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
 NO YES  
1
2
3
4
5
6
2.

Night sweats
 NO YES  
1
2
3
4
5
6
3.

Sweating
 NO YES  
1
2
3
4
5
6
4.

Dissatisfaction with my personal life
 NO YES  
1
2
3
4
5
6
5.

Feeling anxious or nervous
 NO YES  
1
2
3
4
5
6
6.

Poor memory
 NO YES  
1
2
3
4
5
6
7.

Accomplishing less than I used to
 NO YES  
1
2
3
4
5
6
8.

Feeling depressed, down or blue
 NO YES  
1
2
3
4
5
6
9.

Being impatient with other people
 NO YES  
1
2
3
4
5
6
10.

Feelings of wanting to be alone
 NO YES  
1
2
3
4
5
6
11.

Flatulence (wind) or gas pains
 NO YES  
1
2
3
4
5
6
12.

Aching in muscles and joints
 NO YES  
1
2
3
4
5
6
13.

Feeling tired or worn out
 NO YES  
1
2
3
4
5
6
14.

Difficulty sleeping
 NO YES  
1
2
3
4
5
6
15.

Aches in back of neck or head
 NO YES  
1
2
3
4
5
6
16.

Decrease in physical strength
 NO YES  
1
2
3
4
5
6
17.

Decrease in stamina
 NO YES  
1
2
3
4
5
6
18.

Lack of energy
 NO YES  
1
2
3
4
5
6
19.

Dry skin
 NO YES  
1
2
3
4
5
6
20.

Weight gain
 NO YES  
1
2
3
4
5
6
21.

Increased facial hair
 NO YES  
1
2
3
4
5
6
22.

Changes in appearance, texture or tone of my skin
 NO YES  
1
2
3
4
5
6
23.

Feeling bloated
 NO YES  
1
2
3
4
5
6
24.

Low backache
 NO YES  
1
2
3
4
5
6
25.

Frequent urination
 NO YES  
1
2
3
4
5
6
26.

Involuntary urination when laughing or coughing
 NO YES  
1
2
3
4
5
6
27.

Decrease in my sexual desire
 NO YES  
1
2
3
4
5
6
28.

Vaginal dryness
 NO YES  
1
2
3
4
5
6
29.

Avoiding intimacy
 NO YES  
1
2
3
4
5
6
30.

Breast pain or tenderness
 NO YES  
1
2
3
4
5
6
31.

Vaginal bleeding or spotting
 NO YES  
1
2
3
4
5
6
32.

Leg pains or cramps
 NO YES  
1
2
3
4
5
6