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

This publication is a narrative review focused on surgical menopause in women undergoing radical cystectomy for bladder cancer.

Key points:

• Standard surgery: Standard female radical cystectomy has traditionally included removal of the uterus, ovaries, fallopian tubes and anterior vaginal wall.
• Patient population: Most women undergoing this surgery are postmenopausal, but a meaningful minority are premenopausal and will experience abrupt surgical menopause if both ovaries are removed.
• Consequences of surgical menopause: Surgical menopause causes immediate loss of sex steroid hormones, leading to:
  • • Vasomotor symptoms (e.g., hot flashes)
  • • Sexual dysfunction
  • • Increased long‑term risks of osteoporosis, cardiovascular disease and cognitive decline
• Ovarian preservation: There is growing recognition that ovarian preservation can be oncologically safe in many younger women, and should be considered to avoid these harms.
• When oophorectomy is appropriate: Nonetheless, oophorectomy remains appropriate for selected premenopausal patients with higher oncologic risk, where removal of the ovaries is justified for cancer control.
• Awareness gaps: The authors highlight that many urologists are insufficiently aware of the consequences and management of surgical menopause, resulting in avoidable morbidity.
• Recommended management when ovarian removal is unavoidable:
  • • Patients should be counseled preoperatively regarding expected symptoms and long‑term health risks.
  • • Cardiovascular risk assessment and bone protection strategies (e.g., screening and preventive measures) should be systematically addressed.
  • • Hormonal and non‑hormonal therapies for menopausal symptom control and long‑term risk reduction should be offered when appropriate, ideally in collaboration with menopause or endocrine specialists.

Overall, the article calls for more deliberate decision‑making around ovarian preservation and more proactive management of surgical menopause in premenopausal women undergoing radical cystectomy.