REAWAKENING THE POSTMENOPAUSAL OVARY DORMANT FOLLICLE ACTIVATION VIA VITAMINS, HRT, AND STEM CELL THERAPY”

Abstract

Background: Menopause has long been viewed as the end of ovarian activity, with the cessation of ovulation and complete follicular depletion. Emerging studies, however, reveal the persistence of dormant follicles post-menopause, challenging this paradigm.

Objective: To investigate whether ovulation potential persists beyond menopause and to evaluate the effectiveness of three different therapeutic strategies—vitamin therapy, hormone replacement therapy (HRT), and intraovarian PRP or stem cell injection—on the reactivation of dormant follicles.

Methods: A prospective controlled study involving 45 naturally postmenopausal women aged 50–60 years was conducted. Participants were randomized into three groups: Group A received vitamin D3, E, and CoQ10 orally; Group B received conventional HRT; and Group C received ultrasound-guided intraovarian injection of autologous PRP enriched with mesenchymal stem cells (MSCs). Baseline and follow-up measurements included serum anti-Müllerian hormone (AMH), estradiol, follicle- stimulating hormone (FSH), and transvaginal ultrasound with Doppler for antral follicle count

(AFC). Ovarian biopsies in a subset were analyzed histologically and immunohistochemically for GDF9, BMP15, and FOXL2.

Results: Dormant follicles were histologically identified in 71.1% of cases. Group C demonstrated the most significant follicular reactivation, with AMH increasing from undetectable to 1.5 ± 0.2 ng/mL (p<0.001) and 53.3% showing new antral follicle development. Group A showed moderate improvement, with elevated AMH and increased expression of GDF9 and BMP15. Group B showed minimal follicular response despite estradiol level normalization.

Conclusion: Dormant ovarian follicles persist after menopause and can be reactivated. Intraovarian PRP/stem cell therapy demonstrated the highest potential for inducing follicular development. Vitamins may also stimulate partial reactivation, while HRT alone had limited regenerative effect. These findings redefine menopause and open new possibilities for postmenopausal fertility and endocrine health.