Perimenopause Symptoms: An Overview of the Greene Climacteric Scale and Hormone Therapy Decision-Making
Written and edited by Sarah Bonza MD, MPH, FAAFP, DipABLM, NBC-HWC
Women approach me on a daily basis and ask if they should be considering hormone therapy. There is no one size fits all answer. The Greene Climacteric Scale helps provide clues for when it’s time to seek medical assistance (Greene, 1976)(Greene Menopause Index, 2007) . Perimenopause is a transitional phase in a woman’s life that can bring about various physical and psychological symptoms. Recognizing and evaluating the symptom burden of perimenopause is crucial for providing appropriate care and support to women during this time. By using this scale, healthcare providers can better understand the specific symptoms experienced by each woman and tailor treatment plans accordingly.
What is perimenopause?
Perimenopause is a natural phase in a woman’s reproductive life that typically occurs in her late 30s to early 50s. During this time, the ovaries gradually begin to produce less estrogen, leading to irregular menstrual cycles and eventually to menopause. Common symptoms of perimenopause include hot flashes, night sweats, mood swings, sleep disturbances, vaginal dryness, and decreased libido(Avis et al., n.d)(Menopause Information, About Menopause, 2022).
The Symptom Burden of Perimenopause
The symptom burden of perimenopause can vary from woman to woman and can have a significant impact on daily life, work, and relationships. Some women may experience mild symptoms that do not greatly affect their quality of life, while others may have severe symptoms that significantly disrupt their daily functioning.The Greene Climacteric Scale is a tool that can help healthcare providers assess the severity and impact of perimenopausal symptoms.
Introducing the Greene Climacteric ScalE
The Greene Climacteric Scale, also known as the Greene Menopause Index(Greene Menopause Index, 2007)(Barentsen et al., n.d)(Heinemann et al., 2003), is a standardized questionnaire used to assess and quantify the symptoms experienced during perimenopause. It consists of 21 questions that cover a range of physical, psychological, and vasomotor symptoms commonly associated with perimenopause. The scale allows women to rate the severity and frequency of each symptom they are experiencing, providing a comprehensive picture of their symptom burden.With the Greene Climacteric Scale, healthcare providers can gain a better understanding of the specific symptoms each woman is facing and how these symptoms are impacting their daily life. This information can guide healthcare providers in developing personalized treatment plans and providing appropriate support and interventions.
Scoring Green Climacteric Scale
The Greene Climacteric Scale assigns a numerical value to each response, with higher scores indicating greater symptom severity.
Greene Climacteric Scale questions to help understand perimenopause and menopause symptom burden
ADMINISTRATION AND SCORING
The Scale is designed to be completed by the subject, but it could be used in the form of a structured interview. Each symptom is rated by the subject according to its severity using a four point rating scale. Scores are assigned as follows:
Not at all = 0
A little = 1
Quite a bit = 2
Extremely = 3
It yields three main independent symptom measures:
Psychological Symptoms : This subscale includes symptoms such as mood swings, irritability, and anxiety. Sum questions 1–11
Anxiety (A) — sum of questions 1 to 6
Depression (D) — sum of questions 7 to 11
Somatic Symptoms: This subscale includes symptoms such as headaches, and muscle/joint discomfort. Sum questions 12 to 18
Vasomotor Symptoms. This includes symptoms such as hot flashes and night sweats. Sum questions 19 to 20
Sexual dysfunction: question 12.
Studies have shown that women with a GCS score over 12 are more likely to be experiencing menopause. However, there is a wide range and it’s possible to score lower than this and still be in the menopausal transition. Many symptoms are not exclusively linked to menopause, so it’s also possible to score higher than 1 and not be in the transition stage. The GCS score doesn’t indicate whether treatment is necessary either. For example, you could have a low score due to experiencing only night sweats. If these night sweats disrupt your sleep and affect your daily functioning, it’s important to discuss potential treatments with your doctor.
Despite its limitations, the GCS is a useful tool for understanding the symptoms experienced at any given time.
When to Consider Hormone Therapy
When discussing treatment options for perimenopausal symptoms with healthcare providers, hormone therapy may be considered. Hormone therapy involves taking menopausal hormone therapy, estrogen or a combination of estrogen and progesterone, to alleviate the symptoms of perimenopause. The decision to consider hormone therapy should be based on a variety of factors, including the severity and impact of symptoms on daily life, personal preferences, and your medical history.
Discussing Hormone Therapy with Your Provider
When discussing hormone therapy with your healthcare provider, it is important to have an open and honest conversation about your symptoms, medical history, and any concerns or preferences you may have. This will allow your provider to make an informed decision about whether hormone therapy is a suitable option for you. Some key points you may want to discuss with your provider include the potential benefits and risks of hormone therapy, any contraindications or precautions based on your medical history, and alternative treatment options that may be available.
Conclusion
Perimenopause can be a challenging time for many women, as they may experience a wide range of symptoms that can significantly impact their quality of life. It is important for healthcare providers to assess the severity and impact of these symptoms in order to provide appropriate support and interventions. By using tools such as the Greene Climacteric Scale, healthcare providers can gain valuable insights into the specific symptoms experienced by women during perimenopause. Women can also use this tool to track their own symptoms on a monthly basis and help guide them when to seek out medical care.
Bonza Health offers a modified 10 question version of the Greene Climacteric Scale. Click here to take the quiz!
References
- Avis, N E., Kronenberg, F., Cen, H R., Santoro, N F., & Archer, D F. (n.d). Clinical Challenges of Perimenopause: Consensus Opinion of The North American Menopause Society. https://journals.lww.com/menopausejournal/fulltext/2000/07010/clinical_challenges_of_perimenopause__consensus.3.aspx
- Barentsen, R., Weijer, P H M V D., Gend, S V., & Foekema, H. (n.d). Climacteric symptoms in a representative Dutch population sample as measured with the Greene Climacteric Scale.. https://maturitas.org/retrieve/pii/S0378512200002127
- Greene Menopause Index. (2007, December 27). https://en.wikipedia.org/wiki/Greene_Menopause_Index
- Greene, J G. (1976, January 1). A factor analytic study of climacteric symptoms. , 20(5), 425–430. https://www.sciencedirect.com/science/article/pii/0022399976900052
- Heinemann, L A., Potthoff, P., & Schneider, H P. (2003, July 30). International versions of the Menopause Rating Scale (MRS). https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-1-28
- Menopause Information, About Menopause. (2022, January 1). https://www.menopause.org/for-women
