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What if you could postpone menopause for decades?

MDlinx May 03, 2024

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.

Davis SR, Lambrinoudaki I, Lumsden M, et al. Menopause. Nat Rev Dis Primers. 2015 Apr 23;1:15004. Doi: 10.1038/nrdp.2015.4. PMID: 27188659.



To stave off these symptoms, researchers are exploring an experimental treatment that could postpone menopause—potentially by decades. 

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).

Johnson J, Lawley SD, Emerson JW, et al. Modeling delay of age at natural menopause with planned tissue cryopreservation and autologous transplantation. American Journal of Obstetrics and Gynecology. January 4, 2024.

When transplanted, the tissue releases mature eggs and hormones that could prevent menopausal symptoms.

Youmshajekian L. Experimental Ovarian Tissue Freezing Could Delay Menopause, but Experts Are Weighing the Risks. Scientific American. April 22, 2024.



The potential to prolong fertility


The researchers say that harvesting ovarian tissue—to later be transplanted back into healthy patients—when women are under 40 years of age could potentially “significantly” postpone menopause and extend fertility potential. 

It could also cause menstruation to continue.

Youmshajekian L. Experimental Ovarian Tissue Freezing Could Delay Menopause, but Experts Are Weighing the Risks. Scientific American. April 22, 2024.

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 said. “As another novel finding, spreading the same amount of tissue to repetitive transplants significantly extends the benefit.”

Depending on certain conditions and variables, researchers say that menopause could be delayed by as many as 47 years.

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,”

Youmshajekian L. Experimental Ovarian Tissue Freezing Could Delay Menopause, but Experts Are Weighing the Risks. Scientific American. April 22, 2024.

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,” she adds. 

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.”

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

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


Dr. Dweck also adds that it is unclear, for example, whether this invasive procedure is superior to menopausal hormone replacement, especially when considering the invasive nature of the procedure.

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.”

Kolibianaki EE, Goulis DG, Kolibianakis EM. Ovarian tissue cryopreservation and transplantation to delay menopause: facts and fiction. Maturitas. 2020 Dec. Doi: 10.1016/j.maturitas.2020.07.007.


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. 

There are also unknowns about how older patients will face the delay of menopause. “How will women fare if they don't get menopause until they’re 85? We just don't know,” Dr. Dweck says. 


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. “Some will suffer greatly with one or many symptoms, while others will float through without significant distress.” 

But no matter what patients experience, “The grin-and-bear-it phenomenon is over,” Dr. Dweck stresses. 


If men had to go through this, there'd be many more options… but this is changing, so I think we're heading in the right direction.

Dr. Dweck says 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,” she says. “I think there's plenty of room for more research on the impact of menopause on a woman's life.”

What this means for you

Researchers are exploring a novel treatment involving cryopreserving ovarian tissue and transplanting it back into the body near menopause to potentially delay menopause by decades, offering hope for prolonged fertility and relief from menopausal symptoms. However, uncertainties remain regarding its efficacy, safety compared to hormone replacement therapy, and the implications of delaying menopause into older age. Despite these advancements, improving menopause management options and raising awareness about its impact on women's health remain crucial.


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