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Management of surgical menopause in female patients with bladder cancer undergoing radical cystectomy

Nature Reviews Urology (2026)Cite this article

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Abstract

Radical cystectomy is the gold-standard treatment for patients with muscle-invasive and very high-risk non-muscle-invasive bladder cancer. In female patients, radical cystectomy has traditionally included removal of the uterus, ovaries, fallopian tubes and anterior vaginal wall. The majority of female patients undergoing radical cystectomy are postmenopausal, but a subset of patients are premenopausal and experience surgical menopause as a result of bilateral oophorectomy. Surgical menopause results from an abrupt loss of sex steroid hormones, resulting in symptoms such as vasomotor instability and sexual dysfunction, while also increasing the long-term risk of osteoporosis, cardiovascular disease and cognitive decline. The importance of ovarian preservation during radical cystectomy is increasingly recognized; however, oophorectomy might still be indicated in selected premenopausal patients for oncological control. In these individuals, awareness and management of surgical menopause among urologists is often limited, resulting in avoidable morbidity. Thus, when surgical menopause is unavoidable, patients should be counselled regarding symptom management, cardiovascular risk and bone protection; and appropriate hormonal and non-hormonal therapeutic strategies should be implemented where indicated.

Key points

  • Surgical menopause occurs following radical cystectomy when bilateral oophorectomy is carried out in a premenopausal woman.

  • Surgical menopause results in an abrupt cessation of ovarian sex hormone production, causing symptoms including hot flushes and sexual dysfunction.

  • Beyond symptomatic effects, surgical menopause is associated with important long-term risks including an increased risk of all-cause mortality, cardiovascular disease, cognitive decline and loss of bone mineral density.

  • Female patients experiencing surgical menopause should receive evidence-based counselling regarding expected symptoms, hormone replacement therapy and appropriate non-hormonal treatment options.

  • Management of surgical menopause should be multidisciplinary, involving urology, gynaecology and/or menopause specialists, and primary care and allied health professionals, to ensure coordinated symptom control, risk reduction and survivorship care.

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Fig. 1: Symptoms and risks associated with surgical menopause.

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Authors and Affiliations

  1. Department of Urology, Ayr University Hospital, Ayr, UK

    Elizabeth Day

  2. Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Francesco Pio Bizzarri, Adam W. Nelson, Alexandra J. Colquhoun & Niyati Lobo

  3. Department of Gynae-Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Ciara Mackenzie

  4. Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK

    Bernadett Szabados & John D. Kelly

  5. Department of Urology, Royal Surrey NHS Foundation Trust, Surrey, UK

    Matthew J. Perry

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N.L., E.D. and F.P.B. researched data for the article. N.L., E.D. and C.M. contributed substantially to discussion of the content. N.L., E.D., F.P.B., C.M. and J.D.K. wrote the article. All authors reviewed and/or edited the manuscript before submission.

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Day, E., Bizzarri, F.P., Mackenzie, C. et al. Management of surgical menopause in female patients with bladder cancer undergoing radical cystectomy. Nat Rev Urol (2026). https://doi.org/10.1038/s41585-026-01124-z

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