Guidance
3 Committee considerations
The evidence
3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This rapid review did not identify any relevant studies.
3.2 The professional experts and the committee considered the key efficacy outcomes to be: quality of life outcomes including menopause-specific questionnaires and endocrine function of the implant (including the levels of oestrogen, progesterone and follicle stimulating hormone) in the short and long term.
3.3 The professional experts and the committee considered the key safety outcomes to be: laparoscopy-related complications (including pain, bleeding and infection), reduced fertility (in the period between ovarian tissue removal and reimplantation), and premature menopause.
3.4 Patient commentary was sought but none was received.
Committee comments
3.5 The committee was informed that the same procedure can be used to preserve fertility or to prevent menopausal symptoms or premature menopause from iatrogenic (such as cancer treatment) or non-iatrogenic (such as hereditary or disease) causes. This guidance is specifically for its use to prevent menopause symptoms in otherwise healthy people and does not cover these other indications.
3.6 The committee was informed that although published evidence for the use of this procedure for fertility preservation for medical reasons exists, there was no published evidence for its use in otherwise healthy people who wanted to prevent menopause symptoms. This underpinned the committee's recommendation for research to be done to establish its safety and efficacy.
3.7 The committee was informed that pharmacological hormone replacement therapy (HRT) has an established efficacy and safety profile for preventing the symptoms of menopause.
3.8 The committee was informed that there is a small risk of significant complications associated with laparoscopy.
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