Removal, preservation and subsequent reimplantation of ovarian tissue to prevent symptoms from the menopause

The condition

2.1 Menopause occurs with the final menstrual period and is usually diagnosed clinically after 12 months of amenorrhoea. It usually happens when someone is between 45 and 55, although around 1% of people have early (premature) menopause before 40.

2.2 As oestrogen levels reduce, most people have some symptoms, which can affect quality of life. Most commonly, these are hot flushes and night sweats. Other symptoms are mood changes, memory and concentration loss, vaginal dryness, a lack of interest in sex, headaches, and joint and muscle stiffness. Menopause can also increase the risk of osteoporosis and cardiovascular disease.

Current treatments

2.3 Symptoms can be treated with pharmacological hormone replacement therapy (HRT). For someone with a uterus, HRT usually consists of an oestrogen and a progestogen. For someone who has had their uterus removed, it is usually oestrogen only. HRT aims to replace the hormones that are no longer produced by the ovaries because of menopause. Non-hormonal treatments can also be used.

The procedure

2.4 The level of reproductive hormones and ovarian reserve is assessed first. If this is adequate, one-third to one-half of the outer cortex of 1 ovary is removed laparoscopically under general anaesthesia and cryopreserved in thin slices. When menopause starts, a slice of the ovarian tissue is thawed and regrafted under the skin in a heterotopic site (for example, the forearm or axilla) with the aim of restoring normal ovarian endocrine function. The transplantation process is reversible and may be repeated to maintain endocrine function. The aim is to prevent the symptoms associated with the menopause.