Menopause in German and Chinese Women
Menopause in German and Chinese Women--An Analysis of Symptoms, TCM-diagnosis and Hormone Status*
Rampp Thomas1, Tan Linda1, ZHANG Lin1, SUN Zhuo-jun2, Klose Petra1, Musial Frauke1, and Dobos Gustav Jurgen1
ABSTRACT Objective: To investigate menopause-related symptoms, traditional Chinese Medicine (TCM)-diagnosis and hormone status of two comparable urban samples of menopausal women, one in Essen (Germany) and the other in Shanghai (China). Methods: Patients suffering from menopause-syndrome were recruited from the TOM-outpatient clinic of the University of Duisburg-Essen in Germany (35 subjects) and from the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine in China (35 subjects). The Kupperman-lndex for tracing menopausal symptoms was applied. The complete TCM-diagnosis was carried out by the same investigator in China as well as in Germany. Testosterone and estrogen blood samples were collected once from every woman. Results: There were significant differences in specific symptoms of the Kupperman-lndex, such as a higher prevalence of formication and depression in German menopausal women; whereas Chinese menopausal women suffered significantly more from vertigo, headache and paraesthesia symptoms. Concerning TCM- diagnosis, Shen -yang deficiency was diagnosed in 51.43% of the German women in contrast to 5.71 % of the Chinese women; 17.14 % of the German women were diagnosed as having Shen-yin deficiency compared to 74.29 % of the Chinese women. The German women showed significantly lower mean hormone levels for testosterone compared to the Chinese women (P≤0.0005). Conclusions: German and Chinese menopausal women do not show different prevalence but have different patterns of menopausal symptoms. Furthermore, from a TCM point of view, German women suffer more from Shen-yang deficiency whereas Chinese women suffer more from Shen-yin deficiency syndrome. These results are supported by significantly lower levels of testosterone in German women compared to Chinese women, which, in TCM, is a characteristic of yang deficiency.
KEY WORDS traditional Chinese medicine, yin, yang, menopause, Chinese, German, Kupperman-lndex, testosterone, estrogen
Demographic effects will lead to an increased population of older people and especially of older women due to their longer life span in comparison to men. Physicians and health care systems will be therefore confronted with an increasing number of women complaining about menopausal symptoms. It is estimated that in 2010 about 171 million women are going to suffer from menopausal symptoms in the Western world(1). Hot flashes, night sweats, and vaginal dryness are clearly tied to the menopausal transition, and there is some positive evidence of a menopausal link for sleep disturbance(2, 3). Vasomotor symptoms are reported with high frequency during the menopausal transition(4). It is often stated that Asian women suffer less from menopausal symptoms in comparison to Western women(5). Social culture reasons and different hormone levels are discussed(6, 7), In addition, Asian medicine treatment derived from traditional Chinese Medicine (TCM) shows promising effects on menopausal symptoms(8).
To investigate possible differences and coherences in menopause-related symptoms in Western and Eastern women, TCM-diagnosis and hormone status of two urban samples of menopausal women, one in Essen (Germany) and the other in Shanghai (China) were compared.
METHODS
Subjects
Patients suffering from menopause-syndrome were recruited from the TCM-outpatient clinic of the University of Duisburg-Essen in Germany (35 subjects) and from the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine in China (35 subjects).
Items and Methods of Observation
Kupperman-lndex
The Kupperman-index was applied because it is a well established popular instrument for tracing menopausal symptoms in Western countries as well as in China. The Kupperman-lndex includes 11 menopausal symptoms which are categorized by their parameter value into four degrees: none (= 0), light (= 1), medium (= 2) and strong ailments (= 3). These parameter values are weighted with a specific factor ( x 1, x 2 or x 4), resulting in different emphases on the analysed symptoms.
TCM-Questionnaire
The complete TCM-diagnosis was carried out by the same investigator in China as well as in Germany. A standardized questionnaire was developed for this occasion.
Determination of Levels of Testosterone and Estrogen
Testosterone (T) and estrogen (E) blood samples were collected from every woman. In Germany and China different technological devices were applied by the laboratories for the analysis of blood samples. In Germany blood samples were analysed using test sets by the company Roche Modular®, whereas in China test sets by the company Abbott® were used. Following the companies propositions both test sets were made comparable.
Statistic Analysis
Means were compared using Students t-test, and frequency distributions were compared using Pearsons Chi-square test.
RESULTS
Comparison of Kupperman-lndex between the Two Groups
Patients were included in the study from the age of 41 to 60 years. German women were an average of 52.00 ± 3.95 years whereas Chinese women were an average of 49.90±4.21 years. This finding showed a significant difference (t=2.227, P=0.029) between the two samples. Nevertheless, comparison of mean values from the Kupperman-lndex of both Western and Eastern women showed no significance in the Kupperman-lndex between the two groups (t=-0.182, P=0.856, Table 1).
Comparison of Distribution of Symptoms between the Two Groups
Findings from the Kupperman-lndex and the standardised TCM-questionnaire showed that German women suffered significantly more from depression, formication, swelling of the four limbs and sensitivity to cold. Chinese women were more disturbed by symptoms like paraesthesia, vertigo, headache and dry mouth and eyes (Table 2). The pattern of menopausal symptoms was significantly different between the German and Chinese women (P≤O.O05).
Distribution of Nationalities to TCM-Diagnosis
The distribution of TCM-diagnosis between the two samples is listed as total number and as percentage (Table 3). Eighteen German women (51.43%) were diagnosed with the TCM-diagnosis Shen yang deficiency compared to only 2 Chinese women (5.71%). Twenty-Six Chinese women (74.29%) showed Shen-yin deficiency in comparison to 6 German women (17. 14%). A combination of Shen-yin and -yang deficiency was diagnosed in 11 German women (31.43%) compared to 7 Chinese women (20.00%). All findings were significant ( X 2=26.189, P≤0.0005).
Comparison of T, E and T/E Ratio between the Two Groups
erman women showed significantly lower T levels in comparison to the Chinese women (t=-5.715, P≤0.0005). The mean values of E for German women in comparison to Chinese women showed no significant difference (P>0.05). The mean value of the T/E ratio for German women was insignificantly different compared to that for Chinese women. Hormone analysis was missing in one German woman (Table 4).
DISCUSSION
There was no significant difference in our study concerning the mean values of the Kupperman-lndex, showing that irrespective of western and eastern culture or race, the prevalence of menopausal symptoms are similar. Nevertheless, there are significant differences in the pattern of menopausal symptoms. One explanation may be the different hormone statuses in the investigated groups. This possible ethnic diversity was already stated by Randolph et al(9) in 2003. The different TCM-diagnoses support this assumption as well, since in TCM menopause symptoms are associated with a so called Shen deficiency. This is to be explained as a metaphorical description for the decline in or deficiency of hormone status in menopausal woment(10).Furthermore, it is interesting that the two main characteristics of TCM-diagnosis, yin and yang, were also reflected in the different ethnic hormone status. The characteristics of yang in TCM-diagnosis is associated with attributes like warmth, strength and masculinity(10). Testosterone is attributed to the TCM yang characteristic and this assumption is supported in our study as showing Shen-yang deficiency in 50% of the German menopausal women which correlated to significantly lower levels of testosterone than the Chinese women. Different life styles or environmental effects may also be discussed in this context.
In conclusion, German and Chinese menopausal women do not show different prevalence but rather different patterns of menopausal symptoms. Furthermore from a TCM point of view German women suffer more from Shen-yang deficiency whereas Chinese women suffer more from Shen-yin deficiency syndrome. These results are accompanied by significantly lower levels of testosterone in German women compared to Chinese women, which is in TCM associated with a missing yang characteristic.
Our findings may provide new appendages for understanding of menopausal symptoms and the possible therapeutic usage of TCM.
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