Treating premature ovarian insufficiency with ovarian tissue transplants

There are many reasons a woman might need to have surgery to remove part or all of her ovaries, such as ovarian cysts, endometriosis or ovarian cancer.

But this type of surgery, called an oophorectomy, can stop the ovaries from working. This means oestrogen can no longer be produced by the ovaries and results in menopause. When this happens to a woman under of the age of 40, it is called premature ovarian insufficiency (POI).

Women experiencing the menopause or POI are typically given hormone replacement therapy (HRT) to replace the missing oestrogen in their body. But it can have side effects and isn’t for everyone.

Dr Hajra Khattak is an NIHR Academic Clinical Lecturer in Obstetrics and Gynaecology at University College London. During the grant award period, she was based at the University of Birmingham and was been studying ovarian tissue transplants as a potential new treatment for POI. Her research, funded by Wellbeing of Women, suggests this could prevent menopause symptoms and potentially even preserve fertility.

What is premature ovarian insufficiency?

Premature ovarian insufficiency (POI) is when the ovaries stop working in women under the age of 40. It means the ovaries no longer produce oestrogen or release eggs, triggering premature menopause.

Women experiencing the menopause can no longer get pregnant and are at increased risk of problems such as heart disease, osteoporosis and cognitive impairment (trouble remembering or learning new things).

Sometimes POI occurs on its own and sometimes it will be the result of cancer treatment or surgery.

Preventing POI with ovarian tissue transplants

Fourteen women took part in Dr Khattak’s study. Each one agreed to have a transplant of fresh ovarian tissue, mainly due to benign gynaecological conditions such as endometriosis and/or pelvic pain. The average age of the group was 36.

Check-ups took place six and 12 months after surgery. This involved an ultrasound, blood test and a questionnaire to assess menopausal symptoms. Any women found to be experiencing menopause symptoms were given HRT and not included in Dr Khattak’s analysis.

Dr Khattak and colleagues found that the ovarian tissue transplants were successful in all but one woman. When analysing the levels of several hormones that contribute to good sexual health and ovulation, including oestrogen, Dr Khattak discovered that these substantially increased for almost all women. Follicles (egg sacs) were also observed in the tissue that was transplanted, suggesting that fertility was preserved.

Dr Khattak says:

“Premature ovarian insufficiency affects around one in 100 women. The lack of oestrogen in the body kickstarts the process of menopause, which can have numerous symptoms that can be difficult to live with, including anxiety, brain fog, insomnia, night sweats, hot flushes and joint pain. It also increases the risk of other conditions like osteoporosis, heart problems and depression.

“Women with POI will inevitably spend more of their lives in this menopausal state and outside of HRT there are relatively few treatment options available. Not every woman will be able to, or want to, take HRT, so finding effective alternatives is important.

“Our results from this study are promising and indicate that use of ovarian transplants in helping symptoms of menopause could benefit many young girls and women provided they are chosen carefully. This wouldn’t have been possible without the support of Wellbeing of Women.”

Dr Khattak also discovered that women who had a high number of eggs in their ovaries before surgery were more likely to have good ovarian function post-transplant. This may be the first step towards understanding who may benefit the most from a transplant procedure. This research also opens doors to considering freezing of ovarian tissue for future transplants in women at risk of POI.

Next steps

This has exciting implications for a natural form of hormone therapy, particularly as women are now often living almost half of their life post-menopause. For younger women affected by POI, this could also help them preserve their fertility for longer.

However, our knowledge of ovarian tissue transplants is still at an early stage. We know that not all women will benefit from such a procedure but do not know why; so larger studies are required to understand exactly who is best suited for a transplant so that treatment can be personalised for each woman.

Wellbeing of Women is funding a number of research projects to improve women’s experiences of menopause and POI, including:

• Dr Roseanne Rosario investigating the link between a genetic mutation and the most common type of POI
• Dr Claire Hardy’s work to develop an online toolkit to help workplaces become more menopause friendly.