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Menopause Rating Scale (MRS) Assessment
Name
*
Email
*
Age (Years)
*
A standardized screening tool to evaluate the severity of perimenopause and menopause symptoms. This form is confidential and does not replace a clinical diagnosis.
Which statement best describes your current menstrual cycle?
*
Which statement best describes your current menstrual cycle?
A
My periods are regular and have not changed significantly.
B
My periods have become irregular, skipped, or changed in flow over the past 12 months.
C
I have not had a period for 12 consecutive months or longer.
D
I have had a hysterectomy or medical procedure that stopped my periods.
Are you currently using any of the following to manage your symptoms?
*
Are you currently using any of the following to manage your symptoms?
None
Hormone Replacement Therapy (HRT)
Herbal or over-the-counter supplements
Prescription non-hormonal medications
Dietary and lifestyle changes
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