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It is important to know the norm or reference values of the MRS scores in the "normal population"

For the comparison of categories of increasing severity of complaints or problems with quality of life across countries or cultures it is important to understand the prevalence of complaints.
Currently, there is only one table with reference values and definitions published - for the German population from the initial standardization of the MRS [ 2 ].

Are these reference values applicable for other countries/cultures?

The data of our large survey permitted such comparisons. The mean values (SD) of the MRS total score and the three domains are depicted in the attached table.

The mean values of the total score and the 3 domain scores are not statistically significant different.
Thus, there is no evidence yet to exclude direct comparisons of MRS values between Europe and USA.
However, the total, psychological and somatic scores were systematically higher in Latin America, and systematically (significantly) lower in Asia (Indonesia) than in Europe/North America. The urogenital scores were significantly lower in Latin America/Indonesia than in Europe/US.

Obviously, the subjective perception of some prevalent symptoms depends on cultural factors - or the symptoms show real differences in prevalence. Thus, direct comparisons of MRS scores between Europe/North America on the one side and regions in Latin America and Asia should be considered with caution.
This does not affect intra-individual comparisons (e.g., pre/ post therapy) within these countries and it may also very little affect the comparison of relative changes (pre/post treatment) among different countries. The latter is a hypothesis and need further research.

Similar mean values may have a different distribution across the proposed four categories of "severity of complaints": no/little symptoms, mild, moderate, and severe complaints, i.e. for the total scale and the three domains.

The prevalence of these categories across the four regions studied is seen in this table.
The comparison of the prevalence (and 95% confidence interval) showed that the above discussed differences between Europe/US and Latin-America or Indonesia very much depend on the severity of complaints.
Whereas the differences in the psychological domain were less impressive, the dissimilarity was most pronounced in the urogenital domain and less also in the somatic domain.

Whether this is due to different perception of identical symptoms, due to differences in the appearance of symptoms or both remains speculation. This however needs to be considered when direct comparisons among different cultures are intended.
The prevalence of different "degrees of severity" of menopausal symptoms measured with the MRS was found to be almost identical in the aggregate of Europe and North America.




[ 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.