Menopause-delaying procedure could help women at risk for heart and bone issues

by WV Marshall

A British clinic has taken a procedure typically used to preserve fertility of young women with cancer and used it as a means to delay menopause for up to two decades, it was reported recently.

While social media lit up with women debating the delay of menopause, doctors said the operation could offer a benefit to women who experience serious health issues, such as heart conditions or osteoporosis, that can be brought on or exacerbated by menopause, The Guardian reported in early August 2019.

So far, fewer than a dozen women have undergone the procedure and it isn’t clear how effective it will be in delaying menopause, Healthline.com reported. Experts also warned that delaying menopause carries its own health risks, including a higher risk of breast cancer.

The procedure – which could cost between $8,500 to $13,300 – involves removing and then freezing a portion of an ovary’s tissue, which later can be thawed and reimplanted to delay the onset of menopause.

“This has the potential to be of significant benefit to any woman who may want to delay the menopause for any reason, or those women who would have taken HRT, and there are lots of benefits around that,” Professor Simon Fishel, the chief executive officer of Birmingham-based ProFam and founder of the CARE Fertility Group, told The Guardian.

“As women, for the first time in human history, are living so much longer in the post-fertile phase, they may be suffering much longer,” Fishel said in a separate interview with Healthline.

While it’s too soon to tell the effectiveness of the procedure, doctors said they hope that performing the experimental surgery now, they eventually hope to be able to delay menopause as a matter of routine in the future. While the women have had the extraction procedure, not one has had the ovarian tissue reimplanted, meaning there’s neither long-term nor follow-up data yet.

“My desire to do this now is to give the opportunity for a young generation of women to use what we believe is no longer an experimental procedure by many experts. If we continue to delay, each generation will continue to miss out,” Fishel told Healthline.

Curiously enough, once the frozen section of ovary is reimplanted, it doesn’t need to be reinserted in or near the ovary – but it must be in a location where it can regain blood supply and start functioning again to build up lower hormone levels.

“The site doesn’t have to be the ovary, and in fact, regrafting the tissue onto or near the ovary requires a more invasive surgical procedure,” said Dr. Amanda Kallen, a reproductive endocrinologist and infertility specialist with the Yale Fertility Center.

Because of the dramatic fall in estrogen levels during menopause, women experience a new batch of health issues, including cardiovascular disease, loss of bone density, and osteoporosis, accompanied by symptoms such as hot flashes, depression, and poor sleep, Kallen said. So, if menopause could be delayed, there’s a chance that these health issues could be avoided.

Also, some women – such as those who experienced a blood clot or stroke – may not be good candidates for hormone replacement therapy that is commonly used to ease menopause symptoms, so freezing ovarian tissue may present an alternative treatment.

But the procedure isn’t without risks, and it’s too soon to tell how safe and effective it could be, Healthline.com said.

For example, experts don’t know how long the frozen section can survive once it’s reinserted in the body. Physicians note that with younger cancer patients, the tissue usually had a shorter survival window.

“Available data, when this has been done with much younger ovaries (young cancer patients), find that their survival can be quite short — much shorter than their quoted 20 years,” Dr. Marcelle Cedars, the director of the University of California-San Francisco Center for Reproductive Health, told Healthline.com.

Richard Anderson, the deputy director of the Centre for Reproductive Health at Edinburgh University, has performed ovarian tissue freezing for young girls and women for 25 years. He told The Guardian that tissue transplants for restoring hormone levels was “old news.” But, he added, “What is less clear is whether this is a safe and effective way of doing so.”

Cedars also noted that delayed menopause potentially could increase the risk of ovarian cancer.

“There are plusses and minuses to delaying menopause. While prolonged estrogen would delay heart disease and osteoporosis, delayed menopause is associated with an increased risk for breast cancer,” Cedars said.

Still, health experts express cautious optimism about the procedure and its potential.

“This is the first project in the world to provide healthy women ovarian tissue cryopreservation purely to delay the menopause,” ProFam’s chief medical officer, Yousri Afifi, told the (London) Sunday Times.