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The development followed international guidelines for quality of life scales

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 [ 1 ].

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 [
2 ].

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 much,

- modification of the scale to a simple, from laymen understandable form,

- 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 ], [ 2 ].
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 sub-scale.

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
practice [ 3 ] and fulfilled the methodological requirements of a modern HRQoL scale [ 4 ].

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: 45-61.

[ 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.