You can always press Enter⏎ to continue
Menopause Rating Scale
Developed by the Berlin Center for Epidemiology and Health Research.
START
HIPAA
Compliance
1
Personal Information
First Name
Last Name
Date of Birth
Previous
Next
Submit
Press
Enter
2
Menopause Stage
Perimenopause
Menopause
Postmenopause
Previous
Next
Submit
Press
Enter
3
Key Dates
When was your last menstrual cycle?
When was your last pap smear?
When was your last mammogram?
Previous
Next
Submit
Press
Enter
4
Other Menopause Considerations
Please select all that apply.
Weight Gain, Weight Fluctuations
Hair Changes, Hair Loss, Change in Hair Texture
Hysterectomy
Ovaries Removed
Previous
Next
Submit
Press
Enter
5
Hot Flashes, Sweating
*
This field is required.
(episodes of sweating)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
6
Heart Discomfort
*
This field is required.
(unusual awareness of heartbeat, heart skipping, heart racing, tightness)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
7
Sleep Problems
*
This field is required.
(difficulty falling asleep, difficulty in sleeping through, waking up early)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
8
Depressive Mood
*
This field is required.
(feeling down, sad, on the verge of tears, lack of drive, mood swings)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
9
Irritability
*
This field is required.
(feeling nervous, inner tension, feeling aggressive)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
10
Anxiety
*
This field is required.
(inner restlessness, feeling panicky)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
11
Physical and Mental Exhaustion
*
This field is required.
(general decrease in performance, impaired memory, decrease in concentration, forgetfulness)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
12
Sexual Problems
*
This field is required.
(change in sexual desire, in sexual activity, in satisfaction)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
13
Bladder Problems
*
This field is required.
(difficulty urinating, increased need to urinate, bladder incontinence)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
14
Dryness of Vagina
*
This field is required.
(sensation of dryness or burning in the vagina, difficulty with sexual intercourse)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
15
Joint and Muscular Discomfort
*
This field is required.
(pain in the joints, rheumatoid complaints)
None
Mild
Moderate
Severe
Extremely Severe
Previous
Next
Submit
Press
Enter
16
Menopause Ratings Scale Results
Psychological (0 to 16)
Somato-Vegetative (0 to 16)
Urogenital (0 to 12)
Total (0 to 44)
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
16
See All
Go Back
Submit