A pilot study on investigation of Chinese medicinal classification andits relationship with hormones in menopausal women

Abstract

Objective: To develop a validated questionnaire for the assessment of menopausal

syndrome in Chinese Medicine and through the analysis of the basic menopausal

syndrome classification in Chinese Medicine to explore the use of objective

hormone markers as one of the evidence for the Chinese Medicinal classification and

guidance for application of herbal medicines by Chinese Medicine Practitioners.

Methods: The major symptoms related to typical syndromes of menopause were

extracted from Chinese Medicine textbook, international diagnostic guide of Chinese

Medicine, classic and contemporary literature of Chinese Medicine and subjective

symptoms were eliminated to facilitate the administrate of a self-reported outcome

questionnaire. The symptoms related to menopause in Chinese Medicine were

identified and redefined to improve the content validity.

A total of 353 menopausal women were included in the study. Participants were

assessed through face-to-face interview by registered Hong Kong Chinese Medicine

Practitioner to complete the questionnaire and serum samples for hormones

measurement were collected after an overnight fast in the morning of the assessment

day. Serum Estradiol (E2), Testosterone (T), Progesterone (P), Luteinizing Hormone

(LH), Follicle Stimulating Hormone (FSH) and Sex-Hormone Binding Globulin

(SHBG) were measured by electrochemiluminescence immunoassays (ECLIA). Free

estradiol (fE2), non-Sex-Hormone Binding Globulin bound Estradiol (non-SHBG-E2),

free Testosterone (fT), and non-Sex-Hormone Binding Globulin bound Testosterone

(non-SHBG-T) were calculated to assess hormone availability and activity. E2/T ratio

was also calculated to investigate the balance of E2 and T in the body.

Results: Principal Component Analysis (PCA) was conducted. Symptoms related to

Deficiency of Yin and symptoms related to Deficiency of Yang were extracted and the

relationship between the syndromes and E2, T, P, LH, FSH, SHBG, fT, non-SHBG-T,

fE2, non-SHBG-E2 and E2/T ratio were investigated.

For symptoms related to Deficiency of Yin, E2 (p<0.000, p<0.000), P (p=0.004,

p<0.000), fE2 (p<0.000, p<0.000), non-SHBG-E2 (p<0.000, p<0.000), E2/T (p<0.000,

p<0.000)，SHBG (p=0.039, p=0.004) showed significant decrease while LH (p=0.013,

p<0.000), FSH (p=0.041, p<0.000) showed increase by comparing hormones of mild

or little with moderate and severe presentation of symptoms.

For symptoms related to Deficiency of Yang, SHBG (p=0.042, p=0.002, p<0.000)

showed an increase, fT (p=0.044, p=0.049, p=0.003) and non-SHBG-T (p=0.044,

p=0.049, p=0.003) showed a decrease which was significant for other three groups

while comparing to the no or little group.

Conclusion: Menopausal Syndrome Questionnaire was developed and validated in

the study. Major syndromes and symptoms involved in the diagnosis of menopausal

syndrome in Chinese Medicine were identified and good test-retest reliability was also

demonstrated. From the result, we hypothesize that the presentation of symptoms

related to Deficiency of Yin may be closely correlated with the menopausal transition

in Western Medicine and the presentation of symptoms related to Deficiency of Yang

may be related to deficiency of bio-active T in menopausal women. The study may

provide further information on the relationship between reproductive hormones and

Chinese Medicinal Classification and provide evidences and guides for effective

treatment of menopausal syndrome in Chinese Medicine.