What if it were possible to pause menopause, preserving hormonal youth for decades? It is the bold promise of an experimental technique that involves freezing and subsequent transplantation of ovarian tissue. An idea that is arousing great interest, but also deep doubts in the scientific community, divided between the fascination of an innovative solution to the problems of menopause and doubts about its real effectiveness and safety.
A technique created to preserve fertility
The idea of transplanting ovarian tissue to delay menopause arises from a technique already used. To be precise: already used to preserve fertility in patients undergoing chemotherapy or entering menopause early. The procedure involves the removal of a part of the internal portion of the ovaries, ovarian cortex, rich in primordial follicles, when the woman is still young. This tissue is then frozen and stored for years, waiting to be reimplanted.
According to some researchers, how Kutluk Oktay from Yale University, this technique should also be applied to healthy women to delay the onset of menopause. A recent modeling study published inAmerican Journal of Obstetrics and Gynecology (I link it here) estimates that by reimplanting portions of frozen ovarian tissue every few years, the hormonal and menstrual cycle could be maintained for several decades, if started before the age of 40. This, says Oktay (who performed the first ovarian transplant 25 years ago) would make women able to maintain their fertility for longer. Even much more.
“Suspended” menopause, benefits and risks still to be evaluated
Proponents of this technique point to the potential benefits of a prolonged premenopausal state. And not just for fertility. For example, this technique could reduce the risk of some chronic diseases linked to estrogen deficiency, including osteoporosis and cardiovascular problems. Furthermore, delaying menopause could improve the quality of life for many women, alleviating often debilitating symptoms such as hot flashes, insomnia and mood swings.
However, many experts warn about the risks and unknowns of such an operation on healthy women. The procedure in fact requires several surgical interventions, both for the collection and for the subsequent reimplantations of the tissue, with the related anesthetic and post-operative risks. It is also not yet clear whether the transplanted tissue could lead to an increased risk of hormone-dependent cancers, such as breast cancer.
“Anti-menopause” transplants, a superfluous solution?
Then there are those who question the real need to delay menopause in healthy women. There hormone replacement therapy (HRT) it is already an effective and consolidated treatment for alleviating the symptoms of menopause and preventing some complications, such as osteoporosis. Although HRT is not without risks and contraindications, many experts consider it a simpler and safer solution than ovarian tissue transplant. As far as I'm concerned (I'll be wrong) it's hard to imagine that a 25, 30 or 35 year old woman would already be worried enough about menopause to undergo such an invasive and experimental procedure.
A frontier yet to be explored
Despite the doubts, interest in this technique seems to be growing. In addition to Oktay's clinic, a startup in the USA, ProFaM Health, is exploring this path with a waiting list of over 100 women interested in preserving their ovarian tissue. Other laboratories, however, are studying drugs such as rapamycin, already valid in other medical fields, too to slow down the aging of the ovaries. Secondo Stine Gry Kristensen, reproductive biologist at Copenhagen University Hospital, this field of research has “enormous potential,” as “very many women, half the human population, could benefit from it.” However, the researcher herself admits that we are still far from widespread application and that much more data is needed to evaluate the effectiveness and safety of this technique.
The road to an “on-demand menopause”, in short, seems long and tortuous. But the idea of being able to control one's biological clock and preserve hormonal youth continues to fascinate and divide the scientific community. Only time and research will be able to tell us whether this is a concrete hope or an illusory, or even dangerous, mirage.
