Menopause, Premature

A report from the world's leading scientific and medical experts on hormone-related health conditions raises new concerns about the profound threats to human health from endocrine disrupting chemicals (EDCs) that are ubiquitous in our surroundings and everyday lives. Everyday exposures to EDCs in the environment may be linked to increasing rates of infertility, diabetes, immune deficiencies, and other serious conditions; Highly Hazardous Pesticides pose ongoing threats. A report from the world's leading scientific and medical experts on hormone-related health conditions raises new concerns about the profound threats to human health from endocrine disrupting chemicals (EDCs) that are ubiquitous in our surroundings and everyday lives. The report, "Endocrine Disrupting Chemicals: Threats to Human Health" provides a comprehensive update on the state of the science around EDCs, with increasing evidence that this large group of toxic substances may be implicated in rising global health concerns. The report from the Endocrine Society, co-produced with the International Pollutants Elimination Network (IPEN), includes detailed analyses on exposure to EDCs from four sources: plastics, pesticides, consumer products (including children's products), and per-and polyfluoroalkyl substances (PFAS), a class of thousands of chemicals known or suspected to be EDCs. The Endocrine Society-IPEN report is being released during the U.N. Environment Assembly (UNEA-6) meeting in Nairobi. At UNEA key agenda items include welcoming the newly adopted Global Framework on Chemicals, advancing global action on highly hazardous pesticides, and threats to the circular economy from plastics and toxic chemicals. The groups' report anticipates an update from UNEP and the WHO expected later this year on their 2012 Report on State of the Science of Endocrine Disrupting Chemicals. "A well-established body of scientific research indicates that endocrine-disrupting chemicals that are part of our daily lives are making us more susceptible to reproductive disorders, cancer, diabetes, obesity, heart disease, and other serious health conditions," said the report's lead author, Andrea C. Gore, PhD, of the University of Texas at Austin. Gore is also a member of the Endocrine Society's Board of Directors. "These chemicals pose particularly serious risks to pregnant women and children. Now is the time for the UN Environment Assembly and other global policymakers to take action to address this threat to public health." Hormones are natural chemicals that contribute to normal development, adaptation, and maintenance of bodily processes and health. By interfering with hormones and their actions, EDC exposure can impact many health-related functions, with consequences for increased risks of many serious conditions. Evidence suggests that EDCs in the environment contribute to disorders such as diabetes, neurological disorders, reproductive disorders, inflammation, and compromised immune functioning. Two of the four analyses in the report look at EDCs used in plastics and as pesticides. Global production of plastics and pesticides is increasing even as scientists warn that chemical and plastic pollution is an escalating crisis. Glyphosate is the world's most widely used herbicide, and a recent study found that glyphosate has eight of ten key characteristics of an EDC. Other studies have found links between glyphosate and adverse reproductive health outcomes. Plastics are made with thousands of known toxic substances, some of which are known or suspected EDCs. The report examines bisphenols and phthalates, two toxic chemical groups found in many plastics. Exposures to EDCs from plastics occur at all phases of plastics production, use, disposal, and even from recycled plastics. The Endocrine Society-IPEN report notes that, while evidence of health threats from EDCs is mounting, current regulations have not kept pace. "EDCs are different than other toxic chemicals, but most regulations fail to address these differences," said IPEN Science Advisor Sara Brosché, Ph.D. "For example, we know that even very low doses of endocrine disrupting chemicals can cause health problems and there may be no safe dose for exposure to EDCs. However, regulations typically do not protect against low-dose effects. We need a global approach to controlling EDCs based on the latest science with a goal of protecting the human right to a healthy environment." At the UNEA-6 meeting, IPEN is also releasing a new report on "The Global Threat from Highly Hazardous Pesticides," highlighting ongoing health and environmental risks from HHPs, especially in low- and middle-income countries. DDT, glyphosate, and chorpyrifos, three HHPs reviewed in the Endocrine Society report, are also highlighted in the new IPEN report as they continue to pose health threats especially in the Global South. In addition to plastics and pesticides, the report looks at EDC exposures from arsenic and lead, and from widely used per- and polyfluoroalkyl substances (PFAS), humanmade "forever chemicals" used as oil and water repellents and coatings. Lead remains in use in paint in many countries, as documented in recent IPEN reports. Endocrine-related conditions from lead exposure may include delayed onset of puberty and early menopause. Arsenic is a common metal that has long been linked to cancer and other health conditions, and more recent evidence shows that arsenic can disrupt multiple endocrine systems. PFAS are used in hundreds of products including clothing and food packaging, but recent studies show that some PFAS can disrupt hormones such as estrogen and testosterone and impair thyroid hormone functions.

A new paradigm around the biological processes of menopause is capturing the attention of scientists. The primary question: can menopause be delayed in healthy women, allowing them to extend their child-bearing years -- and perhaps even forestall some of the health risks and uncomfortable symptoms linked to plummeting estrogen levels? Most women agree that menopause has its advantages and disadvantages. Some relish the end of menstruation and concerns about unplanned pregnancies, while others dread the possibililty of hot flashes, moodiness, and other unpleasant symptoms. What some women consider a brief and barely noticeable phase in their lives can evolve into lasting changes and discomfort for others. Now, a new paradigm around the biological processes of menopause is capturing the attention of a small group of scientists around the country. The primary question: can menopause be delayed in healthy women, allowing them to extend their child-bearing years -- and perhaps even forestall some of the health risks and uncomfortable symptoms linked to plummeting estrogen levels? These questions can be controversial: Some people believe that such research could lead to life-changing benefits for women, while others consider menopause to be a biologically driven life stage that should not be pathologized by medical science. At Yale School of Medicine (YSM), Kutluk Oktay, MD, PhD, an ovarian biologist who is director of the Laboratory of Molecular Reproduction and Fertility Preservation, recently added a new chapter to this conversation by publishing research on various possible outcomes when menopause is delayed in healthy women via ovarian tissue freezing. Oktay, who developed and performed the world's first ovarian transplant procedure with cryopreserved tissue for a patient with a medical indication in 1999, sees a future in which healthy women could use this process of freezing tens of thousands of eggs within the ovarian tissue to stave off menopause for as long as several decades -- or even prevent its onset altogether. "For the first time in medical history, we have the ability to potentially delay or eliminate menopause," said Oktay, who is also an adjunct professor of obstetrics, gynecology & reproductive sciences at YSM. A mathematical model predicts outcomes for delayed menopause Using data from hundreds of previous ovarian cryopreservation and transplantation procedures, and molecular studies of how ovarian follicles behave in ovarian tissue, Oktay and his colleagues built a new mathematical model, published in the American Journal of Obstetrics & Gynecology, to predict how long the surgery could potentially delay menopause under a range of circumstances in healthy women. Since Oktay performed the first successful transplantation with cryopreserved tissue, ovarian tissue cryopreservation has been successfully used in cancer patients to preserve their fertility before their treatments, which can often permanently damage the egg reserve in the ovaries and trigger menopause. During this outpatient procedure, a surgeon laparoscopically removes the whole ovary or layers of the outer portion, which contains hundreds of thousands of dormant, immature eggs (known as primordial follicles). These tissues are then stored in sealed containers after being frozen with a specialized process and kept as low as negative 320 degrees Fahrenheit. Freezing ovarian tissue with this specialized process preserves it for later use. At some point -- typically years -- in the future, the surgeon reimplants the thawed tissue into the patient either laparoscopically or with a simple procedure, using methods developed by Oktay, that places the tissue under the patient's skin while intravenous sedation is administered. Within three to 10 days after that, this transplanted tissue regains connections with the surrounding blood vessels and restores ovarian function in about three months. The recently published mathematical model focusing on healthy women undergoing ovarian tissue cryopreservation considers multiple factors, including the age at which a patient gets the procedure, which plays a significant role in how long menopause can potentially be delayed. "The younger the person, the larger number of eggs she has, as well as the higher the quality of those eggs," Oktay said. The model accounts for women between the ages of 21 and 40. Beyond age 40, data show that the procedure is unlikely to delay menopause for a woman with average egg reserve, but this can change with the development of more efficient freezing and transplantation methods in the future. Furthermore, the model offers insight into the ideal amount of ovarian tissue to collect. The more tissue a surgeon removes, the longer the procedure can potentially delay menopause. However, the removal of too much tissue can lead to early menopause. "This model gives us the optimum amount of tissue to harvest for a person of a given age," said Oktay. The model also takes into account the healing process after a surgeon returns the harvested ovarian tissue to the patient. During this healing process, some of the primordial follicles are lost. Studies on animal models show that as many as 60% of primordial follicles do not survive post-transplantation, leaving 40% that are viable. With newer technologies, Oktay said that he believes surgeons can attain a survival rate of up to 80%. As the procedure continues to improve, he hopes to eventually achieve a 100% survival rate. Thus, the model accounts for survival rates ranging from 40% to 100%. Additionally, through transplanting portions of the harvested tissues over several procedures, the research indicates that menopause can be delayed even longer. For example, the team's model shows that returning a third of the outer portion of the ovary over each of three procedures delayed menopause longer than returning all of the tissue through one surgery. Based on the model, Oktay predicts that for most women under 40, ovarian cryopreservation can significantly delay menopause. And for women under 30, the procedure may be able to prevent menopause altogether. Because many women lose their ability to become pregnant sooner than they desire, ovarian cryopreservation could be an appealing option for them, said Hugh S. Taylor, MD, chair and Anita O'Keeffe Young Professor of Obstetrics, Gynecology & Reproductive Sciences at YSM. "Women are also frequently deferring pregnancy until later in life for professional or social reasons," he added. "The ability to freeze and later transplant ovarian tissue…offers a way to extend their fertile lifespan." Does delaying menopause via cryopreservation offer health benefits? Delaying menopause with ovarian cryopreservation also may confer certain health benefits associated with a later menopausal age. Based on new research by Oktay and his colleagues, around 11% of women experience late-onset natural menopause -- or menopause after age 55. Studies show that women who experience menopause later may live longer and have a lower risk for a range of conditions, including cardiovascular disease, dementia, retinal disease, depression, and bone loss. However, uncertainty remains over whether later menopause actually reduces those health risks. Oktay hypothesizes that those risks also may be mitigated in healthy women who delay menopause via ovarian tissue cryopreservation. If risk for such chronic diseases is reduced in healthy women who undergo this procedure, it could be a significant benefit. However, Taylor said that "additional research is needed to determine long-term benefits as well as risks." In ongoing research, Oktay and his team are studying the outcomes of healthy women who have opted to delay menopause through this procedure. Publication of these studies is far in the future, but in the meantime, the mathematical model offers a starting point for considering the feasibility and possible benefits of forestalling menopause in healthy women. The study was co-authored by Joshua Johnson, PhD, of the University of Colorado School of Medicine; Sean D. Lawley, PhD, of the University of Utah; and John W. Emerson, PhD, of Yale University.

TUESDAY, Jan. 30, 2024 -- For women approaching the final menstrual period (FMP), heavy metals may diminish ovarian reserve, according to a study published online Jan. 25 in the Journal of Clinical Endocrinology & Metabolism . Ning Ding, Ph.D., M.P.H., from the University of Michigan in Ann Arbor, and colleagues examined the associations of heavy metals with anti-Müllerian hormone (AMH), a marker of ovarian reserve, among 549 women from the Study of Women's Health Across the Nation with 2,252 repeated AMH measurements taken from 10 to 0 years before the FMP. High-resolution inductively coupled plasma mass spectrometry was used to measure urinary concentrations of arsenic, cadmium, mercury, and lead. The researchers found that women in the highest versus the lowest tertile of urinary arsenic or mercury concentrations had lower AMH concentrations at the FMP after adjustment for confounders (percentage change, −32.1 and −40.7 percent for arsenic and mercury, respectively). Accelerated rates of decline in AMH over time were seen in association with higher cadmium and mercury (percent change per year, −9.0 and −7.3 percent, respectively). "This information may enable researchers to address adverse health outcomes known to be associated with metals and with reproductive hormone changes (e.g., premature menopause, bone loss and osteoporosis, increased risks of cardiovascular disease, cognitive decline, vasomotor symptoms)," the authors write. Abstract/Full Text (subscription or payment may be required) Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions. Posted January 2024 More news resources FDA Medwatch Drug Alerts Daily MedNews News for Health Professionals New Drug Approvals New Drug Applications Drug Shortages Clinical Trial Results Generic Drug Approvals Subscribe to our newsletter Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.