Menopause Diagnostic Tools

CeMCOR Daily Diary

This scale, developed by the Centre for Menstrual Cycle and Ovulation Research, is aimed at perimenopausal women, including women with regular cycles who have hot flushes or night sweats. The purpose is to help women become aware of the way their body responds to the menopausal changes and to any treatments being used to manage those changes. The link below provides an option for just the scale, for the scale and extra lines to include therapies, and a set of detailed instructions. Video instructions are also available.

The daily diary is intended to be filled out once a day (suggested before bed), allowing women to track their menstrual cycles, symptoms and treatments. [14]

The scales and instructions can be found here.

Daily Hot Flash Diary

This is the most commonly used diary for academic hot flash studies. Women record the frequency and severity of their hot flashes using a 4-point scale: mild, moderate, severe, very severe to provide a hot flash index, which is the sum of the number of hot flashes multiplied by severity. The definitions for the 4-categories of hot flash severity are listed below. [3] Note that Guttuso et al. 2013, observed approximately 50% of women reported confusion when trying to complete their diaries based on the definitions listed below. [4] These hot flash definitions are based on first hand descriptions of women’s perception of their hot flash severity.

The definitions are as follows:

Mild:
• Duration: Lasting less than five minutes
• Physical symptoms: Warmth, felt uncomfortable, red face
• Emotional symptoms: not expected
• Action needed: Usually no action taken

Moderate:
• Duration: Lasting up to 15 minutes
• Physical symptoms: Head, neck, ears, or whole body felt warm; tense, tight muscles; clammy (wet skin); a change in heart rate or rhythm (heart speeds up or changes beat); some sweating; dry mouth
• Emotional symptoms: felt irritated, felt agitated (restless), felt as though energy was drained out, felt embarrassed when having a hot flash in front of others, felt tired, felt annoyed
• Action needed: Needed to use a fan, awakened sometimes at night, needed to uncover, took off layers of clothing, drank water, opened the windows even when cold outside, wore lighter clothing

Severe:
• Duration: Lasting up to 20 minutes
• Physical symptoms: Warmth, sometimes described as a raging furnace or burning up; a change in heart rate or rhythm (heart speeds up or changes beat); felt faint; headache; severe sweating; weakness; a pricking, stinging sensation over the skin; chest heaviness
• Emotional symptoms: embarrassment; anxiety; feelings of having a panic attack
• Action needed: Needed to stop what was being done at that time, usually awakened at night and removed covers, needed to remove clothes, opened windows, kept the house a cooler temperature, frequently used fans

Very Severe:
• Duration: Lasting up to 45 minutes
• Physical symptoms: Boiling heat, rolling sweat, difficulty breathing, felt faint, felt dizzy, feel and/or legs cramping, a change in heart rate or rhythm (heart speeds up or changes beat), felt slightly sick to stomach
• Emotional symptoms: Felt distressed, had the urge to escape, had difficulty functioning
• Action needed: Awakened frequently at night, needed to change sheets and pajamas, needed to take a cold shower, needed to hold ice on skin.

The Daily Hot Flash Diary can be found here.

Generalized Anxiety Disorder Assessment (GAD-7)

The Generalized Anxiety Disorder Assessment (GAD-7) is a questionnaire that is used to measure or assess the severity of generalized anxiety disorder (GAD).

The GAD-7 scale can be found here.

Global Quality of Life Scale

The Global quality of life scale is a tool designed to measure overall quality of life, where 0 is the lowest possible and 100 is the highest possible quality of life.

The Global Quality of Life Scale can be found here.

Greene Climacteric Scale

The Greene Climacteric Scale (GCS) provides a snapshot measure of menopausal transition symptoms [5]. It is often used to assess change over time in different symptoms, and is particularly useful for women to track changes, if any, that occur after treatment. The Scale consists of 21 questions covering five domains: anxiety, depression, somatic (physical) symptoms, vasomotor symptoms, and sexual function. Each question is answered on a 4-point scale and answers are summed to give a total quality-of-life measure where a higher score indicates a worse quality of life.

The Greene Climacteric Scale can be found here.

Hot Flash Related Daily Interference Scale (HFRDIS)

The Hot Flash Related Daily Interference Scale (HFRDIS) is a 10-item questionnaire used to assess the impact of vasomotor symptoms (hot flashes) on daily activities over the past week on the women’s quality of life following breast cancer. The questions cover ten categories: work, social activities, leisure activities, sleep, mood, concentration, relation with others, sexuality, and enjoyment of life and overall quality of life. [8]

The Hot Flash Related Daily Interference Scale can be found here.

Hot Flush Behavior Scale (HFbehS) or Hunter Menopause Scale

The Hot Flush Behavior Scale (HFBehS), also called the Hunter Menopause Scale, measures behavioral reactions to vasomotor symptoms with the goal to contribute to a better understanding of the factors that influence the experience and impact of hot flashes and night sweats. It measures the behavioral strategies that women use in response to hot flashes and night sweats and is grounded in the direct experiences of women suffering hot flashes and night sweats. [7]
The scale itself consists of three categories of behaviours:
(i) avoidance – e.g. I have to leave or avoid social situations because of hot flashes;
(ii) active coping behaviours – e.g. I carry things with me (fans, drinks, wet wipes) in case I have a hot flash; and
(iii) positive behaviours – e.g. when I have hot flashes or night sweats, I try to accept them and let them flow over me.

Responses to the scale can guide health care providers to the best and most effective interventions, particularly psychological ones, given that the scale helps to understand how women’s thinking and behaviours impact their experiences with hot flashes and night sweats. [7]

The Hot Flush Behavior Scale can be found here.

Kupperman Menopausal Index (KMI) aka the Kupperman Index (KI) aka the Kupperman-Blatt Index, aka the Blatt-Kupperman Index

The Kupperman Index (KI) is a tool developed in the 1950s that, while widely criticized, continues to be used but often in a modified format. The questions are a mix of self-reported information from women as well as health-care provider scores. [8a] The KI is numerical index that scores 11 menopausal symptoms: hot flushes, paresthesia (burning or prickling sensations), insomnia, nervousness, melancholia (deep sadness or depression), vertigo, weakness, arthralgia (joint stiffness or pain) or myalgia (muscle aches or pain), headache, [heart] palpitations, and formication (sensation of insects crawling on your skin). Each symptom is rated from 0 to 3 according to severity. The scores are weighted and a total sum is calculated with a higher score indicating a worse quality of life. [9]

In 1998, a critique of the Blatt-Kupperman menopausal index indicated that the tool needed reassessment. The key criticisms focus on statistical shortcomings – primarily that no statistical justification is given for how scores are weighted, the categories can have overlapping scores and the scores are summed incorrectly. As well, there are no measures for the key symptoms of vaginal dryness and loss of libido. The measures that are included, as shown below, were poorly defined increasing the possibility of incorrect answers from respondents. The paper concluded that more modern scales without the weaknesses of the Kupperman Index should be used to measure patterns of symptoms and complaints. [9]

The original Kupperman Index can be found here.

Source: The Blatt-Kupperman menopausal index: a critique. Alder, E. Maturitas, Volume 29, Issue 1, 19 – 24

Menopause Rating Scale

The Menopause Rating Scale (MRS) was developed in the 1990s to fill a gap in existing standardized scales for measuring the severity of women’s menopausal transition symptoms and the impact of those symptoms on health-related Quality of Life (HRQoL). [1]

The MRS assesses eleven menopausal symptoms: hot flushes, heart concerns (such as palpitations etc.), sleep problems, depressive mood, irritability, anxiety, physical and mental exhaustion, sexual problems, bladder problems, vaginal dryness, and joint and muscular discomfort. [2]

Each of these items is scored from 0-4 (where 0 is no symptom experience and 4 is very severe experience). Those scores are then summed for a total quality-of-life score. The higher the score, the worse quality of life is being experienced.

Key objectives of the MRS are:

• To be easily completed by women themselves (not by their health-care providers)
• To measure health-related quality of life (QoL) or severity of complaints in mid-life women
• To measure changes over time
• To measure changes across different cultures, as the MRS is available in 25 languages
• To measure changes before and after treatment of with hormone replacement therapy
• To measure all of the above in a standardized way

The Menopause Rating Scale can be found here.

Menopause-specific quality of life (MENQOL)

The Menopause-Specific Quality of Life (MENQOL) questionnaire is used to measure changes in women’s quality of life. The MENQOL consists of 29 questions across four categories of menopausal transition symptoms: vasomotor, psychosocial, physical, and sexual.
Each question is scored either 1 for No; 2 for Yes, but not at all bothered through to 8 for Yes, extremely bothered. These scores are then totaled for a quality of life score. The higher the score, the worse the quality of life. [10] [11]
The MENQOL has been independently assessed and found to be a reliable and valid tool to assess quality of life. [12]

The scale can be found in the paper ID0295-TR-72179/MENQOL_AU2.2_1month-recall_eng-CAori.doc. however at this time we do not have permission to share the table.

Physical Activity Readiness Questionnaire – PAR Q and PAR Q+

The PAR-Q contains only seven yes or no questions shown in the attached questionnaire. Your results can indicate if you are ready to begin an exercise program or if you have additional conditions that need to be addressed.

If you answered no to all of the questions in the PAR-Q form, you should be able to start an exercise regime. You have a low risk of experiencing medical complications from exercise. If you haven’t been active regularly, you may wish to consult a physiotherapist, a certified fitness trainer or your healthcare provider. Remember that you should start slowly and increase your frequency and intensity gradually.

If you answer yes to one or more PAR-Q questions it is recommended that you take the PAR-Q+ questionnaire containing 10 follow-up questions. These questions explore any specific health conditions you may have, such as arthritis or cancer. It is recommended that you consult a physician before starting an exercise plan. Talk to your healthcare provider for more detailed guidance.

PAR Questionnaire.

PAR+ Questionnaire.

RAND Short Form 36 Health Survey (SF-36)

The Medical Outcomes Study (MOS) was a multi-year, multi-site study to explain variations in patient outcomes. Part of the study developed a 36-item Short Form Health Survey (SF-36). This survey is made up of generic and easily administered self-reported quality-of-life measures. This survey is widely used in health care for routine monitoring and assessment of care outcomes in adult patients.

This survey assesses overall health and quality of life. Using it over time will allow women to track how they feel and how well they can undertake their usual activities. [15]

The Rand SF-36 can be found here.

Women’s Health Questionnaire (WHQ)

The Women’s Health Questionnaire (WHQ) looks at quality of life in women experiencing the menopausal transition. Thirty seven questions cover 2 primary categories of emotional and physical health such as depression, anxiety, sleep problems, somatic symptoms (such as backache and breast tenderness). The questionnaire is reliable and has been found to be sensitive to detecting change. The WHQ is often used to assess treatment options including hormone replacement therapy. [13]

We do not have permission to post at this time but it can be found in Professor Myra Hunter, King’s College London, UK: WHQ_AU1.0_eng-GBori.doc