The first time I saw ovaries was in a middle school health class. The gym teacher awkwardly pointed at a diagram on a projector screen as he informed us that women were born with all the eggs they were ever going to have in life. I remember thinking it was fitting that the female anatomy looked like the top of an hourglass, the ovaries steadily releasing eggs into the uterus like grains of sand, my fertile window slowly ticking closed with each passing period.
But it turns out our ovaries aren’t just keeping time on our fertility. Scientists now believe the ovaries play a key role in female longevity, helping to regulate the systems that keep our heart, bones, and brain healthy. “I’m on a campaign to stop calling them reproductive organs, because that’s just one piece of what they do,” says Jennifer Garrison, PhD, an assistant professor at the Buck Institute for Research on Aging in Novato, California. “They are the endocrine organ that [acts as] the architect of health for female bodies, full stop.”
The ovaries are part of a complex signaling network, along with the hypothalamus and the pituitary gland, that communicates with almost every tissue in the body. If the ovaries are not functioning properly, it can be a sign of various health risks. For girls and young women, it can lead to issues going through puberty or irregular menstrual cycles. For women in their twenties, it can indicate the risk of polycystic ovarian syndrome (PCOS) or metabolic disorders. For women in their thirties, it can manifest in fertility issues and miscarriages. For those in their forties, when ovarian function typically starts to fluctuate, it can lead to all of the symptoms we associate with perimenopause: sleep troubles, hot flashes, mood changes, and many more.
Once the ovaries stop releasing eggs for 12 consecutive months, typically between ages 45 and 55 (aka menopause), women may see a dramatic increase in their risk of cardiovascular disease, osteoporosis, dementia, depression, autoimmune disease—the list goes on and on. This may help to explain why even though women live longer than men on average, they may also spend a significantly longer portion of their lives in poor health.
“Aging is the number one risk factor for chronic disease in the modern world, and the ovaries are the fastest-aging organ—aging at least two times the rate of other tissues in the body,” Garrison says. “If we are interested in extending healthy longevity, we have to understand how and why ovaries are aging so much faster.”
Unfortunately, like most aspects of women’s health, the ovaries have been chronically understudied. Scientists aren’t even sure why menopause happens in humans at all. We are peculiar in this way: Aside from a few species of toothed whales and one group of chimpanzees from Uganda, humans are the only species that stops reproducing. Some research suggests that entering menopause later in life correlates with living longer, and a study published in 2009 finds that men whose sisters had children later in life (after age 45) were also likely to live longer. Scientists aren’t sure why, but one theory is that women who reach menopause later may be better at repairing DNA damage, a trait that their brothers may carry, too. The unique aging rate of our ovaries actually makes them ideal for studying longevity.
“Oftentimes, you can’t test health span and longevity interventions in humans because that would be a 90-year clinical event, but ovaries provide an accelerated model of human aging that we can actually study in young people,” Garrison says.“If we can understand the mechanism causing ovaries to age faster, that can tell us something about aging in the rest of the body, for women and men.”
Scientists and biotech start-ups are now seeing the potential too, devoting research and funding to explore ways to prolong ovarian function. One key way to do this is by slowing the rate at which eggs are lost. Quick physiology refresher: Women are born with roughly 1 to 2 million “primordial” follicles, which hold immature egg cells called oocytes. Between 300,000 and 400,000 are left by the time you reach puberty. After puberty, some hundreds of them start maturing every day, but only one egg is usually released each month.
“Women ovulate about 500 eggs in the average reproductive lifespan, but generally by age 51, 99.9 percent are wasted,” says Kutluk Oktay, MD, PhD, director of the Laboratory of Molecular Reproduction and Fertility Preservation at the Yale School of Medicine, who is a fertility specialist and reproductive surgeon. To address this, Oktay developed the first-ever ovarian transplant procedure using cryopreserved tissue.
While egg freezing and egg retrieval for IVF may yield 10 to 15 mature eggs for the average woman under 35, ovarian tissue freezing collects hundreds of thousands of immature eggs. The ovarian tissue is then preserved and later transplanted back into the body, where it’s been found to resume growing and extend ovarian function. “Women have such a large egg reserve—why not tap into it before it’s wasted for no purpose, and then allow them to use it later?” Oktay says.
Utilizing data from previous procedures, Oktay and his team built a mathematical model, published in the American Journal of Obstetrics & Gynecology, to predict how long cryopreservation could extend ovarian function in healthy women. Data shows that for most women under age 40, ovarian cryopreservation and transplantation can significantly delay menopause—and for women under 30, it may prevent it altogether. “If you can collect eggs at a younger age, when eggs are of better quality, and transplant them at a later age, you’re kind of moving the clock backward,” Oktay says. Ideal candidates are women under age 40, with an age-appropriate ovarian reserve and a family history of early menopause or postmenopause complications. The retrieval and transplant procedure are done laparoscopically, and in general, the costs are similar to a round of IVF.
At Columbia University Irving Medical Center in New York, researchers are looking at ways to slow egg loss using rapamycin, a drug that is FDA-approved for use in organ transplant patients. A current study shows that given at low weekly doses, it could lengthen fertility in mice by 20 percent. “The hope is that by slowing ovarian aging using a safe, inexpensive pill, we can extend health span and lifespan,” says Zev Williams, MD, PhD, a study author and director of the Columbia University Fertility Center. Researchers are still blinded to whether study participants are receiving the drug or a placebo, but are encouraged that they are not seeing any severe adverse reactions or disruptions in menstrual cycles. “We are also getting reports from patients of feeling better—better energy, mood, memory, and even skin—but we will need to wait until we unblind the results to see if these improved symptoms are due to the rapamycin,” Williams says.
Already FDA-approved for use in organ transplant patients, rapamycin has been widely studied, has a good safety record, and is available at low cost. “If it is found to be effective at slowing ovarian aging, it has the potential to be quickly translated into making meaningful improvements in women’s health,” Williams adds.
Other researchers are focused on AMH, an anti-Mullerian hormone, which regulates the number of growing follicles (the tiny fluid-filled sacs that hold and release eggs) in the ovaries. A low AMH level may mean egg supply is shrinking, says David Pépin, a molecular biologist at the Mass General Research Institute. He developed a synthetic form of AMH to boost levels and put the brakes on egg loss. Biotech start-up Oviva Therapeutics, which Pépin helped cofound, has begun experimenting with an AMH injection on animals, though an actual ovarian longevity drug could be decades away.
For now, women should not view menopause with a sense of impending doom. “It’s not all bad,” says Mary Jane Minkin, MD, a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine and a Menopause Society certified menopause clinician. “Severe PMS, endometriosis, fibroids—all that stuff gets cured with menopause, not to mention the relief of not having periods or worrying about pregnancy.”
Minkin is encouraged by the growing interest in menopause research, but remains somewhat skeptical of the efforts to stop menopause. “What it can do for prolonging fertility is terrific, but if we’re just talking about the effects of menopause, personally, I think it’s a lot cheaper and less invasive to use hormone replacement therapy than it is to do all this mucking around with the ovaries.”
Many women were scared off hormone therapy after a 2002 Women’s Health Initiative study suggested it increased breast cancer and stroke risk, but more recent research suggests the study was flawed, primarily because it focused on an older population that was postmenopausal. The therapies today have also gotten safer, and we know a lot more than we did two decades ago. Doctors now use natural micronized progesterone and transdermal estrogen patches and gels to manage menopause symptoms—both of which
have shown low cancer or clotting risks in controlled studies. But you should always talk with your health care provider to decide what is safest for you.
In fact, a new study published in the JAMA Network Open surveyed more than 100,000 women in the UK and found that women on hormone therapy during perimenopause age more slowly than women who are not, regardless of their socioeconomic background. The strongest anti-aging effect was found in women who started using the hormone therapy at around age 48 and took it for four to eight years.
“Right now, the standard of care is ‘Don’t do it, but if you absolutely need it for your hot flashes, we’ll give it to you,’” Garrison says. “I think that should be flipped so that the standard of care is ‘You should do it unless there’s some reason why your doctor thinks otherwise.’”
Seeing the outsize role ovarian health plays in female longevity, it makes you wonder why a diagnostic health panel of the ovaries isn’t routinely conducted at annual doctor’s visits, like checking blood pressure and cholesterol. We should know not just how healthy the ovaries are, but where each of us is on that trajectory, so we can use the appropriate interventions. Unfortunately, we just don’t have those biomarkers yet, so even if you were to go out and get a giant hormone panel, there isn’t enough data for your doctor to discern what it all means.
There’s hope this will change sooner rather than later, as efforts increase to close the gap on how we approach and fund women’s health research. Earlier this fall, First Lady Jill Biden announced that the Pentagon will commit $500 million to advance women’s health research as part of a broader White House goal to focus more resources on women and chronic diseases.
In the meantime, what can young women do to keep their ovaries young? There are endless offerings of wellness experts, supplements, trackers, and biohacking tips, Garrison says, “but it’s important to remember some of these things are experimental, and supplements aren’t always safe.” That’s not to say healthy lifestyle factors can’t make a difference. “If you were to do a clinical study with diet and exercise up against any of the new anti-aging ovarian treatments being studied right now—rapamycin, AMH, any of them—diet and exercise are still going to win by a mile.”
A version of this story appears in the December 2024/January 2025 issue of ELLE.
