The development followed international guidelines for quality of
The original MRS is used since 1992. It was developed
to give a physician the possibility to document climacteric symptoms
and their changes during the treatment [
A critical methodical assessment by one of the participants in
the development of this new scale showed methodical deficiencies
which theoretically as well as practically limited the
use of the scale [
The result were the following suggestions:
||verification of the scale in a representative sample of
women in that stage of life,
||development of a questionnaire that can be filled out
by the woman herself, first of all because the self-assessment
in the field of sensitivities is to be preferred
to the doctors assessment, and secondly because this kind
of questionnaire would not limit future areas of use so
||modification of the scale to a simple, from laymen understandable
||psychometric analysis of the collected data and development
of simple-to-use evaluation aids,
||provision of a classification of complaints derived from
an examination of the normal population, e.g. for comparisons
with special patient groups.
In 1996 (January, February), a questionnaire was completed by
a representative random sample of 689 German women aged 40 to
60 years in order to evaluate the newly established Menopause
Rating Scale (MRS) [
1 ], [
Based on this investigation, the revised and final version of
the MRS was prepared; this revision mainly concerned the layout
and some adjustments regarding the number of items, and the practicalities
of a self-administered questionnaire.
The MRS was formally standardized according to psychometric rules.
It consists of a list of 11 symptoms which have to be answered:
The respondent have a choice among 5 categories: no symptom, mild,
moderate, marked, and severe.
During the standardization of this instrument, three independent
dimensions were identified explaining 58.8% of the total variance
(factor analysis): psychological, somato-vegetative, and urogenital
Each of the eleven symptoms contained in the scale can get 0 (no
symptom) or up to 4 scoring points (severe symptom) depending
on the severity of the complaints perceived by the women completing
the scale (an appropriate box is to be ticked). The total score
of the MRS ranges between 0 (asymptomatic) and 44 (highest degree
of complaints). The minimal/maximal scores vary between the three
dimensions depending on the number of complaints allocated to
the respective dimension of symptoms:
- sychological sub-scale
- somato-vegetative domain
- urogenital domain
An instrument easy to handle emerged that became standard to measure
climacteric complaints in the medical
3 ] and fulfilled the methodological requirements of a modern
HRQoL scale [
The increasing recognition among clinicians and researchers of
the role of patient-reported data as outcome measure (PRO) found
its way into requirements issued by the Drug Authority FDA (USA)
as how to develop and to assess relevant scales (2006).
Although the MRS scale was developed long ago, almost all requirements
can be met with data/information collected/published over the
years. This can be found in a review
of the MRS scale as PRO instrument attached as a PDF-file.
[ 1 ]. Hauser GA, Huber IC, Keller PJ, Lauritzen C, Schneider
HPG: Evaluation der klinischen Beschwerden (Menopause Rating Scale).
Zentralbl Gynakol 1994; 116:16-23.
[ 2 ]. Potthoff P, Heinemann LAJ, Schneider HPG, Rosemeier HP,
Hauser GA. Menopause-Rating Skala (MRS): Methodische Standardisierung
in der deutschen Bevölkerung. Zentralbl Gynakol 2000; 122:280-286.
[ 3 ]. Schneider HPG, Behre HM. Contemporary evaluation of climacteric
complaints: Its impact on quality of life. In: Hormone replacement
therapy and quality of life. The Parthenon Publishing Group. (Edited
by: Schneider HPG) Boca Raton, London, New York, Washington. 2002:
[ 4 ]. Greene, JG. Measuring the symptom dimension of quality
of life: General and menopause-specific scales and their subscale
structure. In: Hormone replacement therapy and quality of life.
The Parthenon Publishing Group. (Edited by: Schneider HPG) Boca
Raton, London, New York, Washington. 2002: 35-43.