All eyes on postponing menopause, because a new technique could make this dream a reality

It’s no secret that menopause symptoms can have a detrimental impact on patients’ well-being and health. From being overwhelmed by hot flashes to dealing with metabolic changes, many women report poor quality of life due to menopause.^[] 

The approach involves cryopreserving ovarian tissue and transplanting it back into the body near menopause, according to research published in the American Journal of Obstetrics and Gynecology (AJOG).^[] When transplanted, the tissue releases mature eggs and hormones that could prevent menopausal symptoms.^[]

The potential to prolong fertility

It could also cause menstruation to continue.^[] However, the procedure is likely to fail if the tissue was originally extracted after the age of 40.

“As an example, the delay in menopause (D) for a woman with a median ovarian reserve who cryopreserves 25% of her ovarian cortex at the age of 25 years and for whom 40% of follicles survive after transplantation would be approximately 11.8 years, but this extends to 15.5 years if the survival is 80%,” the AJOG researchers wrote. “As another novel finding, spreading the same amount of tissue to repetitive transplants significantly extends the benefit.”^[]

Procedure success was based on a few key variables: age at tissue harvest, how much tissue was harvested, the transplantation of the tissue, how many procedures were completed, and the post-transplant follicle survival rate. 

While this approach has been referred to as “unconventional,”^[] it isn’t a new procedure, Alyssa Dweck, MS, MD, FACOG, a board-certified gynecologist and Chief Medical Officer of Bonafide Health, tells MDLinx.

“Cryopreservation as a procedure is not new in general but is novel for the indication of preventing menopause,” she says. “It’s been used in women who want to save tissue for implantation to maintain fertility after cancer treatment, or in women who go through early or premature menopause."

Dr. Dweck says the procedure may offer hope to some patients: “Benefits include endogenous hormone replacement and another option for those suffering from menopause symptoms or wanting to be proactive against symptoms and bone loss. Other benefits might include prolonged fertility.”

According to Samantha Pulliam, MD, FACOG, a board-certified subspecialist in female pelvic medicine and reconstructive surgery and Chief Medical Officer of Axena Health, there are still many unanswered questions around the procedure’s efficacy. The method is a “thought exercise about what is possible,” she says, noting that, while anything that could delay the onset of menopause would be welcomed by many women, there are still a lot of unknowns.

“There are key pieces to the steps in the process that don't have data," Dr. Pulliam tells MDLinx. "They talk about transplanting ovarian tissues, but there’s no clue about how long the follicles will survive."

According to an article published in Maturitas, “There is no evidence to suggest that OTCT [ovarian tissue cryopreservation and transplantation] is superior to hormone replacement therapy in terms of both efficacy and safety.”^[]

There are also clear limitations and risks associated with the procedure. “It's not just taking a pill; it's a surgery,” Dr. Dweck says. Risks include infection, bleeding, and anesthesia issues. She also mentions possible access issues, including costs and insurance coverage. 

Menopause awareness is key

Regardless of whether ovarian tissue-freezing becomes mainstream, helping patients manage menopause is a must.

“The menopause experience is truly individual,” Dr. Dweck says.

But no matter what patients experience, “The grin-and-bear-it phenomenon is over,” Dr. Dweck stresses. She explains that there are other menopause management options, including lifestyle modification, such as diet, exercise, and stress reduction; cognitive behavioral therapy; herbs and supplements; hormone therapy; and pharmacological options, such as NK3 antagonists, selective serotonin reuptake inhibitors, gabapentin, and oxybutin. 

“Menopause deserves attention, like contraception, abortion care, or cardiovascular disease in women,” Dr. Pulliam says. “Menopause happens to every single woman, and yet we understand little about its long-term effects or the impacts of our treatments. [...] I think there's plenty of room for more research on the impact of menopause on a woman's life.”