4.2 Biologic plausibility
More than 50% of hysterectomy is
accompanied
by oophorectomy because oophorectomy is the only unambiguous method to
prevent ovarian cancer.14, 24, 42, 43 It is well known
that the risk of CVD in women is lower than that in men due to the
presence of estrogen before menopause, but after entering menopause, the
risk of CVD is unbiased in men and women.11, 44 The
possible reason for this result is the decrease of estrogen level due to
the oophorectomy.45 Considering the surgical menopause
due to oophorectomy, the American College of Obstetrics and Gynecology
suggests premenopausal women choose hysterectomy with ovarian
preservation if no genetic risk of ovarian cancer.46And some studies showed that ovarian preservation is beneficial to
cardiovascular and nerve system.47-50 While in our
results, the statistical significance was shown when the ovaries are
preserved. As we all know, no recognized endocrine factors that have
direct influence on the cardiovascular system can be produced from
uterus.13 This association may be interpreted as a
decrease of ovarian blood flow due to hysterectomy, leading to premature
ovarian failure.14, 45 And the decline of ovarian
reserve function subsequently promotes the consumption of follicles and
finally accelerates arteriosclerosis.51, 52 In
addition, there are a series of studies to prove that hysterectomy with
ovarian preservation can also reduce the endogenous
hormones.51-53