Effects of Pre-menopause Hysterectomy on Blood-lipids and Hormones Alternative Treatment 

We studied patients who underwent pre-menopause hysterectomy for their menopause syndrome, the changes on their blood-lipids, and situation of taking Fufuchun medicine. We researched the necessity of hormone alternative treatment after the hysterectomy.

Materials and Methods 

I. Research Subjects

50 cases of pre-menopausal women who came to our hospital between 1992 and 1995 for hysterectomy due to the gynecologic benign pathologic change, together with 42 patients of other cases of the same age who had homolateral adnexectomy and hysteromyomectomy, for a total of 92 cases. Ages ranged from 37 to 50 with average age 43.6, post-operative period from one half to 4 years. All cases had no cardiovascular diseases and organic diseases with liver, kidney, mammary gland and genitals, with nearly three months free of hormones and other medicines that would affect the blood-lipids. Aside from the similarity in age, patients' occupation, educational background and financial background were researched to narrow down similar conditions for better comparison. 

II. Research Method 

1. Medical history inquiry, survey on menopausal syndromes, and conduct of physical examination and gynecologic check up. 

2. Determination on Blood-lipids: All 92 cases got their venous blood in the early morning of the next day after 12 hours of fasting for the determination of six norms on blood-lipids: 
Triglyceride (TG), Total Cholesterol (TC), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C), Apoprotein AL (ApoAl), and Apoprotein B (ApoB). The Japanese-made Large Scale Fully Automatic Bio-chemistry Analyzer is used. Based on centrifugal speed, quality control for each determination norm is within normal range. 

3. Selected 3 cases where the patients who had hysterectomy are having obvious menopause syndrome, and are taking Fufuchun medication. Observation is made within the patient, not among patients. 
Changes on menopausal syndrome and blood-lipid after medication. Method of medication: once a day, 2 tablets each time, consecutively for 3 months is one course of treatment. Fufuchun medicine is a product of Beijing Leibo Pharmaceutical Manufacturer. It is a compound preparation of estrin and progestin, containing calcium and many other vitamins at the same time. 

4. Statistical Method: t-test method is used.

Results 

I. The Situation of Menopause Syndrome 

Major syndromes selected during the follow up visits. The comparison is made based on two groups: Patients who underwent hysterectomy and patients who kept their uterus. For results please refer to Table 1: 
Table 1: Comparison of Incidence of Menopausal Syndrome Sicknesses of the Two Groups

II. Changes on Blood-lipids 

From the table, we can see that compared with the group with uterus, the group with hysterectomy has higher figures for TG, LDL-C, and ApoB (P<0.005), while the two groups have similar figures for TC. 
Table 2: Comparison on the Density of Blood-lipid of the Two Group(x+ s)

III. After treatment, menopausal syndromes of both groups have shown obvious improvements. After three months, the total efficacy is 100%. For changes in blood-lipids after medication, please refer to table 3. 

Table 3. 30 Cases of Changes in Blood-lipid Before and After the Medication(x+ s)

From table 3, we can see that after the Fufuchun treatment, TG, LDL-C and ApoB have drastically reduced (P<0.05) and HDL-C and ApoAJ have obvious increased (P<0.05). TC has decreased but it has no statistical significance. 

Conclusion

I. Contemporary research suggests that after the hysterectomy the remaining ovaries will start to have senilism in its function [1-4]. Siddle's research (1987) found out that the age when hypofunction of ovary occurs for the group with hysterectomy is obviously younger than the group experiencing natural menopause. It also proves that 2 years after the operation, the incident rate of hypofunction is 34%, increasing to 54% after 4 years. The longer the period after the operation, the higher the hypofunction rate for ovaries to experience senilism [3]. This material shows that people with hysterectomy have more chances to experience menopausal syndrome. The reason for it is because after the uterus is removed, the paroophoron coming from the vein and artery of uterus is cut off, which restricts the blood supply to the ovary, causing degeneration of oospore and lack or disorder of hormone. Aside from the effect of blood flow, research suggests that uterus is not the hormone target organ, instead it generates many bio-active objects and hormones. It is already known that the estrin and progestin of the ovary start their functions via recipients. Endometrium consists of abundant recipients that play a role in the regulation of endorcrine [2]. After the uterus is removed, the recipients inside the uterus disappear, messing up the functional cycle time of the recipients, with its essence unknown. However, from clinical point of view, both hysterectomy with or without ovary, have negative long-term effects, with the remaining ovary very likely to have hypofunction. 

II. Changes on Blood-lipids after Hysterectomy 

The risk of suffering from cardiovascular diseases for women who had pre-menopausal hysterectomy with one or both ovaries, has drawn the attention of many scholars with different opinions [5]. Through previous 10 years of follow up observation, Centerwall found out that women with menopausal uterus removed, compared to the same age of women who did not have their uterus removed, had 3 times more incidence of coronary heart disease, about 4% incidence of disease, and that 0.4% of them died 10 years earlier. Along with the further study on the relationships between estrin, blood-lipid and coronary heart diseases, as well as the advance in the technology of blood-lipid testing, we conducted the six norms of blood-lipid test using the 92 cases as our research objects. The results show that for women who had their uterus removed, all blood-lipid norms related to the coronary heart disease increased, especially the increase of LDL-C and ApoB, which currently are considered as the dangerous factors for causing atherosclerosis. At the same time, their HDL-C, the anti-atherosclerosis lipid decreased. All this shows that removal of uterus before menopause does increase the risk for cardiovascular diseases. It can also be explained that after the uterus removal, ovary starts its senilism and the estrin level decreases, which is not ideal for the metabolism of blood-lipids. It is believed that uterus may have certain hormone or other endocrine function that prevents cardiovascular diseases. In addition, the patient's own health, surrounding environment, nutritious condition and the spiritual psychological activities after the operation should not be neglected for their influence on the incidence of disease. 

III. Hormone Alternative Treatment after the Removal of Uterus 

Hormone alternative treatment for women after menopause has been accepted by many scholars, and has been widely used in clinical practice. Whether there is a need to implement the hormone alternative for women who had their uterus removed before menopause and kept one or both ovaries is a new issue. This has also drawn the attention of many scholars both domestically and internationally. Wenxi Cai suggests [3] that it is not advisable to remove uterus for uterus benign pathologic change, and for women who had already received the operation and are under 45 years old shall use appropriate estrin supplement. We provided 3-month Fufuchen treatment to 30 cases who had obvious menopause syndrome after the operation. After the medication, their menopausal syndrome saw marked improvement, with total efficacy rate of 100%. The changes in blood-lipids after the medication shows that Fufuchun can make some lipids that cause atherosclerosis, such as TG, LDL-G and APoB, to decrease, while make the lipids that are anti-antheroscelerosis, such as HDL-C and ApoAl, to increase, thus, protecting the function of the cardiovascular system.