −0.14). Segmented regression identified a threshold at 27 years (1.92), with a sharper decline below this age (slope: −0.35, 95% CI: −0.47 to −0.23; p<0.001) and a more gradual decline beyond it (slope: −0.12, 95% CI: −0.14 to −0.10; p<0.001). In women with endometriosis, AMH levels also declined with age (slope: −0.16, 95% CI: −0.17 to −0.14; p<0.001), with no significant threshold observed.Conclusion Our study showed that women with endometriosis had significantly lower AMH levels compared with healthy controls and did not demonstrate the age-related threshold observed in the control group, where AMH levels declined more sharply before 27 years of age. These findings suggest that endometriosis may alter the typical pattern of AMH, indicating that clinicians should interpret AMH levels with caution in this population. Further research is needed to validate these results in other populations and explore alternative biomarkers or strategies for more accurately assessing ovarian reserve in women with endometriosis.https://bmjopen.bmj.com/content/15/7/e102774.full
spellingShingle Fereidoun Azizi
Fahimeh Ramezani Tehrani
Samira Behboudi-Gandevani
Maryam Mousavi
Shahla Noori Ardebili
Marzieh Saei Ghare Naz
Association between anti-Mullerian hormone levels and age in women with endometriosis: insights from a population-based study
BMJ Open
title Association between anti-Mullerian hormone levels and age in women with endometriosis: insights from a population-based study
title_full Association between anti-Mullerian hormone levels and age in women with endometriosis: insights from a population-based study
title_fullStr Association between anti-Mullerian hormone levels and age in women with endometriosis: insights from a population-based study
title_full_unstemmed Association between anti-Mullerian hormone levels and age in women with endometriosis: insights from a population-based study
title_short Association between anti-Mullerian hormone levels and age in women with endometriosis: insights from a population-based study
title_sort association between anti mullerian hormone levels and age in women with endometriosis insights from a population based study
url https://bmjopen.bmj.com/content/15/7/e102774.full
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