AMH levels in PCOS: Anti-mullerian hormone and PCOS severity

Polycystic Ovary Syndrome (PCOS) affects reproductive, endocrine, and metabolic systems in women. There are several conditions that can indicate PCOS, and insulin resistance and hormonal imbalance are some of them. High testosterone, sex hormone binding globulin (SHBG), luteinizing hormone (LH), and anti-mullerian hormone (AMH) levels are the hormones a health care provider will likely check to diagnose PCOS. It was discovered that high AMH levels can be PCOS signs.

But what is anti-mullerian hormone in PCOS, and what is the PCOS AMH level? Let’s find out in this article.

Struggling to lose weight with PCOS? Take our quiz now to find a personalized solution just for you >>

What is anti-mullerian hormone in PCOS?

Anti-mullerian hormone (AMH) is a hormone that young ovarian follicles (small antral follicles) release during the female reproductive years. These small antral follicles, which are actually visible on ultrasound, are the early stage of ovarian follicles, each containing an immature egg. This hormone is also produced in the testicles in males. 

In females, AMH indicates ovarian reserve – a female's egg count, or how many eggs are left in the ovary. The more antral follicles a female has, the higher her AMH levels will be.

The AMH levels gradually increase starting from birth, peak at around age 25, then decline. This hormone is also one of the indicators of menopause, because at that stage it becomes undetectable. 

AMH level is also one of the biomarker predictors of PCOS and is used for detecting and diagnosing the condition. 

Reasons for high AMH levels in PCOS

High AMH levels can indicate PCOS, because women with this condition often have many of those antral follicles that don't develop properly. As a result, women with PCOS tend to have irregular cycles, anovulatory cycles, and infertility issues. Simply speaking, it’s like a garden full of seeds (antral follicles), which can’t grow into plants. 

Normally, this hormone called AMH regulates the phases of a follicle development – it limits antral follicle maturation. AMH ensures the follicles don’t develop too early and takes it time to mature. But when AMH levels are too high, it can actually inhibit egg development and stop ovulation.

From one side, you might think, why would a lot of small follicles, which are potentially future eggs, be a bad sign? А high AMH level can also indicate a good ovarian reserve in some cases. Although true, it doesn’t really mean that all the follicles are able to mature further into an egg; they can just sit in this antral phase. So, even with a high AMH level, the body might not release a healthy egg for fertilization. 

High AMH level doesn't necessarily mean better fertility; it often reflects an imbalance in the ovary's ability to develop further and ovulate. 

Another reason for high PCOS AMH levels is insulin resistance. When cells can’t utilize glucose effectively, insulin levels increase. This elevated insulin stimulates the ovaries to produce more AMH. Additionally, insulin resistance can also lead to increased androgen levels, which further contributes to higher AMH production.

What AMH level indicates PCOS?

Doctors can use AMH levels to spot signs of PCOS. But what exactly is the PCOS AMH level?

AMH levels are measured in nanograms per milliliter (ng/mL) in a blood test. First of all, it depends on your age. Average AMH levels by age are the following: 

• 25 years old: 3.0 ng/mL.
• 30 years old: 2.5 ng/mL.
• 35 years old: 1.5 ng/mL.
• 40 years old: 1 ng/mL.
• 45 years old: 0.5 ng/mL.

Doctors usually suggest this general range:

• High: over 3.0 ng/mL.
• Normal: Between 1.0 ng/mL and 3.0 ng/mL.
• Low: Under 1.0 ng/mL.
• Severely low: 0.4 ng/mL.

But as we already discovered, it is possible that a high AMH level indicates PCOS. Considering the ranges given above, PCOS AMH level ng/ml might be greater than 3.0, and studies usually recommend that AMH higher than 3.8–5 ng/mL is used for diagnosing PCOS. However, this is something individual and shall be defined by a specialist. 

In one study, it was discovered that PCOS AMH level of 3.15 ng/mL could be used for early diagnosis. 

Several studies compared ranges of AMH levels in healthy fertile women to the AMH levels of PCOS-affected women, divided by their age groups. They noticed that women with PCOS had more than twice the AMH level than their peers. For example, a healthy female aged 20-27 in this study had an AMH level less than or around 5 ng/mL, while females with PCOS of the same age had it around 5 to 10 ng/mL and above.

Another study also confirms the elevation of AMH level by two- or three-fold in females with PCOS.

However, keep in mind that none of these numbers already means PCOS, it’s just a clue for further medical investigation.

AMH levels PCOS severity – ranges and symptoms

Now that we’ve sorted out the normal ranges of AMH levels, you might wonder if there are AMH levels of PCOS severity. 

Several studies made efforts to define these ranges. For example, they discovered that increased AMH levels are associated with PCOS severity. 

Extremely high AMH levels are likely to indicate PCOS. In a study, it was discovered that more than 97% of women with ultrahigh AMH (above 10 ng/mL) had PCOS. In this study, researchers divided women with PCOS into 3 groups by the severity of the symptoms. The range in this study is quite similar to others used in other studies. Thus, AMH levels of PCOS severity can be similar to this range:

• Mild type: 5-10 ng/mL, 
• Severe: over 10,01-14 ng/mL, 
• Ultra severe: over 14 ng/mL. 

Moreover, PCOS-affected women who have higher levels of AMH tend to have worse symptoms. Some of these symptoms discovered in the studies were:

• Polycystic Ovarian Morphology (PCOM): Women with AMH over 10 ng/mL had a higher prevalence of PCOM (multiple cysts on the ovaries).
• Oligomenorrhea: Higher prevalence of irregular menstrual cycles.
• Hyperandrogenemia: Women with high AMH levels had a higher prevalence of hyperandrogenemia, which means having high levels of male hormones (androgens) like testosterone.
• Increased Ovarian Stimulation: Women with high AMH levels had a higher risk of ovarian hyperstimulation syndrome (OHSS) when undergoing assisted reproductive technology (ART). 
• Increased Clinical Pregnancy Rates: Interestingly, despite the increased risk of OHSS, women with high AMH levels also showed higher clinical pregnancy rates following ART. 

Can you reduce PCOS AMH level?

There are ways to reduce AMH levels if you are managing PCOS. 

Medications

Medical doctors sometimes prescribe metformin (an insulin-sensitizing agent) to treat irregular periods. One study showed that this medication lowered AMH levels in PCOS patients after six months of therapy. Another study on infertile women showed similar positive results.

Vitamin D

There are also studies that showed a correlation between vitamin D and AMH levels in women with PCOS. One study showed that AMH was significantly decreased after taking vitamin D in females with PCOS. Interestingly, different results were observed for ovulatory women without PCOS – vitamin D supplements actually significantly increased their AMH levels. 

CoQ10

Coenzyme Q10 (CoQ10) as a supplement was also proven to lower AMH levels in PCOS patients. This antioxidant can reduce androgen levels and normalize glucose metabolism in females with PCOS by reducing oxidative stress that promotes hyperandrogenism, as discovered in a study. 

Omega-3 

There are talks about the Omega-3 effect on PCOS symptoms and AMH, particularly. However, there are not that many studies available. One of them said that Omega-3 and Omega-6 did not affect ovarian reserve as determined by AMH. The other research only pointed out that Omega-3 improved the menstrual cycle by helping make it relatively regular in females with PCOS.

Diets

The effect of certain diets were mostly studied on PCOS-affected women with obesity but showed positive results in regulating AMH levels. However, this is more related to weight management than nutrition. 

Exercise

You’ve probably already heard a thousand times that exercise is good for everything and does miracles for almost any disease or condition. Actually, a study discovered that PCOS AMH levels can decrease with strength or aerobic exercise. 

Please be aware that vitamins and supplements shall not be taken without a doctor’s prescription to avoid unexpected side effects. Supplement combination and their dosage is something that needs to be analyzed by a health care professional after certain clinical analysis.

Final verdict

Anti-mullerian hormone (AMH) is a hormone that is produced in ovaries and indicates ovarian reserve – a female's egg count. You can test your AMH level with a blood test.

While a high AMH level can suggest a large ovarian reserve, it can also be an indicator of PCOS. Elevated AMH levels are often found in women with PCOS. 

It is important to remember about variability. AMH normal and abnormal levels can fluctuate within individuals, age groups, and between different populations. Higher AMH levels are frequently associated with more severe PCOS symptoms. 

Certain prescribed medications, vitamins, and supplements, as well as exercise, can lower high AMH levels in PCOS-affected women, but it’s important to consult your doctor first.