Would you have an operation to delay menopause?

Photo: iStock
Photo: iStock Photo: iStock

News that menopause could soon be a condition of the past, thanks to a ground-breaking technique called hormonal restoration, has received mixed responses from the medical and menopausal communities.

Pioneered by a team led by British IVF expert Simon Fishel of the CARE fertility group, the process involves the harvesting of a tiny sliver of healthy ovarian tissue from a young woman.

This is then frozen at minus 150C and can be stored cryogenically safely for decades before being replanted under the same woman's skin when symptoms of the menopause first start to appear.

At this point, Fishel and his colleagues have found, the ovarian tissue tricks the body into maintaining a natural level of hormones without fluctuation. Each sliver can be effective for up to 20 years but the process can itself be repeated indefinitely.

Fishel explains the operation has been used for years to help cancer patients recover their fertility and so is known to be both safe and effective, but only now is it being offered to prevent otherwise healthy women going through the menopause. "It was a question of joining up the dots," he says.

If the procedure is approved by the NHS for this reason - it is currently only available privately - millions of women would potentially be saved its debilitating symptoms, including anxiety, hot flushes and loss of libido. They may also benefit from the longer-lasting protective effects of hormones on the heart and bone density.

The news of this breakthrough has not been greeted with universal enthusiasm, however, with some critics suggesting that going through the menopause - typically at age 51 in the UK - is natural and should be respected, and others saying that delaying menopause could make its eventual arrival much harder to endure.

But for many women, the prospect could be life-changing. More than half of those surveyed by the British Menopause Society say that the menopause had a negative effect on their lives.

And for women like TV presenter Michelle Heaton, who went into early menopause at 33, the news is even sweeter.

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Now 39, Heaton may be too late to consider storing ovarian tissue herself but, as she explains, it is not too late for her seven-year-old daughter, Faith.

"It's just the best news," she says, bursting into tears.

As a carrier of the BRCA2 gene mutation, which increases the risk of ovarian cancer to 30 per cent, Heaton always felt she had no choice but to have a full hysterectomy as soon as she had given birth to her two children, Faith and A J, five.

The subsequent menopause she has endured, says Heaton, has been "so, so hard. Even though I have hormone replacement therapy (HRT), I have changed. Things are not the same. I can be so grumpy. I get insomnia so I am always tired. I get hot flushes and headaches."

And at the back of her mind there have been worries about Faith; 50 per cent of those with BRCA2 pass on the gene. Now, thanks to this new technique, her daughter (if affected) would be able to store ovarian tissue as a young woman, which would mean that she could have any preventive surgery necessary to avoid cancer - but also prevent the menopause.

"This is amazing," says Heaton. "It would be incredible for her."

In fact, says Fishel, there are very few cases where this type of hormonal restoration wouldn't be suitable.

"If it was deemed that the ovarian tissue was healthy," says Fishel, "free of malignancy, then a person with the BRCA gene mutation may well be a candidate. The medical position is first, do no harm, so we would have to make sure no metastatic cells were being transferred in the process.

"But I think we can be pretty solid on this. It's a technique already used for patients with other sorts of cancers to protect their future fertility."

He also says it would be suitable for patients with endometriosis, as the 4x8mm slivers of harvested tissue can be cleaned of endometrial cells before storage. Patients with polycystic ovary syndrome would be taken on a case-by-case basis, but he is confident that most could be helped.

Fishel says hormonal tissue can be harvested up to the age of 40 - possibly 43, if the patient's own mother had a late menopause and/or their ovarian reserve, the number and quality of potential eggs in the ovary, was high.

Restoration can begin at the first sign of impending menopause and be repeated as necessary every decade or so, depending on how much tissue was stored in advance. Potentially, menopause could be avoided all together.

Measures would have to be taken to prevent late-life accidental pregnancies, but Fishel says that would not be a complicated process. "We could interfere with the lining of the uterus, for example," he says, "so that a pregnancy couldn't implant."

Fishel also points out that the other advantage of the technique - which is offered by ProFam (protecting Fertility and Menopause) at a cost between $6,000 and $11,000 depending on a range of factors including level of aftercare, and about $150 -180 a year for storage - is that the hormones being replaced will suit exactly the woman in question.

"It is the most natural form of HRT," he says. "Traditional HRT is pharmacological and a blunt instrument as women get similar doses despite what their body might naturally produce. Nothing we manufacture in a lab can be as exquisitely tuned as hormones secreted naturally by our body."

It's a point Heaton thinks about, too. "My personal levels of oestrogen, progesterone and testosterone will be different to everyone else's. So how does a patch or a gel replicate what my body would do naturally?"

"I would definitely have had this done," she says. "But I will investigate it for Faith - the sooner the better."

The Daily Telegraph, London