- Email: [email protected]
Response: transplantation of ovarian tissue to postpone menopause – is it really more advantageous for women's health than menopause hormone therapy?
Reproductive BioMedicine Online (2015) 31, 828
w w w. s c i e n c e d i r e c t . c o m w w w. r b m o n l i n e . c o m
LETTER Response: transplantation of ovarian tissue to postpone menopause – is it really more advantageous for women’s health than menopause hormone therapy? To the Editor We want to thank Von Wolff and colleagues for their correspondence (von Wolff et al., 2015) concerning our recent paper (Yding Andersen and Kristensen, 2015) in which we describe a novel way of postponing menopause by transplanting the woman’s own ovarian tissue cryostored during earlier reproductive years. Freezing of ovarian tissue is now technically available and increasingly used in connection with fertility preservation for young women receiving gonadotoxic treatment. The question posed is whether it is advisable to also use this technique for postponing menopause? Von Wollf and colleagues argue that replacing frozen/ thawed ovarian tissue (tissue menopause hormone therapy; THT) may be beneficial for women with an intact uterus, whereas women without a uterus should receive conventional menopause hormone therapy (MHT). There are no references included to support these statements, and earlier studies concerning the precise effects of MHT and late onset of menopause are being revisited (Lobo, 2014; Lobo et al., 2014). The jury is still out and the conclusions concerning the effects on general health, including cardiovascular disease, osteoporosis and risk of breast cancer, plus a number of other issues related to the welfare of postmenopausal women, may be subject to new interpretations (Lobo, 2014; Lobo et al., 2014). One of the central messages from the current literature is that individualisation is key and that new genetic diagnostic tools should be considered when choosing MHT and avoiding menopausal effects. It may be that hysterectomized women are better off with only oestrogen therapy for MHT and should initially not be considered for THT that would also include progestins during the luteal phase. However,
hysterectomized women are, depending on the country of residence, a relatively small group of patients that therefore don’t distort the overall picture. For instance, a strong familiar disposition for osteroporosis may affect the choice of therapy. Hysterectomy may be one parameter for consideration in the individualising equation on which to base the best approach. We acknowledge that there has been no clinical trial performed for THT, which is obviously needed to confirm that women over the age of 50 years benefit from this procedure. The input from Von Wolff and colleagues may be valuable in designing such a clinical trial. We agree that THT may be a physiological solution to improve the welfare for some parts of the large and growing group of postmenopausal women.
References Lobo, R.A., 2014. What the future holds for women after menopause: where we have been, where we are, and where we want to go. Climacteric 17, 12–17. Lobo, R.A., Davis, S.R., De Villiers, T.J., Gompel, A., Henderson, V.W., Hodis, H.N., Lumsden, M.A., Mack, W.J., Shapiro, S., Baber, R.J., 2014. Prevention of diseases after menopause. Climacteric 17, 540– 556. von Wolff, M., Dittrich, R., Stute, P., 2015. Transplantation of ovarian tissue to postpone menopause – is it really more advantageous for women’s health than menopausal hormone replacement therapy? RBMOnline (current issue). 31, 827. Yding Andersen, C., Kristensen, S.G., 2015. Novel use of the ovarian follicular pool to postpone menopause and delay osteoporosis. Reprod. Biomed. Online 31, 128–131.
Claus Yding Andersen, Stine Gry Kristensen Laboratory of Reproductive Biology, University Hospital of Copenhagen, Denmark E-mail address: [email protected]
http://dx.doi.org/10.1016/j.rbmo.2015.08.014 1472-6483/© 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
w w w. s c i e n c e d i r e c t . c o m w w w. r b m o n l i n e . c o m
LETTER Response: transplantation of ovarian tissue to postpone menopause – is it really more advantageous for women’s health than menopause hormone therapy? To the Editor We want to thank Von Wolff and colleagues for their correspondence (von Wolff et al., 2015) concerning our recent paper (Yding Andersen and Kristensen, 2015) in which we describe a novel way of postponing menopause by transplanting the woman’s own ovarian tissue cryostored during earlier reproductive years. Freezing of ovarian tissue is now technically available and increasingly used in connection with fertility preservation for young women receiving gonadotoxic treatment. The question posed is whether it is advisable to also use this technique for postponing menopause? Von Wollf and colleagues argue that replacing frozen/ thawed ovarian tissue (tissue menopause hormone therapy; THT) may be beneficial for women with an intact uterus, whereas women without a uterus should receive conventional menopause hormone therapy (MHT). There are no references included to support these statements, and earlier studies concerning the precise effects of MHT and late onset of menopause are being revisited (Lobo, 2014; Lobo et al., 2014). The jury is still out and the conclusions concerning the effects on general health, including cardiovascular disease, osteoporosis and risk of breast cancer, plus a number of other issues related to the welfare of postmenopausal women, may be subject to new interpretations (Lobo, 2014; Lobo et al., 2014). One of the central messages from the current literature is that individualisation is key and that new genetic diagnostic tools should be considered when choosing MHT and avoiding menopausal effects. It may be that hysterectomized women are better off with only oestrogen therapy for MHT and should initially not be considered for THT that would also include progestins during the luteal phase. However,
hysterectomized women are, depending on the country of residence, a relatively small group of patients that therefore don’t distort the overall picture. For instance, a strong familiar disposition for osteroporosis may affect the choice of therapy. Hysterectomy may be one parameter for consideration in the individualising equation on which to base the best approach. We acknowledge that there has been no clinical trial performed for THT, which is obviously needed to confirm that women over the age of 50 years benefit from this procedure. The input from Von Wolff and colleagues may be valuable in designing such a clinical trial. We agree that THT may be a physiological solution to improve the welfare for some parts of the large and growing group of postmenopausal women.
References Lobo, R.A., 2014. What the future holds for women after menopause: where we have been, where we are, and where we want to go. Climacteric 17, 12–17. Lobo, R.A., Davis, S.R., De Villiers, T.J., Gompel, A., Henderson, V.W., Hodis, H.N., Lumsden, M.A., Mack, W.J., Shapiro, S., Baber, R.J., 2014. Prevention of diseases after menopause. Climacteric 17, 540– 556. von Wolff, M., Dittrich, R., Stute, P., 2015. Transplantation of ovarian tissue to postpone menopause – is it really more advantageous for women’s health than menopausal hormone replacement therapy? RBMOnline (current issue). 31, 827. Yding Andersen, C., Kristensen, S.G., 2015. Novel use of the ovarian follicular pool to postpone menopause and delay osteoporosis. Reprod. Biomed. Online 31, 128–131.
Claus Yding Andersen, Stine Gry Kristensen Laboratory of Reproductive Biology, University Hospital of Copenhagen, Denmark E-mail address: [email protected]
http://dx.doi.org/10.1016/j.rbmo.2015.08.014 1472-6483/© 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.