Scientists ‘reverse’ the menopause: could this become part of mainstream medicine?

Greek gynaecologists have developed a technique that reverses the menopause, the New Scientist has reported.

Platelet-rich plasma treatment is used to aid the recovery of soft tissue, and researchers believe it can ‘rejuvenate’ damaged ovaries.

During the trial they injected the substance — concentrated blood plasma enriched with platelets — into the ovaries of six menopausal women. Three went on to become pregnant through IVF.

Konstantinos Sfakianoudis, a gynaecologist at Genesis Athens, said: ‘The treatment offers a window of hope that menopausal women will be able to get pregnant using their own genetic material.

‘I had a patient whose menopause had established five years ago, at the age of 40. Six months after the team injected PRP [platelet rich plasma] into her ovaries, she experienced her first period since menopause.’

Instant analysis
Menopause is the result of complex genetic and molecular changes that are usually predetermined biologically. Of the oocytes (eggs) a baby girl is born with, only about 400 will ever be ovulated, with the rest undergoing a process of breakdown called atresis.

Once there are only a handful of viable eggs left, a slow process begins culminating in the menopause, or complete cessation of menstrual cycles, with the end result being that periods stop permanently and the production of estradiol, the main form of oestrogen in the female body pre-menopause, decreases tremendously, thus leading to the symptoms of menopause.

In some women, events such as autoimmune disease or treatment for cancer with chemotherapy or radiotherapy result in premature menopause, something not genetically predetermined but with similar results; the same is true for women who have their ovaries removed surgically for whatever reason.

Going through menopause can be trying for women for many reasons. HRT was designed to overcome the negative physiological effects of the process. It has proved to be useful but it is not free from potential adverse events.

Being able to keep women menstruating and hence producing their own hormones means theoretically they will be spared drug side effects.

However, normal processes are sometimes associated with harm. Late menopause is a known risk factor for breast and endometrial cancer, and we have no way of knowing if this procedure, should it be offered eventually to women on the verge of or past menopause, will be associated with higher rates of cancer. Higher rates of ovarian cancer, the most deadly of all gynaecological cancers, might be another unintended complication.

It would, however, be a godsend for those women who have undergone menopause prematurely; instead of having to take exogenous hormones they will be able to produce their own, regardless of whether or not fertility is possible, thus sparing them from the risks of early onset osteoporosis and other health issues as well as the potential complications such as increased rates of breast cancer and clots.

A concern in women who have undergone menopause whatever the age will be the possible higher risk of genetic or chromosomal anomalies in babies conceived.

I would argue, however, that with the advances in genetic testing, particularly testing of foetal DNA derived from the mother’s blood, a technique pioneered in the UK, we would know quite early on if there was a risk of anomalies and hence women would still have an element of choice.

Often in medicine a new procedure can only be accurately assessed in hindsight. Laparoscopic surgery (keyhole), IVF and uterine transplants are all examples of new techniques that were condemned initially but are now part of mainstream practice.

Further research in the form of animal and human trials will be needed before this new procedure can be evaluated as being safe, needed or even desirable in patients. But for now this is a very promising result.
TSA