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Feature Gynaecology

Experimental treatments risk further medicalisation of menopause

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n992 (Published 11 May 2021) Cite this as: BMJ 2021;373:n992
  1. Sally Howard, journalist
  1. London
  1. sal{at}sallyhoward.net

Many women experience debilitating menopause symptoms. Fledgling interventions aimed at delaying menopause or treating symptoms are attracting commercial interest, but robust evidence of potential benefit and harms for patients is lacking. Sally Howard reports

Ovarian tissue cryopreservation and transplantation (OTCT)—surgical procedures successfully used to restart ovarian function in young women who have undergone chemotherapy1—are being offered to healthy women in the United Kingdom with a view to reinstate their pre-menopausal endocrine function. But robust evidence of effectiveness and safety in this indication is lacking, and some experts see this as overmedicalisation of menopause.

The private Birmingham based clinic Profam charges healthy women between £7000 and £11 000 (€8000-€12 500; $9500-$15 000) for OTCT. Before menopause, a slice of oocyte rich ovary is laparoscopically resected, cryopreserved, and then regrafted into the pelvis or subcutaneously in the forearm after menopause.

Meanwhile, patients in Canada are being advertised a proposed surgical treatment for early menopause that would involve transferring newly recognised germline stem cells from the ovarian lining to the ovary despite limited knowledge of their development into new oocytes.2 Fertility CARE: The IVF Center, a clinic based in Florida, US, markets the treatment OvaPrime as a “means of stopping your biological clock,” which is “on the cusp of being approved for mainstream use just over the northern border.”3

“We’re seeing something like the commercial big bang that happened with IVF in the 1990s,” says Evelyn Telfer, a biologist at the University of Edinburgh who researches the clinical potential of germline oocyte precursor cells. Private IVF clinics have proliferated since the 1990s, and some now sell a plethora of non-evidence based add-on interventions. “This risks what we saw with IVF—patients paying a lot of money for treatments not ready to be rolled out,” she says.

ProFam’s cofounder Simon Fishel, an IVF scientist, …

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