| ObjectiveThrough clinical epidemiology,Chinese medicine syndrome research and modern statistics,this study aims to understand the common symptoms and Chinese medicine syndromes of Menopasual Disorders amongst Singapore Chinese females.By conducting a clinical survey on Singaporean Chinese females with Menopausal syndromes and analysing the results,we would have a better understanding of the common symptoms,Chinese Medicine syndromes and relevant risk factors of Menopausal syndrome in Singapore.As Chinese Medicine research on this area has not been conducted,this research would assist to provide us with more information and insights on Menopausal syndrome specific to Singaporean Chinese females,this would also act as a platform to improve the Chinese Medicine treatment efficacy in Singapore.MethodsUsing convenience sampling survey method,the study recruited females who met thediagnostic criteria and was surveyed from October 2018 till June 2021 in various Chinese Medicine clinics such as Singapore Chung Hwa Medical Institution（Toa Payoh Branch）,NTU Chinese Medicine Clinic,private Chinese Medicine clinics and community places.A total of 206 participants,who are Singaporean Chinese（citizen or permanent resident）female,aged between 40-60 years old,with symptoms fulfilling the diagnostic criteria of Menopausal syndrome and also fulfill the inclusion and exclusion criteria of the study were recruited.The study involves a face-to-face survey with participants to answer a“Singapore region Menopausal syndrome clinical symptoms and influencing factors questionnaire”and a“Modified Kupperman（KI）Index questionnaire”.Singapore registered CM physicians,who are familiar with the study,are involved in the data collection.With given consent by the participants,physicians will conduct the survey onsite and ensure the participant fully understands the questions asked.The physician will check that all questions are answered and is also in charge of the CM diagnostics portion of the questionnaire.If any questions were incomplete or there were answers with doubts,the physician will seek rectification and clarification from the participant.The data collected was collated with Microsoft Office 2013 Excel and further analysis were done with SPSS 26.0.Count data was presented in percentage（%）,measurement data was presented as means±standard deviation（??±?）or median M(P25～P75).Data comparisons methods used were Pearson Chi-square test of independence,Kruskal-Wallis Test or Mann Whitney U test.Risk factor analysis was conducted using a case-control method.The variables were first selected using univariate binomial logistic regression,after which selected variables underwent stepwise binomial logistic regression（Forward-LR）.Hosmer-Lemeshow（HL）test was used to test the goodness-of fit of the model.Results1.Mean age of the 206 participants was 52.20±4.21,median age was 52.00,the most common age group belonged to the 51-55 years old group（46.10%）.Of the 206 participants,36（17.48%）were patients who seeked treatment for menopause while 170（82.52%）were not seeking treatment for menopause.Majority of the participants has an education level of university or post graduate degree（37.90%）,60.70%of the participants had an educational level equivalent to A levels or Diploma or above.In terms of occupation,management jobs were the majority（27.20%）,while in terms of occupation types,jobs involving brain work were the majority（40.80%）.The average Body Mass Index（BMI）of the participants was23.11±3.50,median was 22.55,with majority in the healthy weight range（48.50%）but overweight and obese range had 44.20%.In terms of diet preferences,participants preferred warm food（45.63%）,followed by bland food（40.78%）,spicy food（26.70%）.Majority of the participants indicated that they exercise once in awhile（50.00%）,followed by exercise frequently（26.20%）,the least was do not exercise（23.80%）.More than one-third of the participants indicated their stress level as high or extreme;42.72%of participants had stable emotions,followed by easily nervous（34.47%）and easily angered（23.30%）.Of the 206participants,35.00%migrated to Singapore.2.Of the 206 participants,104（50.50%）were pre-menopausal,102（49.50%）were post-menopausal（45.60%-natural menopause;3.90%-surgical menopause）.The mean age of menarche was 12.87±1.52,median age of menarche was 13.00,mean age of menopause was 51.04±3.06,median age of menopause was 51.50.Amongst those who have menopaused,majority were in the 51-55 years old（52.90%）and 46-50 years old（36.30%）age group,totalling 89.20%.3.Modified KI mean score was 15.74±7.58,median score was 15.00.In terms of severity,majority had mild symptoms（47.10%）,followed by moderate symptoms（41.30%）.Based on the clinical symptoms listed in Modified KI questionnaire,the frequency of symptoms displayed,in order of most to least are:Fatigue（82.52%）,Arthralgia/myalgia（79.13%）,Nervousness（77.67%）,Insomnia（66.02%）,Headache（62.62%）,Sweating/hot flushes（59.22%）,Sexual complaints（51.94%）,Heart palpitation（50.00%）,Vertigo（50.00%）,Paresthesia（43.20%）,Melancholia（41.75%）,Urinary Tract Infection（29.61%）,Formication（28.16%）.4.The most common CM syndrome is Kidney Yin deficiency（27.70%）,followed by Kidney deficiency-Liver stagnation（20.40%）,Disharmony between Heart and Kidney（18.40%）,Liver and Kidney Yin deficiency（17.00%）,Kidney Yin and Yang deficiency（14.10%）and Spleen and Kidney Yang deficiency（2.40%）,the least seen syndrome was Kidney Yang deficiency（0.00%）.Based on the most common syndromes,the Kidney,Liver and Heart are the main organs involved in Menopausal syndrome.5.Comparisons between CM syndromes and basic information revealed that the distribution of CM syndromes was statistically different with the distribution for pre/post menopause,age groups,KI overall score,duration in Singapore and stress（P<0.05）.The distribution of KI overall score was statistically different with the distribution of education level,stress,number of pregnancies,work satisfaction level and relationship satisfaction level（P<0.05）.Parity was statistically different with the age of menopause（P<0.05）.6.CM syndrome correlation analysis showed that age was negatively correlated with Kidney deficiency-Liver stagnation syndrome;menopause was positively correlated with Kidney Yin deficiency syndrome;stress was positively correlated to Kidney deficiency-Liver stagnation syndrome;higher monthly household income is positively correlated with Kidney deficiency-Liver stagnation syndrome;low exercise frequency is negatively correlated with Kidney and Liver Yin deficiency syndrome;KI overall score was negatively correlated with Kidney Yin deficiency syndrome and positively correlated with Disharmony between Heart and Kidney syndrome.7.KI overall score correlation analysis showed that work satisfaction level,BMI,number of miscarriages and past medical history were positively correlated with KI overall score.ConclusionSingaporean Chinese females that participated in the study were mainly between 51-55years old,with a mean age of 52.20±4.21.More than one-third of the participants indicated their stress level as high or extreme;majority of them reported to have stable emotions,easily nervous and easily angered were also commonly reported.The severity of menopausal symptoms were mainly mild and common symptoms were fatigue,arthralgia/myalgia,nervousness,insomnia,headache.The most common CM syndrome for Menopausal syndrome is Kidney Yin deficiency,followed by Kidney deficiency-Liver stagnation and Disharmony between Heart and Kidney.The primary pathology lies with Kidney Yin deficiency and secondary pathology is related to Liver stagnation and Heart misnourishment,signifying that the Kidney,Liver and Heart are the main organs involved in Menopausal syndrome.The most common influencing factors of CM syndromes of Menopausal syndrome in Singapore Chinese female are physical factors,socioeconomic factors,and lifestyle factors such as:age,pre/post menopause,stress,monthly household income,exercise frequency,KI overall score.Influencing factors of KI overall score were work satisfaction level,BMI,number of miscarriages and past medical history. |
