The menopause isn’t so scary that young women need to sign up for costly surgery | Catherine Bennett

The benefits of tissue harvesting to delay a supposed middle age hell are doubtful

Against a background of tasteful pastel – which signals from the off that we are in the land of discretionary spending on faulty female anatomy – the ProFaM website makes its unique bid for women’s money. Ovarian tissue storage! And not only for fertility-related reasons. Who’d want a menopause? “Will you be ready?” the website challenges. “You never know what the future holds, so freeze the biological clock and prepare for the future.”

For many women, alas, the offer will be empty. The ProFaM clockstopping technique requires young ovarian tissue and costs up to £7,000 for removal (storage and reinstatement extra). “Age 25-30 is optimal,” the doctors say. Once reinstalled, the tissue is supposed to function as “natural HRT”.

The average age at menopause is 51. To defer the menopause – theoretically at least, via this method – women need to pay for an operation before they’ve thought about middle age, or experienced its social construction as an affliction, or, probably, considered volunteering as guinea pigs in non-essential experiments. Nobody knows how long, how well or how safely thawed ovarian tissue will function once it’s replaced in a much older body, because it hasn’t been done yet.

“We believe we are now in a position to offer the opportunity to postpone the menopause” seems to be the closest ProFaM gets to closing the argument for costly speculative surgery. It’s a bit like persuading very thin people to pay for an untrialled weight loss technique they might not need for a quarter of a century, if ever. And what if, one day, “menopausal” ceased being an insult? Meanwhile, ProFaM needs healthy – and affluent – young women to pay up.

Step forward Savannah Fishel, 22, the daughter of Dr Simon Fishel, a co-founder of ProFaM. In BBC interviews that may prefigure the corpororation’s new non-inquisitorial style, father and daughter last week together made the case for using Fishel ovary-harvesting services, presumably, in Ms Fishel’s case, at a discount.

“I’ve seen menopausal problems manifest themselves in family members,” Ms Fishel offered, by way of objective scientific reasoning. The technique sounded, the BBC reporter hazarded, a bit experimental? One for the fertility expert. “It’s experimental with a group of patients we want it to benefit,” Mr Fishel said. “But in its own element, each element of it is not experimental, no.” You couldn’t help wondering at this point if we haven’t all been a bit unfair to Gwyneth Paltrow. Is vaginal steaming so much more disreputable than minced ovary with still indeterminate menopause-postponing powers?

It was left to another doctor, Dr Melanie Davies of Fertility Preservation UK, commenting separately, to confirm that Fishel’s technique is unproven, to warn against “healthy women going through surgery that would not otherwise be needed”, and make the case, instead, for conventional hormone replacement therapy.

More usefully for the Fishels, the BBC illustrated its report with one of those stock pictures of a tormented middle-aged woman who has stepped away from normal, happy people into private, menopausal hell. Unless Savannah Fishel’s dynastic loyalty can substitute for peer-reviewed studies, sustained aversion to the menopause is likely to be as critical to ProFaM’s prosperity as are misogyny and gerontophobia to buccaneering aesthetic surgery, and the cultural pressure to reproduce to the sale of unpromising IVF.

Conversely, too much awareness about the significant number of women who are either unafflicted or only temporarily troubled by the menopause – or immeasurably more affected by other life events – could be disastrous for a business posited on a narrative of female biological doom. There can’t be enough doom, or gloom, where no compelling argument exists. Have women realised, for instance, that female longevity is not the unqualified bonus they may have thought? “As women, for the first time in human history, are living so much longer in the post-fertile phase,” Fishel likes to argue, “they may be suffering much longer.”

But perhaps women define suffering – and indeed their reasons for existing – differently? Though one in four women, as a study suggested, report severe menopausal symptoms, that suggests three out of four don’t. Some actively exult. US research suggests that their experience will relate to prevailing cultural attitudes. “In societies where age is more revered and the older woman is the wiser and better woman, menopausal symptoms are significantly less bothersome,” Yale’s Dr Mary Jane Minkin has said. Should young women, not knowing into which category they will fall, pay, insurance style, for future interventions they may not want?

Mercifully for Fishel’s embryonic industry, a growing and welcome openness about the menopause seems to favour his version, in alighting predominantly on its potential to cause distress, as opposed to its potential – compared with other middle-aged afflictions – manageability. To hear Dawn Butler, before the election, advancing Labour’s case for dedicated menopause rooms and menopause leave, was to wonder why any woman should be expected to work through an enveloping fog of heat, mood changes, cognitive decline and misery. Not to mention why these arrangements should be more urgent than, say, carers’ leave or bereavement rooms.

If Labour’s menopause policy did raise awareness, it probably did just as much to consolidate the view that this process is a scary, debilitating illness that regularly defies all treatment. Earlier media rejoicing about Fishel’s evidence-light scheme had already indicated the degree to which the menopause is pathologised as a relentless biological curse on women, who await their saviour.

Whether it is ethical for UK clinicians, in the absence of long-term trials, to monetise this kind of thinking is for professional bodies to decide. Maybe private ovary-freezing is no less respectable than other offers of inessential but encouraged “self-optimising” surgery?

As a lay person I would only add that one of the unexpected benefits of a post-fertile existence turns out to be the protection it offers against ambitious male gynaecologists.

• Catherine Bennett is an Observer columnist


Catherine Bennett

The GuardianTramp

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