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THE MENOPAUSE SYMPTOM INDEX - MENSI
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The questions should be asked, “In the last month did you experience . . . ?”
Indicate the response by circling the response:
0 = No, 1 = Occasionally, 2= Yes, on a regular basis.
The reply to the second part of the questions, “Is it a real problem for you?” should be indicated by circling Y for Yes or N for No. |
In the last month,
did you experience... |
No |
Occasionally |
Yes |
Is it a real
problem for you? |
| 1. Hot or warm flashes? |
0 |
1 |
2 |
Y |
N |
| 2. Palpitations? |
0 |
1 |
2 |
Y |
N |
| 3. Headaches? |
0 |
1 |
2 |
Y |
N |
| 4. Sleep disturbance? |
0 |
1 |
2 |
Y |
N |
| 5. Chest pressure or pain? |
0 |
1 |
2 |
Y |
N |
| 6. Shortness of breath? |
0 |
1 |
2 |
Y |
N |
| 7. Numbness? |
0 |
1 |
2 |
Y |
N |
| 8. Weakness or fatigue? |
0 |
1 |
2 |
Y |
N |
| 9. Pain in bone joints? |
0 |
1 |
2 |
Y |
N |
| 10. Memory loss? |
0 |
1 |
2 |
Y |
N |
| 11. Anxiety? |
0 |
1 |
2 |
Y |
N |
| 12. Depression? |
0 |
1 |
2 |
Y |
N |
| 13. Fear of going out of the home? |
0 |
1 |
2 |
Y |
N |
| 14. Loss of urinary control? |
0 |
1 |
2 |
Y |
N |
| 15. Vaginal dryness? |
0 |
1 |
2 |
Y |
N |
| 16. Loss of sexual desire? |
0 |
1 |
2 |
Y |
N |
| 17. Pain with intercourse? |
0 |
1 |
2 |
Y |
N |
| 18. Disrupted function: Home? |
0 |
1 |
2 |
Y |
N |
| 19. Disrupted function: Work? |
0 |
1 |
2 |
Y |
N |
| 20. Other symptons: |
0 |
1 |
2 |
Y |
N |
| MENSI SCORE (0-38): |
Number of Yes Answers: |
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The Menopause Symptom Index can be used to assess a woman’s symptoms and the degree to which they affect her quality of life (QOL). A total score of 12 or more from the first three columns indicates that clinical intervention should be strongly considered; the clinician should look at the total number of “yes” answers on the right side to gauge how treatment will affect patient’s perception of her QOL.
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