AMS Symptom Scorecard

AMS Symptom Scorecard

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PERSONAL INFORMATION

Name(Required)

SYMPTOM SCORE (Modified Greene Scale)

This symptom score can be used to document symptoms and monitor response to treatments. It should NOT be used to diagnose perimenopause or menopause. Perimenopause commences when menstrual cycle changes occur, with differences in length of consecutive cycles. Menstrual cycle changes cannot be used to diagnose perimenopause or menopause for people using hormonal contraception, or who have had an endometrial ablation or hysterectomy.
SEVERITY OF PROBLEM IS SCORED AS FOLLOWS
SCORE: None=0; Mild=1; Moderate=2; Severe=3

Not all of the symptoms listed are necessarily oestrogen deficiency symptoms.
 
Score before MHT
3 months after starting MHT
6 months after starting MHT

Hot flushes

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Lightheaded feelings

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Headaches

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Brain Fog

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Irritability

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Depression

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Unloved feelings

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Anxiety

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Mood changes

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Sleeplessness

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Unusual tiredness

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Backache

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Joint pains

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Muscle pains

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

New facial hair

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Dry skin

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Crawling feelings under the skin

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Less sexual feelings

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Dry vagina

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Uncomfortable intercourse

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

Urinary frequency

Please enter a number from 0 to 3.
Please enter a number from 0 to 3.
Please enter a number from 0 to 3.

TOTAL
SEVERITY OF PROBLEM IS SCORED AS FOLLOWS
SCORE: None=0; Mild=1; Moderate=2; Severe=3

Not all of the symptoms listed are necessarily oestrogen deficiency symptoms.