The Daily Telegraph - 06.08.2019

(C. Jardin) #1

The Daily Telegraph Tuesday 6 August 2019 *** 17


A revolutionary procedure could save women from the often debilitating symptoms of


‘the change’ – but not everyone agrees it’s good news, as Victoria Lambert discovers


Would you have an operation


to delay the menopause?


Continued on page 18

ALAMY; GETTY IMAGES

N


ews that the 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.
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

‘Ama zing news’:
Michelle Heaton,
who hopes the
technique could
help daughter Faith

‘I will investigate this


for my daughter,


and the sooner


the better’


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 £3,000 and £7,000 depending on a
range of factors including level of aftercare, and
about £80-100 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.”

Jenni Murray,
Woman’s Hour presenter

It’s a little late for me, at the age of 69 and post-
menopausal for nearly 25 years, to even consider
the much-publicised surgery to remove a bit of
the ovary, preserve it and then pop it back in at a

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