Menopause symptom score

By the day of the appointment, the last few weeks often blur into a vague "I have not been myself." The Greene Climacteric Scale turns that into 21 ratings, each from 0 to 3, a total, and group scores for psychological symptoms, somatic symptoms, vasomotor symptoms and sexual interest. Anxiety and low mood sit inside the psychological group. You can compare today's figures with a later set, including one you complete after treatment.

Patient.info says there is no single score that confirms menopause, rules it out, or automatically indicates that treatment is needed. The figures are general information you can show a clinician.

Score the 21 symptoms

What this scale measures

Greene's 1998 paper in Maturitas looked at seven factor-analytic studies of climacteric symptoms and described a standard measure of the core symptoms. RWS, which licenses the questionnaire, describes 21 items with four answers on each one. PhenX calls it a brief, validated, self-administered scale that is easy to use and score.

Menopause Matters reprints the questions with permission from Dr Greene. The same instrument is on the RWS site linked above. The NHS and NICE use symptoms and age for this diagnosis. This questionnaire is a research measure you can take to your appointment.

The menopause symptom checklist for your GP follows NHS symptom groups. You mark how often each one happens and how much it bothers you from 1 to 10. That sheet has no published total. The list here is the fixed research set, and the points add up. A menopause symptom quiz is often a short untitled list. The menopause rating scale is a separate questionnaire, with 11 items. An NCBI Books appendix lists both, and it says this scale has 21 questions.

The form asks how bothered you are right now, which you can answer while your periods are still changing. The stage checker uses your age and the date of your last period, which is a different question from how strong the symptoms feel.

How the points add up

Each symptom uses four answers, from the RWS scoring page: Not at all is 0, A little is 1, Quite a bit is 2, Extremely is 3. RWS reports that patients typically finish in about five minutes. PhenX records the sums like this:

• Psychological, the first 11 symptoms
• Anxiety, the first 6 of those
• Depressed mood, symptoms 7 to 11
• Somatic, symptoms 12 to 18
• Vasomotor, symptoms 19 and 20
• Sexuality, symptom 21

Anxiety and depressed mood are part of the psychological score. The total counts each symptom once. The highest possible scores are 33 for the psychological group, 18 for anxiety, 15 for depressed mood, 21 for somatic symptoms, 6 for vasomotor symptoms and 3 for sexuality. Because each of the 21 symptoms scores up to 3, the highest total is 63. The same NCBI appendix says to add all 21 questions for a quality-of-life score, and a higher score means a worse quality of life. These sources do not name a total at which HRT should start.

Take four example ratings, with every other symptom at 0. Hot flushes at Quite a bit (2). Sweating at night at Extremely (3). Difficulty in sleeping at Quite a bit (2). Irritability at A little (1).

The anxiety score uses only the sleep rating, which is 2. The depressed-mood score uses only the irritability rating, which is 1. Psychological is 3, somatic is 0, vasomotor is 5 and sexuality is 0. The total comes to 8.

Score your symptoms

RWS says the UK English scale was validated on paper, and has not been adapted for a tablet, a handheld, the web or an automated phone line. The same FAQ says academic researchers can use the scale at no charge. Commercial pharmaceutical use requires email permission and a per-patient fee. The form below follows the published wording so the group scores can be added in the browser. The paper questionnaire remains the version RWS validated.

Please indicate the extent to which you are bothered at the moment by any of these symptoms. That is the PhenX introduction. The first six add up as anxiety. The next five add up as depressed mood.

Taking the numbers to a GP

From age 45, NICE quality statement 143 says perimenopause or menopause is diagnosed from symptoms alone, without a confirmatory laboratory test, when the symptoms fit. Bring the scores if they help you explain how you have been feeling. A clinician still makes the diagnosis at the appointment.

Menopause Matters uses the scale to assess changes in different symptoms, before and after menopause treatment. Fill in the same 21 items again before a review, and you have two totals to compare. For timings on flushes, sleep and mood after HRT starts, see how long HRT takes to work.

If you are over 45 and thinking about HRT, the NHS suggests you note any recent changes to your periods before the appointment. Before that appointment, see how to start HRT for the questions worth taking in.

Day-by-day flushes and night sweats, with the triggers you suspect, belong in the hot flush and night sweat diary. For tension, panic, low mood and irritability, see HRT, anxiety and low mood in menopause. Individual symptoms are gathered in menopause symptoms.

Sources

• Patient.info: Greene Menopause Scale
• Greene 1998, Maturitas
• RWS: Greene Climacteric Scale instrument
• RWS: scoring
• RWS: frequently asked questions
• PhenX protocol 880401
• NCBI Books appendix D, NBK447620
• Menopause Matters: Greene score
• NICE quality statement 143
• NHS: about hormone replacement therapy
• How we research and source health guides
• Privacy policy

My take

I would complete the questionnaire on a quiet evening during the week of the appointment, and I would take the printout even if the overall score looks low. What helps is seeing which group changed: vasomotor, psychological, somatic, or sexual interest. Starting treatment is a decision for you and the clinician at the appointment. The figure 8 is the example from the four ratings above.

Score the 21 symptoms