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:
Earlier identification: Recognizing women at higher risk of low ovarian reserve earlier, providing quantitative support for fertility planning in later reproductive age.
Better management: Combining AMH profiling with symptom assessment to support more precise management of perimenopausal symptoms and improve quality of life in midlife.
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.
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Reference
DOI: 10.1097/CM9.0000000000004161
About Ruimin Zheng (PhD) from the National Center for Women and Children’s Health, China
Ruimin Zheng (PhD) is a senior researcher and Master’s supervisor in public health at the National Center for Women and Children’s Health, China CDC, and is currently the Deputy Director (acting) of the Department of Women’s Health. Her work focuses on women’s health services and prevention of common gynecologic conditions, adolescent health, menopause care, and life-course mental health management and interventions. She has contributed to more than ten national and international women’s health projects and has published 50+ peer-reviewed articles as first/corresponding author, alongside editing/translating 10+ monographs and delivering technical training programs.
About Yingying Qin (MD & PhD) from Shandong University, China
Yingying Qin (MD & PhD) is a Professor and Chief Physician at Shandong University, a doctoral supervisor, Deputy Director of the State Key Laboratory of Reproductive Medicine and Offspring Health, and the President of Shandong Provincial Hospital and Deputy Secretary of its Party Committee. She has led translational programs on female reproductive aging. She was among the global top 2% scientists in both Obstetrics & Gynecology and Endocrinology & Metabolism, contributed to national textbooks/consensus statements, and received major awards such as the China Youth Science and Technology Award and the National Maternal and Child Health Science & Technology Award.
About Ting Guo (MD & PhD) from Shandong University, China
Ting Guo (MD & PhD) is a Professor, Associate Chief Physician, and doctoral supervisor at Shandong University. Her research focuses on the regulatory mechanisms underlying the establishment and maintenance of ovarian reserve, as well as the genetic and environmental causes and potential interventions for pathological ovarian aging; she has contributed to mapping the genetic landscape of premature ovarian insufficiency (POI) and has identified 30 pathogenic genes associated with POI. She has published more than 30 SCI-indexed papers as first or corresponding author, holds four Chinese invention patents, leads multiple national research projects, and has received several major scientific awards.
Funding information
This study was supported by the National Natural Science Foundation of China (Nos. 82125014, 82421004,32070847, and 82371646); National Key Research & Developmental Program of China (No. 2022YFC2703800); The Fundamental Research Funds of Shandong University (No. 2023QNTD004); Basic Science Center Program of NSFC(No. 31988101); the Key Project of Natural Science Foundation of Shandong Province(No. ZR202105250005); Program for Excellent Young Scholars of Shandong Province (No. ZR2022YQ69); Taishan Scholars Program for Young Experts of Shandong Province (No. tsqn202211371).
Chinese Medical Journal
Observational study
People
Age-specific anti-Müllerian hormone reference values using an ultrasensitive assay: Associations with ovarian aging and menopausal transition symptoms
17-Aug-2026