Let’s Talk Leaks: How Surgical Menopause Affects Your Bladder
When your ovaries are removed, sadly it’s not just your hormones that change. The sudden loss of oestrogen after surgical menopause can have a direct impact on your pelvic floor, bladder and vaginal tissues – leaving many of us experiencing prolapse, urgency, recurring UTIs or unexpected leaks.
There’s a lot of shame around leaks, urgency and incontinence and for many women, we can feel embarrassed, especially if we’ve been pretty diligent in doing our pelvic floor exercises and reducing triggers such as alcohol and caffiene. But the truth is that there is nothing to be ashamed of – but why does this happens commonly for women in surgical menopause – and, importantly, what can we do about it?
1. Oestrogen loss weakens the pelvic floor
Oestrogen is vital for keeping the pelvic floor muscles and the connective tissues that support your bladder, uterus and bowel strong and elastic. When levels drop abruptly after ovary removal, these tissues thin and weaken, making prolapse or leaks more likely.
Even if you’ve never had bladder issues before, the sudden crash in oestrogen can unmask underlying weakness caused by childbirth, genetics or chronic constipation.
What helps:
HRT with oestrogen (and progesterone if needed) can help restore tissue strength and elasticity. If you can’t take systemic HRT, vaginal oestrogen creams, pessaries or rings can deliver localised support directly to the tissues that need it most.
2. The bladder becomes more sensitive
The bladder and urethra both have oestrogen receptors. When oestrogen levels fall, these linings become thinner and more prone to irritation. This can cause urgency, frequency and even pain when you urinate — symptoms often mistaken for infection.
Many women find that what used to be a mild urge to pee suddenly becomes a full-blown dash to the toilet and suddenly, your life is revolving around the nearest loo.
What helps:
In addition to vaginal oestrogen, pelvic floor physiotherapy can retrain your bladder and strengthen control. Avoiding caffeine, alcohol and artificial sweeteners may also reduce irritation.
3. UTIs become more common
Lower oestrogen changes the vaginal microbiome (aka the urobiome), reducing the “good” lactobacilli that help protect against infection. Without that natural defence, bacteria like E. coli can travel up the urethra more easily, causing recurring urinary tract infections (UTIs).
The good news is that most often, they are treatable – but maybe not in the way you think. In fact, research shows that postmenopausal women who use vaginal oestrogen have significantly fewer UTIs than those who don’t.
What helps:
Vaginal oestrogen, plenty of water, and – if needed – non-antibiotic UTI prevention such as D-mannose or methenamine can all play a part. Always get checked if you have pain, blood in your urine, or a fever.
4. Loss of collagen affects pelvic support
Collagen – the protein that keeps tissues firm and lifted – declines rapidly after menopause. The pelvic floor relies on collagen-rich fascia to hold everything in place. After surgical menopause, the combination of low oestrogen and reduced collagen can lead to pelvic organ prolapse, where the bladder, bowel or uterus descend and press on the vaginal wall.
What helps:
Weight-bearing exercise, good nutrition (including adequate protein and vitamin C), and pelvic floor rehab all support collagen maintenance. Topical or systemic oestrogen can help too. If you are tempted to try supplementation, it’s worth reading The Motherload’s guide to collagen.
5. Nerves and blood flow change
Oestrogen also maintains healthy blood flow to the urethra and vagina. When it falls, reduced circulation can impair nerve sensitivity, leading to a weaker “urge” signal or difficulty fully emptying the bladder. This can increase the risk of residual urine and subsequent infections.
What helps:
Staying active improves circulation; so can gentle yoga or Pilates focused on the pelvic area. If you notice persistent problems emptying your bladder, ask your GP for a bladder scan or referral to a urogynaecologist.
6. Testosterone plays a role too
Testosterone isn’t only about libido – it can also support muscle tone, including in the pelvic floor. After ovary removal, testosterone levels drop by up to 50%. That can make it harder to maintain muscle mass and bladder control for women in surgical menopause.
What helps:
Where appropriate, testosterone replacement can improve pelvic tone, energy and sexual function. It’s now licensed for women in the UK under the brand AndroFeme which can be prescribed privately in the UK under special arrangements,. However, it does not yet have full UK marketing authorisation — although it’s expected in 2026.
So are leaks inevitable?
The good news is that urinary and pelvic changes after surgical menopause are not inevitable, but they are common — and they are treatable. Oestrogen, progesterone and testosterone all play protective roles in the bladder and pelvic tissues, and restoring those hormones can make a profound difference. Combined with pelvic floor rehab, lifestyle changes and good hydration, you can regain control and comfort again.
