Radio Review: Rewinding the Menopause

When I read the title of this radio programme – 'Rewinding the Menopause' – I was a little disappointed, expecting that it would be all about research enabling ever-older women to bear children. Yet I could not have been more wrong about the programme that host Dr Aarathi Prasad was about to present.

The story begins with a controversial scientific study. Back in 2004 a group of scientists from the Massachusetts General Hospital and Harvard Medical School published their discovery of germline stem cells in the mammalian ovary that could be used for oocyte production after birth. The prevailing dogma of reproductive science had stated that 'young girls are given a bank account of eggs at birth that is not renewable and, as they mature and become women, they use those eggs up until their ovaries fail and they enter the menopause,' explained Professor Jonathan Tilly, who led that research.

These findings have been heavily disputed over the past decade, and many members of the scientific community still believe that germline stem cells cannot exist in the mammalian ovary. Professor Evelyn Telfer from the University of Edinburgh was initially one of the fiercest critics of Professor Tilly's work as his findings so dramatically contradicted the knowledge gained about the ovary in the preceding thirty years. Professor Telfer is still very much involved in the debate, but in recent years she has not only gained confidence in Professor Tilly's findings, she has even begun her own research on ovarian germline stem cells.

Briefly, the laboratory work involves tagging these stem cells with green fluorescent protein and injecting them into human ovarian tissue, which is subsequently transplanted into a live mouse. As these cells mature into new human eggs they can be easily traced as they literally glow green. The finding is especially important in the potential treatment of premature ovarian failure, but it has not yet been tested whether these eggs can be fertilised.

Recently, a young mother made the news in Belgium, being the first woman in the world to give birth following ovarian tissue transplantation (see BioNews 806). Her ovaries were frozen when she was still a child. Such a procedure is often recommended for girls who are about to undergo cancer treatment, which could damage their ovaries. The programme heard from one expert who believes that as many as one in ten of these young patients could benefit long term from freezing their ovarian tissue.

The programme also looked at the use of transplanted ovarian tissue as a natural alternative to hormone replacement therapy (HRT). Many women are prescribed HRT as treatment for symptoms of the menopause or to prevent osteoporosis, yet they typically associate HRT with undesirable side effects, such as agitation. So the use of ovarian transplantation could improve the quality of life of women undergoing an early menopause or young cancer patients, who must also rely on HRT if their ovaries have been removed.

In fact, ovarian transplantation is now regularly performed by Dr Kutluk Oktay, Medical Director and Founder of the Innovation Institute for Fertility Preservation and IVF in New York City. He described how he transplants ovarian tissue under the skin in the forearm or the abdomen, and claims that the major side effect reported by his patients is cosmetic (during ovulation swelling is visible under the skin, hence long sleeves are preferred). But, as Dr Octay emphasised 'overall women felt quite normal'.

In her programme, Dr Prasad also tried to raise awareness of the physical and psychological problems associated with this major life transition. Indeed, the impact of the psychological issues associated with the menopause came to me as a surprise. On the other hand, I felt rather sceptical about some of the reported problems, which came across as exaggerated, lowering the impact of the message. For instance, one of the interviewees recalled hot flushes, sweatiness and 'a tomato face' while giving a presentation at work. But many ovulating women will face similar challenges at certain points in their menstrual cycle due to hormonal fluctuations. Furthermore, such symptoms could have occurred purely as a result of stress, which many people experience when required to speak in public.

Overall, I would recommend Dr Prasad's programme, which provided great insights into the latest scientific and medical developments as well as bringing to listeners' attention the problems often faced by women undergoing the menopause. However, in order to hint at the broader clinical developments – which could have perhaps attracted a younger audience as well – I would have titled it something like 'The Human Ovary and its Extraordinary Capabilities'.