Understanding the Menopause Rating Scale (MRS)

Menopause is a natural occurrence for all women as they reach the end of the time when they can bear children. Their periods stop, their hormone levels change, and women enter the next stage of their lives.

Before women transition to menopause, they start developing symptoms while they are still in perimenopause. Perimenopause can begin as much as ten years before women go through menopause. Signs of hot flashes, mood swings, changes in libido, vaginal dryness and more, start during that window of time. They may experience low estrogen symptoms or estrogen dominance and changes in their FSH levels.

Women have often struggled to describe the severity of their symptoms so that their doctors can understand which ones interfere most in their daily life. Doctors typically focus on those menopausal symptoms treated using oral hormones, estrogen creams, and other medication or suggest non-medical interventions such as yoga, supplements, herbs and diet changes.

The Menopause Rating Scale (MRS) is a questionnaire that ranks the severity of 11 symptoms that occur during the transition to menopause. Women indicate on a scale starting with 0 (no symptoms), 1 (mild), 2 (moderate), 3 (severe), 4 (extremely severe) how much the symptoms are affecting their health-related quality of life. These climacteric symptoms represent the gradual change of a woman’s ovarian function during perimenopause, before menopause actually arrives.

The questions fall into three subcategories:

• Hot flashes, heart discomfort, sleep problems, and joint and muscular discomfort are considered somatic symptoms.
• Depressive mood, irritability, anxiety, and physical and mental exhaustion are considered psychological symptoms.
• Sexual problems, bladder problems, vaginal dryness and are considered urogenital.

The Menopause Rating Scale asks these questions:

Which of these symptoms are you experiencing now?

Put an “X” in the box for each symptom you are experiencing based on how severe you feel it affects your life. Mark an “X” in the none: 0 column for those symptoms that do not affect you.

Symptoms	None	Mild	Moderate	Severe	Extremely Severe
score	0	1	2	3	4
1. Hot flashes, sweating, (episodes of sweating)
2. Heart discomfort, unusual awareness of heartbeat, heart skipping, heart racing, tightness
3. Sleep problems (difficulty falling asleep, difficulty in sleeping through the night, waking up early)
4. Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings)
5. Irritability (feeling nervous, inner tension, feeling aggressive)
6. Anxiety (inner restlessness, feeling panicky)
7. Physical mental exhaustion (general decrease in performance, impaired memory, decrease in concentration, forgetfulness)
8. Sexual problems (changes in sexual desire, in sexual activity and satisfaction)
9. Bladder problems (difficulty in urinating, increased need to urinate, bladder incontinence)
10. Dryness of vagina (sensation of dryness or burning in the vagina, difficulty with sexual intercourse)
11. Joint and muscular discomfort (pain in joints, rheumatoid complaints)
Total

Source: http://hormonebalance.org/userfiles/file/MRS%20QOL%20questionnaire%20.pdf

Women can fill out the MRS questionnaire before a medical appointment. Some doctors may instead fill out the questionnaire themselves during a medical exam.

The scores are totaled up for each category—a grand total score ranks the severity of the symptoms a woman experiences around menopause.

The breakdown of scored points is:

• mild symptoms add up to 11 points,
• moderate adds up to 22 points,
• severe adds up to 33 points and
• extremely severe adds up to 44 points.

The MRS can help determine what a woman’s baseline level is before any treatment changes are started. Then, the woman can retake the test to see whether there has been improvement after treatment.

For example, a 2004 study examined the scores of over 9000 women who were experiencing symptoms around menopause. The average age of the women was about 50 years old. Nearly half of the women were still perimenopausal (51.9%) or had already gone through the transition to menopause (48.1%). The doctor completed the scale after interviewing the woman, the woman did not fill in the questionnaire herself.

The women were rated on the MRS before receiving hormone therapy and then six months later. “Patients with little/no complaints before therapy improved by 11%, those with mild complaints at entry by 32%, with moderate by 44%, and with severe symptoms by 55% - compared with the baseline score.” The overall improvement was 36%.

One of the benefits of the MRS is that it gives women confirmation that the symptoms they are struggling with are real, and real for other women.

Once women become more aware that these difficulties are related to perimenopause and low estrogen symptoms, they often seek alternatives to help with these hormone imbalances. They can feel hopeful that they can get their mojo back.

History of the MRS and its use today

In the 1990s, the Menopause Rating Scale (MRS) was created as a standardized method to measure health symptoms related to aging. The early version of the MRS was first published in German and later translated into English. It allows groups of women who live in different environments and different countries to be compared to see if aging and transition into menopause are similar.

The MRS can be subject to cultural differences and interpretation. One study of 4009 women in Columbia gave the questionnaire to women of different ethnicities who were aged 40-59 years old to rate their symptoms as they transitioned to menopause.

Some of the women who lacked reading skills in Spanish had a nurse help them understand the questions in their native dialect. What was found is that women of Mestizo ethnicity had the highest depressive score. Afro-Columbian women had the highest anxiety score, and indigenous women had the highest irritability and physical and mental exhaustion scores.

Surprisingly, several journal articles discussed the use of the MRS between 2000 and 2010, but little has been written more recently on its use. The MRS scale is an excellent tool to help women identify their symptoms while they transition to menopause. The scale is very clear and puts the most common climacteric symptoms on a single list. It could easily be published in women’s magazines or websites and brought to a doctor’s appointment even without the doctor requesting the woman fill it out.

It is unclear why it has fallen out of favor when the early articles sounded so hopeful. Perhaps with social media growth and a slew of menopause tracking apps that monitor women’s symptoms around menopause, a paper tool seemed less useful.