NEW YORK (Reuters Health) – A high Menopause Rating Scale (MRS) score supports the decision to treat bothersome climacteric symptoms, researchers from Chile report.
“There was no previous study that objectively indicated the need for treatment of climacteric symptoms,” Dr. Juan Enrique Blumel of Universidad de Chile, in Santiago, told Reuters Health by email. “Our study indicates that a score of 14 or more on the MRS questionnaire marks the need for treatment.”
The MRS has been validated in several languages and is the most commonly used instrument for evaluating the severity of symptoms associated with menopause. A total score of 17 indicates “severe symptomatology,” but no cutoff score has been determined to be an objective indication of the need for treatment.
Dr. Blumel and colleagues used MRS data from 500 healthy women aged 40 to 59 years to establish a cutoff score that would allow better decisions regarding the need to start treatment of menopausal symptoms.
The percentage of women who felt they required treatment increased along with their MRS scores and reached 90% in those who considered at least one of their symptoms to be very severe, the researchers report in Maturitas, online February 15.
Symptoms most commonly deemed to require treatment when rated very severe included physical and mental exhaustion, muscle and joint discomfort, and bladder problems, whereas sexual problems, anxiety, and heart discomfort were least frequently considered to require treatment.
ROC curve analysis identified an MRS total score of 14 or more as the optimal cutoff score for defining the need for treatment. This cutoff had a sensitivity of 76.5% and a specificity of 83.6%; 97.1% of women who consider that they require treatment for at least one of their symptoms would be treated on the basis of this cutoff score.
“The presence of a single climacteric symptom with a very severe intensity is associated in almost all women with a score of 14 or more points in the MRS questionnaire, a score that indicates the need for treatment,” Dr. Blumel said.
“Physicians should ask women not only for the classic vasomotor symptoms, but also for the other symptoms that are included in the MRS scale,” he said. “Hot flushes are not the most frequent symptoms in climacteric women; we and other researchers have shown that musculoskeletal discomfort and fatigability are much more frequent and are rarely considered climacteric symptoms.”
Dr. Stephanie S. Faubion from Mayo Clinic’s Office of Women’s Health in Rochester, Minnesota, told Reuters Health by email, “Midlife women in the community have bothersome menopause-related symptoms that are not being addressed. It is also clear that women will say they need treatment when symptoms are severe if we ask them. Asking about these symptoms (hot flashes, night sweats, sleep and mood disturbances, sexual symptoms, vaginal dryness) should be routine for clinicians caring for midlife women.”
“These questions aren’t validated individually (only the total score), so if this is used, the total score should be used,” she said. “It’s interesting that the mood-related scores are more highly correlated with total MRS scores over 14. We have also noted that mood seems to be a strong driver of perceptions about menopause.”
Dr. Faubion added, “We do actually use the MRS in our clinical practice, though I’m in a tertiary care setting in a specialty menopause practice. I do find it useful, but women will tell you when they need treatment if you ask them, which was demonstrated clearly in this study. I don’t think the MRS will make or break decision making for the clinician who is in front of a patient. For research purposes, the MRS is useful for assessing bothersome (clinically meaningful as demonstrated in this study) menopause-related symptoms and for monitoring response to therapies.”
SOURCE: http://bit.ly/2IcCon1
Maturitas 2018.
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