Results:

By 2008, 1,769 women had reached natural menopause, 77 women had a hysterectomy with ovarian conservation, and 106 women had a hysterectomy with bilateral oophorectomy. The influence of natural and hysterectomy with or without ovarian conservation was similar for high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein B (ApoB), homeostasis model of assessment-insulin resistance, systolic blood pressure, plasminogen activator inhibitor type 1, and factor VIIc over time. Several CVD risk factor changes did differ during the intervals prior to and following hysterectomy, compared to the changes prior to and following final menstrual period (FMP), but not in a pattern suggesting increasing CV risk following hysterectomy. Prior to hysterectomy with ovarian conservation, triglycerides and tissue plasminogen activator (t-PA) changes declined and ApoA increased, compared to the changes prior to natural menopause, suggesting a lower risk trajectory among these women presurgically. Prior to hysterectomy with bilateral oophorectomy, C-reactive protein increases were greater than prior to a natural menopause, but no differences occurred after surgery, compared to after FMP. Multivariable analyses showed that annual changes in CVD risk factors did not vary by group with few exceptions, and the significant group differences that did emerge were not in the anticipated direction.