We used to think that once ovaries had passed through the menopausal transition, the scarred, shrunken organs sat inert in the body. But the discovery that the ovaries of aged mice become infiltrated with immune cells suggests the organ may be linked to widespread inflammation after menopause.

“We assumed the organ had done its job [post-reproduction],” says at Northwestern University in Illinois. “What we found was super surprising.”

In March, Duncan and her colleagues published a , which hasn’t yet been peer reviewed, looking at the protein composition of ovaries in post-menopausal women aged 50 to 75. They expected all the ovaries to be fairly similar, but instead Duncan found their “molecular signatures changed quite dramatically over the decades, which told us: this organ is not stagnant, it’s changing over time”.

To better understand what happens, Duncan and her team have now studied the ovaries of mice in more detail. They analysed the tissue and gene expression within the ovaries of young (aged 2 months), reproductively old (18 months) and post-reproductive (24 months) mice.

Mice don’t have a menstrual cycle like us – their uterus lining is reabsorbed, not shed as a period. They also don’t go through the menopause like we do, but their egg reserves deplete with age and their cycles become irregular. “What we are referring to when we talk about menopause is the age-related decline in fertility and [hormonal] function, and mice absolutely go through that same thing,” says Duncan.

Some of the results were expected: the older ovaries lost their egg-producing follicles, for example, and showed more scarring. What’s more, genes involved in reproduction and the creation of hormones like estradiol, a form of oestrogen, were downregulated. But the team also found that genes linked to inflammation and immune activity became increasingly active, and the number of immune cells in the ovaries, including T cells and macrophages, increased with age.

Free newsletter

Sign up to Health Check

Sign up to newsletter

Further research is required to uncover what this may mean for immune – and overall – health, but Duncan suspects this represents an identity change for the ovaries, rather than them becoming “an immune superpower”. “[The ovaries are] losing sort of the reproductive signature and taking on an immune signature, but I don’t think that’s necessarily a good thing.”

Ageing tissues undergo “inflammaging”, a state of chronic, low-grade inflammation. Immune cells are heavily involved in this, which makes Duncan suspect that post-reproduction, ovaries contribute by releasing inflammatory signalling molecules. “It is possible [this post-reproductive change] means nothing, but it’s also possible it’s sending out these signals and communicating with other parts of the body,” she says.

We’re finally learning how perimenopause profoundly changes the brain

The hormonal upheaval in the run-up to menopause can cause cognitive difficulties. But researchers are also finding that this can be a critical window for protecting long-term brain health

Duncan stresses the study was only in mice, but at the University of California, San Francisco, suspects similar immune changes occur in humans, given . “Both organisms cease cycling when their supply of oocytes [immature egg cells] dips below a critical threshold, and other changes including fibrosis and increased innervation [nerve distribution] are shared,” she says.

It is unclear why ageing mice may have evolved this change in signature, says Duncan, but if the same change applies to humans, it could have been an advantage to acquire an immune cell reservoir when fewer people lived to old age. But this may lead to inflammation and even autoimmune conditions in modern life.

The findings raise questions about the importance of the ovaries post-menopause. If healthy, they are generally left in place because they , which help maintain bone mineral density and libido. But Laird says the study adds to growing evidence that that causes issues like rheumatoid arthritis post-menopause. “The findings are a call to carry out detailed and functional studies on the cellular and molecular components of the post-reproductive ovary,” she says.

A first-of-its-kind cream that targets the underlying cause of vitiligo will be made available on the National Health Service in England. In clinical trials, the cream significantly increased pigmentation in the white skin patches caused by the condition, but the treatment , as vitiligo isn’t painful or dangerous.

“Usually, people [with vitiligo] are asymptomatic in terms of physical symptoms, but it can cause a lot of emotional hardship,” says at Indiana University, who led two trials of the new ruxolitinib cream treatment.

The cream, which is already available in the US, is sold under the name Opzelura. It treats non-segmental vitiligo, which occurs when symmetrical white patches appear on both sides of the body. This is thought to be caused by the immune system attacking melanocytes, the cells that make the pigment melanin, which gives skin colour.

The treatment is the first drug to be robustly tested that acts directly on the pathway that causes vitiligo, says at Vitiligo Support UK. “That’s why this [decision] is such a landmark,” she says.

Ruxolitinib works by inhibiting two enzymes that cause . Existing treatments, like steroid creams, can restore some pigment, but suppress immune function more broadly.

, published in 2022, found that the drug increased pigmentation and reduced the noticeability of vitiligo patches compared with a placebo cream. This occurred (vitiligo is more noticeable on darker skin), and in more than a third of those who came off the drug after the trial.

Free newsletter

Sign up to Health Check

Sign up to newsletter

The National Institute for Health and Care Excellence (NICE) weighed up these results in the past, but judged ruxolitinib to for use on the NHS. Now, it says the cream should be made available to people aged 12 and older with non-segmental vitiligo when other topical treatments haven’t worked or are unsuitable.

Vitiligo, which , varies in severity. Some people have just a few small patches, while for others they can be large, red, inflamed or discoloured.

“Patients and clinicians sometimes think we shouldn’t treat vitiligo, [because] it doesn’t kill you [and] it’s not painful,” says at the British Association of Dermatologists. But vitiligo can have serious complications, such as a higher risk of .

The only four skincare ingredients that have been proven to work

In the quest for better skin, we are faced with an overwhelming choice of creams and serums to enhance our appearance. Here's what works – and what doesn't

Natalie Ambersley – a vitiligo ambassador for the charity , which supports people with physical differences – says that people shouldn’t feel judged for treating the condition, but adds that after spending years using existing treatments, she won’t be seeking out ruxolitinib. “I’ve learned to accept my skin,” she says. “We’re [all] unique and we can embrace what we look like.”

“It’s great that there are people who love the skin they’re in, but that’s not for everyone,” says Rush.

An oral version of ruxolitinib, which is used to treat some cancers and rheumatoid arthritis, , including lymphoma, heart problems and serious infections. But these have not been reported with the topical version. In the two vitiligo trials, ruxolitinib caused only mild side effects, including acne and itchiness. “There is super minimal systemic absorption,” says Eleftheriadou.

Ruxolitinib is also thought to be safer than steroid creams, which can cause skin thinning with long-term use. People with severe vitiligo may also be offered ultraviolet therapy, but this isn’t widely accessible.