Menopause Symptoms: Climacteric Scale

Reproduced with kind permission from Dr Greene.

PURPOSE
To provide a brief but comprehensive and valid measure of climacteric symptomatology. The Scale yields three main independent symptom measures. One of Psychological Symptoms; one of Somatic Symptoms; and one of Vasomotor Symptoms. The Scale can be, and has been used, to assess changes in different categories of symptoms in response to treatment interventions; in clinical trials of hormone replacement therapy; in comparative studies of different groups of women; in epidemiological studies and in basic research into the aetiology of climacteric symptoms. In this respect, it should be noted that the term Climacteric Scale is used to indicate that these symptoms may occur at any time throughout the climacteric and are not necessarily confined so the time of the menopause.

CONSTRUCTION
The Scale was originally constructed on the basis of a factor analysis of symptoms presented by a group of climacteric women attending a menopause clinic (1). It has subsequently been modified to take account of findings from five later factor analytic studies carried out by researchers in other countries using both general population and clinical samples (2, 3). Overall there was high agreement from later studies in regard to twenty symptoms of the original scale and confirmation that these fell into three main groupings — psychological, somatic and vasomotor, although there was some consensus that the psychological symptoms could be further subdivided. Final symptom selection and their allocation to different sub-scales has therefore been based on replication of findings across six different studies. The wording of each symptom has also been standardised so reflect that most commonly used in each of these studies.
The final form of the Scale can he found here.

ADMINISTRATION AND SCORING
The Scale is designed for completion by the subject, but if desired or necessary, 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. Such a rating method was used in she original factor analysis (1) and gives greater sensitivity to the measures than does a binary present/absent rating. Scores are assigned as follows:

Not at all = 0
A little = 1
Quite a bit = 2
Extremely = 3

CALCULATION OF SCALE SCORES
For the Psychological Scale (P) sum symptoms 1 to 11
For the Somatic (physical) Scale (5) sum symptoms 12 to 18
For the Vasomotor Scale (V) sum symptoms 19 to 20

The P Scale can be further subdivided to give measures of :
Anxiety (A) — sum items 1 to 6
Depression (D) — sum items 7 to 11
Symptom 21 is a probe for sexual dysfunction (5).

PSYCHOMETRIC PROPERTIES
(a) Reliability
Test — retest of 50 menopausal women over a 2 week period yields the following reliability co-efficients:

Psychological Scale 0.87
Somatic (physical) Scale 0.84
Vasomotor Scale 0.83

These are statistically highly significant.

(b) Content Validity
Only symptoms which have been confirmed by other factorial studies as having a statistically significant factor loading have been included in the final scale (2, 3).

(c) Construct Validity
Construct validity has been demonstrated in relation to life stress (4), bereavement (5), psychological treatment (6), and hormone replacement therapy (7).

NORMATIVE DATA

(Menopausal and postmenopausal urban Scottish women randomly sampled from the electoral role or consecutive referrals to a menopause clinic.)

DIAGNOSTIC USE
The Scale can also be used to identify menopausal women who are severely and possibly clinically anxious and/or depressed. The recommended cut-off points are:

Clinically Anxious = Anxiety Score of 10 or more
Clinically Depressed = Depression Score of 10 or more

These scores are based on a comparative study of the Scale with the Hospital Anxiety and Depression Scale, a scale designed to diagnose psychiatric disorders among general hospital patients.

REFERENCES

1. Greene, J. G. (1976) A factor analytic study of climacteric symptoms. Journal of Psychosomatic Research, 20, 425—430.
2. Greene, J. G. (1984) The Social and Psychological Origins of the Climacteric Syndrome. (Chapter 7—Methodological Issues in Climacteric Research). Gower: Aldershot, Hants.
3. Greene, J. G. (1990) Factor Analyses of Climacteric Symptoms: Toward a Consensual Measure. Unpublished Report. Department of Psychological Medicine, University of Glasgow.
4. Greene, J. G. and Cooke, D. J. (1980) Life stress and symptoms at the climacteric. British Journal of Psychiatry, 136, 486—491.
5. Greene, J. G. (1983) Bereavement and social support at the climacteric. Maturitas, 5, 115—124.
6. Greene, J. G. and Hart, D. M. (1987) Evaluation of a psychological treatment programme for climacteric women. Maturitas, 9, 41—48.
7. Dow, M. G., Hart, D. M. and Forrest, C. A. (1983) Hormonal treatments of sexual unresponsiveness in post menopausal women: a comparative study. British Journal of Obstetrics and Gynaecology, 90, 361—366. J. G. Greene Department of Clinical Psychology Gartnavel Royal Hospital Glasgow G12 OXH United Kingdom

Dr. J. G. Greene.
Department of Clinical Psychology
Gartnavel Royal Hospital
Glasgow
G12 OXH
United Kingdom