What are the licensed menopause symptom scales researchers use?

The 21-item scale

Developed by a researcher working with a menopause clinic in Glasgow. The original factor-analytic work was published in 1976, and the standard version came in a 1998 paper. It has 21 items covering psychological symptoms (anxiety and low mood), somatic symptoms, vasomotor symptoms, and a sexuality item. Respondents rate each on a four-point scale and the items are summed.

The NIH-funded PhenX Toolkit publishes it as a standard measurement protocol, which is a reasonable sign of how established it is in research use.

The 11-item scale

Developed in Germany in the early 1990s, originally administered by a physician and later revised to be self-administered. It has 11 items across three subscales — psychological, somato-vegetative and urogenital — each rated 0 (no complaints) to 4 (very severe). It has been translated into more than 25 languages. The methodological review in Health and Quality of Life Outcomes is the standard reference.

What a score can and cannot tell you

Both instruments produce a total score, and published papers describe severity bands derived from research populations. It is tempting to read your own number against those bands and conclude something. Please don't, and we won't help you to.

Here is why. A score is a summary of what you reported on a particular day. It is not a diagnosis, it is not a measurement of hormone levels, and the reference ranges come from the specific populations those instruments were standardised on — which may not resemble you. Interpreting a score in the context of your history is clinical work, and it belongs with a clinician.

What a score is genuinely good for is comparison with your own earlier scores. If the same 11 or 21 questions, asked the same way, produce a different total in March than in January, something has changed. That is a real and useful signal, and it is the honest reason to use a standardised instrument rather than a free-text diary.

Licensing, and why HormoneLog uses neither

Both instruments are the intellectual property of their developers and are administered by licensing organisations. The 21-item scale is available to academic researchers without fee, while pharmaceutical companies pay per patient enrolled — there is no published fee tier covering a commercial consumer app. The 11-item scale is free for non-commercial research use and requires contact for commercial licensing. Neither licence covers what HormoneLog is.

HormoneLog implements neither instrument. It uses its own Symptom Burden Index, built on the same clinical domains this field already organises symptoms into, and the word "validated" is never used to describe it — that word describes the published instruments, not an app that mentions them.

The gap this sits in

A 2023 review of menopause apps in BMC Women's Health — which explicitly excluded symptom-tracking apps, focusing on lifestyle and osteoporosis content — found that none of the apps it did review had been formally trialled or tested in peer-reviewed research, and that most lacked any mechanism for sharing data with a healthcare provider or exporting a structured record for clinical use. The same review found average readability sat at around a college-graduate reading level, and that a third of the apps indicated third-party data sharing.

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