Menopause Quality of Life Questionnaire

Menopause Quality of Life Questionnaire

The Menopause-Specific Quality of Life Questionnaire is a self-report measure assessing the presence and severity of symptoms. This questionnaire is based on many research studies and has proven to be a validated and standardized way of assessing severity of menopause symptoms and the degree to which they adversely affect your life.

Use this questionnaire to assess your symptoms prior to starting hormone replacement therapy and then during to track your progress. As you undergo treatment, your total score should decrease, indicating that symptoms have resolved or decreased in severity.

For each of the items below, indicate by checking “Yes” or “No” whether you have experienced the problem in the PAST WEEK. If you have, rate the degree to which you have been bothered by the problem.
Not at all
bothered

Extremely
bothered
1.

Hot flashes or flashes
NOYES  
1
2
3
4
5
6
2.

Night sweats
NOYES  
1
2
3
4
5
6
3.

Sweating
NOYES  
1
2
3
4
5
6
4.

Dissatisfaction with my personal life
NOYES  
1
2
3
4
5
6
5.

Feeling anxious or nervous
NOYES  
1
2
3
4
5
6
6.

Poor memory
NOYES  
1
2
3
4
5
6
7.

Accomplishing less than I used to
NOYES  
1
2
3
4
5
6
8.

Feeling depressed, down or blue
NOYES  
1
2
3
4
5
6
9.

Being impatient with other people
NOYES  
1
2
3
4
5
6
10.

Feelings of wanting to be alone
NOYES  
1
2
3
4
5
6
11.

Flatulence (wind) or gas pains
NOYES  
1
2
3
4
5
6
12.

Aching in muscles and joints
NOYES  
1
2
3
4
5
6
13.

Feeling tired or worn out
NOYES  
1
2
3
4
5
6
14.

Difficulty sleeping
NOYES  
1
2
3
4
5
6
15.

Aches in back of neck or head
NOYES  
1
2
3
4
5
6
16.

Decrease in physical strength
NOYES  
1
2
3
4
5
6
17.

Decrease in stamina
NOYES  
1
2
3
4
5
6
18.

Lack of energy
NOYES  
1
2
3
4
5
6
19.

Dry skin
NOYES  
1
2
3
4
5
6
20.

Weight gain
NOYES  
1
2
3
4
5
6
21.

Increased facial hair
NOYES  
1
2
3
4
5
6
22.

Changes in appearance, texture or tone of my skin
NOYES  
1
2
3
4
5
6
23.

Feeling bloated
NOYES  
1
2
3
4
5
6
24.

Low backache
NOYES  
1
2
3
4
5
6
25.

Frequent urination
NOYES  
1
2
3
4
5
6
26.

Involuntary urination when laughing or coughing
NOYES  
1
2
3
4
5
6
27.

Decrease in my sexual desire
NOYES  
1
2
3
4
5
6
28.

Vaginal dryness
NOYES  
1
2
3
4
5
6
29.

Avoiding intimacy
NOYES  
1
2
3
4
5
6
30.

Breast pain or tenderness
NOYES  
1
2
3
4
5
6
31.

Vaginal bleeding or spotting
NOYES  
1
2
3
4
5
6
32.

Leg pains or cramps
NOYES  
1
2
3
4
5
6