Institutional members access full text with Ovid®

Antral follicle count predicts natural menopause in a population-based sample: the Coronary Artery Risk Development in Young Adults Womens Study

Wellons, Melissa F. MD, MHS1; Bates, Gordon Wright MD2; Schreiner, Pamela J. PhD3; Siscovick, David S. MD, MPH4; Sternfeld, Barbara PhD5; Lewis, Cora E. MD6

doi: 10.1097/GME.0b013e31827f06c2
Original Articles

Objective: The timing of menopause is associated with multiple chronic diseases. Tools that predict this milestone have relevance for clinical and research purposes. Among infertile women, a positive relationship exists between antral follicle count (AFC) and response to controlled ovarian hyperstimulation, a marker of ovarian reserve. However, an age-independent relationship between AFC and menopause has not been demonstrated. Thus, our objective was to evaluate the relationship between AFC measured in women aged 34 to 49 years and incident natural menopause during 7 years of follow-up.

Methods: The Coronary Artery Risk Development in Young Adults Study is a longitudinal community-based study (Chicago, IL; Birmingham, AL; Minneapolis, MN; and Oakland, CA) begun in 1985-1986. In 2002-2003, the Coronary Artery Risk Development in Young Adults Women’s Study measured follicle-stimulating hormone (FSH) levels and performed a transvaginal ultrasound protocol that included AFC (2-10 mm follicles on both ovaries). Incident natural menopause was assessed by surveys in 2005-2006 and 2009-2010.

Results: In our sample (n = 456), the median (interquartile range) AFC and FSH level were 5 (2-9) and 7.8 (5.6-11.0) mIU/mL, respectively, at a mean (range) age of 42 (34-49) years in 2002-2003. One hundred one women reported natural menopause by 2009-2010. In Cox models, current smoking, stable menses, FSH level higher than 13 mIU/mL, and AFC of 4 or less were independently associated with incident natural menopause. Compared with AFC higher than 4, those with an AFC of 4 or less were nearly twice as likely to have undergone menopause during 7 years of follow-up (hazard ratio, 1.89; 95% CI, 1.19-3.02) after adjustment for covariates.

Conclusions: AFC has been found to be independently associated with natural menopause during 7 years of follow-up after controlling for other markers of ovarian aging.

In this study, women with an antral follicle count (AFC) of four or less were nearly twice as likely (compared to women with an AFC greater than four) to report menopause at follow-up 7 years later, even after controlling for known correlates of ovarian aging.

From the 1Department of Medicine, Vanderbilt University, Nashville, TN; 2Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; 3Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; 4Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, WA; 5Division of Research, Epidemiology, and Prevention, Kaiser Permanente, Oakland, CA; and 6Division of Preventive Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL.

Received April 18, 2012; revised and accepted November 20, 2012.

Funding/support: The Coronary Artery Risk Development in Young Adults Study (grants N01-HC-95095, N01-HC-48047, N01-HC-48048, N01-HC-48049, N01-HC-48050, N01-HC-05187, N01-HC-45205, N01-HC-45204, and N01-HC-45134), as well as the Coronary Artery Risk Development in Young Adults Women’s Study (grant R01-HL-065611), was supported by the National Heart, Lung, and Blood Institute. M.F.W. was supported by a National Heart, Lung, and Blood Institute Career Development Award (K23-HL-87114).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Melissa F. Wellons, MD, MHS, Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue, Nashville, TN 37203. E-mail:

© 2013 by The North American Menopause Society.