Greene Climacteric Scale — Menopause Symptom Self-Test
Take the validated 21-item Greene Climacteric Scale in 2 minutes. Greene 1998, anchored to NAMS 2022. Free, no signup — answers stay in your browser.
Last updated: Sources verified:
What you are about to take
The Greene Climacteric Scale measures 21 menopausal and perimenopausal symptoms over the past few days. Each item 0-3, total 0-63. Four subscales — psychological, somatic, vasomotor, sexual — show which cluster is driving the picture. About 2 minutes. No signup. John Greene published the scale in Maturitas in 1998 (PMID 9643513) as a clinical tool, and major guidelines (NAMS 2022, ACOG) continue to cite it. Your answers stay in your browser — we never see them. Start the test below ↓
✓ Validated by Greene (1998, Maturitas) ✓ Referenced in NAMS 2022 and ACOG menopause guidance ✓ 2 minutes, 21 questions ✓ Private — answers never leave your device
How the Greene scale is scored
Each of the 21 questions is answered 0 (not at all) to 3 (extremely). Total 0-63. Bands are interpretive, drawn from Greene 1998 percentiles and confirmed against decades of follow-up literature.
| Total score | Band | What the band typically means |
|---|---|---|
| 0-10 | Minimal symptoms | Few or no menopausal symptoms — not necessarily pre-menopause |
| 11-21 | Mild | Early perimenopause pattern — manageable with lifestyle and observation |
| 22-42 | Moderate | Active transition — clinical conversation about MHT or alternatives is reasonable |
| 43-63 | Severe | Substantial disruption — see a clinician soon, MHT or non-hormonal treatment recommended |
The four subscales matter more than the headline number for treatment decisions:
Greene subscales — what each measures
- Psychological (items 1-11, score 0-33) — anxiety items 1-6 (heart racing, tension, sleep, panic, concentration) and depressive items 7-11 (energy, interest, mood, crying, irritability). This subscale is usually the first to elevate in perimenopause.
- Somatic (items 12-18, score 0-21) — dizziness, head tightness, numbness, headaches, joint and muscle pain, loss of sensation, breathing difficulty. Often interpreted as something else (joint pain blamed on age, dizziness on stress) until paired with the vasomotor pattern.
- Vasomotor (items 19-20, score 0-6) — hot flushes and night sweats. The most biologically specific menopausal cluster. Even at score 4-6 with a low total, this signals estrogen fluctuation.
- Sexual (item 21, score 0-3) — loss of interest in sex. Often a mix of estrogen change, sleep loss, mood, and relationship factors. Worth a separate conversation.
When this test is useful — and when it isn’t
Useful for:
- Naming and quantifying experiences that have been hard to discuss
- Tracking change across quarters during MHT or lifestyle changes
- Bringing a structured score to a GP or gynecology visit instead of a vague “I feel off”
Not useful for:
- Diagnosing menopause — that is dated retrospectively, 12 months after the final period
- Distinguishing perimenopause from thyroid disease, depression, or anemia — those need bloods
- Predicting how long the transition will last — Greene measures symptom load, not biological stage
Menopause is a transition, not a disease
Average age of natural menopause in Western countries is 51, but the transition can begin in the early 40s and last 4-10 years. About 75-80% of women experience vasomotor symptoms; about 25-30% rate them as moderate-to-severe and disruptive to daily life (NAMS 2022). The SWAN study (Avis 2015, JAMA Intern Med) found the median duration of moderate-to-severe hot flushes is 7.4 years — much longer than the older ‘few years’ figure.
Modern menopause medicine has moved well past the ‘just push through it’ era. For most women under 60 within 10 years of menopause, MHT is the most effective treatment for vasomotor symptoms, with cardiovascular and bone-density benefits as well. For those who cannot or do not want MHT, non-hormonal options have grown: fezolinetant (an NK3-receptor antagonist) for vasomotor symptoms, low-dose paroxetine, venlafaxine, gabapentin, CBT-Meno for hot flushes and sleep, and vaginal estrogen for genitourinary symptoms (very low systemic absorption, safe for most including many breast cancer survivors).
What to do at each band
- 0-10 (minimal): Nothing required. Retake in 6 months if you are in the perimenopausal age range. Maintain weight-bearing exercise and calcium / vitamin D.
- 11-21 (mild): Identify which items scored 2 or 3 — those are your levers. Sleep hygiene, exercise, alcohol moderation, and a cooler bedroom often drop the score 2-4 points within 2-4 weeks. Mention vasomotor items at your next GP visit.
- 22-42 (moderate): Book a GP or gynecologist visit within 4-6 weeks. Bring the score and the subscale breakdown. Ask about MHT and non-hormonal options. Most women in this band drop 8-15 points within 3 months on effective treatment.
- 43-63 (severe): Book within 2 weeks. If your primary doctor dismisses the symptoms, ask for a referral to a certified menopause specialist (NAMS or local). For most women under 60 within 10 years of menopause, MHT is first-line for severe vasomotor symptoms.
Related tests
- PHQ-9 depression screener — perimenopause raises depression risk 2-4× (Bromberger 2011, Arch Gen Psychiatry)
- GAD-7 anxiety screener — anxiety items on Greene overlap with GAD-7
- BMI calculator — weight gain is common in perimenopause; central adiposity raises cardiovascular risk independently
Sources, verified 2026-05-18
- Greene JG. Constructing a standard climacteric scale. Maturitas 1998;29(1):25-31. (PMID 9643513)
- NAMS / The Menopause Society. The 2022 Hormone Therapy Position Statement. Menopause 2022.
- ACOG. Management of Menopausal Symptoms — Practice Bulletin. American College of Obstetricians and Gynecologists.
- Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med 2015;175(4):531-539. (PMID 25686030)
Privacy
The Greene Climacteric Scale calculation runs entirely in your browser. Your individual answers and the calculated band never leave your device. We send one anonymous event to a privacy-respecting analytics service: your locale code and the band string (for example mild_symptoms). No raw answers, no per-item data, no identifier of any kind.
Frequently asked questions
What does a Greene score of 25 mean?
A score of 25 sits in the moderate band (22-42). Greene 1998 (Maturitas, PMID 9643513) described this range as the level at which most women in his reference cohort sought medical advice. The NAMS 2022 hormone therapy position statement and ACOG menopause bulletin both treat the moderate band as a clinical-conversation threshold — not a wait-and-see one. Bring this number to your GP or gynecologist.
From what Greene score should I consider hormone therapy?
There is no single cutoff. The Greene scale was designed as a symptom map, not a treatment threshold. That said, NAMS 2022 supports menopausal hormone therapy as first-line for moderate-to-severe vasomotor symptoms in women under 60 within 10 years of menopause. If your vasomotor subscale (items 19-20) is 4-6 or your total is in the moderate-severe range and the symptoms disrupt sleep or daily life, that is the conversation to have.
What is the vasomotor subscale and why does it matter?
The vasomotor subscale is items 19 (hot flushes) and 20 (night sweats), scored 0-3 each, total 0-6. Greene 1998 and every menopause guideline since identify these as the most specific menopausal symptoms — psychological items can be explained by life stress, but hot flushes and night sweats are biologically tied to estrogen withdrawal. Even a low total score with vasomotor 4-6 is a clinically meaningful signal.
Natural vs surgical menopause — does the Greene scale differ?
The scale itself does not change, but the interpretation does. Surgical menopause (bilateral oophorectomy) produces a sudden estrogen drop and usually higher Greene scores within weeks, vs the gradual fluctuation of natural perimenopause. NAMS 2022 recommends MHT for women with surgical menopause under 45 unless contraindicated — the cardiovascular and bone-density case is strongest there.
Is hormone therapy safe?
For most women under 60 within 10 years of menopause, yes — and the benefits for symptoms, bone density, and cardiovascular outcomes outweigh the risks (NAMS 2022 position statement; ACOG bulletin). The earlier Women's Health Initiative (WHI 2002) findings overstated risk because the trial cohort was older and a decade past menopause. Modern guidance favors individualized risk-benefit, started in the menopausal transition or early postmenopause.
How long do hot flushes last?
Longer than most people expect. The SWAN study (Avis 2015, JAMA Intern Med, PMID 25686030) followed over 1,400 women across the menopausal transition and found a median total duration of moderate-to-severe vasomotor symptoms of 7.4 years. Women whose hot flushes started in early perimenopause had a median of 11.8 years. This is one of the most-revised numbers in menopause medicine and a strong argument against the 'just push through it' message.
Insomnia during menopause
Sleep disturbance (Greene item 3) is one of the most disabling perimenopausal symptoms. Night sweats fragment sleep mechanically, and estrogen withdrawal independently disrupts sleep architecture. Cognitive behavioral therapy for insomnia (CBT-I) has trial-quality data for menopausal sleep specifically (NAMS 2022). Bedroom 17-19°C, cotton bedding, no alcohol within 3 hours of bed all help.
Menopause and depression
Perimenopause raises the risk of a new depressive episode roughly two- to four-fold compared to premenopausal years (Bromberger 2011, Arch Gen Psychiatry). Greene items 8 (loss of interest), 9 (unhappy/depressed), and 10 (crying spells) overlap with what a PHQ-9 would detect. If those score 2 or 3, take the PHQ-9 too — hormonal change and clinical depression often co-occur and respond best when treated together.
Brain fog in menopause
Real and well-documented. Greene item 6 (difficulty concentrating) captures part of it. Verbal memory in particular dips during the menopausal transition (Maki 2017, Menopause). For most women cognition recovers within a few years post-menopause. MHT may improve cognitive symptoms specifically when started during the transition rather than after — the 'window of opportunity' hypothesis (NAMS 2022).
Sexuality after menopause
Greene item 21 captures loss of interest in sex, but the full picture includes vaginal dryness (genitourinary syndrome of menopause / GSM), pain on intercourse, and changes in arousal. Vaginal estrogen is highly effective for GSM with very low systemic absorption (NAMS 2022) and is safe for most women — including many breast-cancer survivors with their oncologist's input. Lubricants and moisturizers help mechanically.
When to see a menopause specialist?
Most general gynecologists or GPs can manage uncomplicated menopause. Consider a certified menopause specialist (NAMS, British Menopause Society, or local equivalent) if your symptoms are severe (Greene 43+), you have contraindications to standard MHT, you have surgical menopause under 45, or your primary doctor dismisses the symptoms.
SSRIs for vasomotor symptoms — do they work?
Yes, modestly. Paroxetine 7.5 mg is FDA-approved specifically for hot flushes (the only SSRI with that indication). Venlafaxine, escitalopram, and citalopram all reduce vasomotor symptoms by roughly 40-60%, vs roughly 70-80% with MHT (NAMS 2022). They are a reasonable choice when MHT is contraindicated or declined, especially with co-occurring mood symptoms.
Soy and 'natural hormones' — what does the science say?
Soy isoflavones produce a modest reduction in hot flushes (~10-20%, vs ~75% with MHT) in meta-analyses, larger in Asian populations who consume soy from childhood. Compounded 'bioidentical' hormones marketed as safer than pharmaceutical MHT are not — they contain the same hormones, with less quality control. NAMS 2022 specifically recommends against custom-compounded bioidenticals.
Can the Greene scale be wrong?
Like any symptom screen, yes. Recent stress, thyroid dysfunction, depression, sleep apnea, or anemia all produce overlapping symptoms. A high Greene score is a starting point for a clinical conversation, not a diagnosis. Conversely, a low score does not rule out menopausal transition — the scale measures symptoms over the last few days, not where you are biologically.
Is my data private?
Yes. The Greene Climacteric Scale runs entirely in your browser. Your individual answers never leave your device. We log one anonymous event with the band string (e.g. `mild_symptoms`) — no raw answers, no IP, no identifier of any kind.
Sources
- Constructing a standard climacteric scale — Greene JG — Maturitas (1998) (peer reviewed, retrieved 2026-05-18)
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society — NAMS / The Menopause Society (Menopause 2022; updated guidance through 2023-2024) (guideline, retrieved 2026-05-18)
- Management of Menopause — ACOG Practice Bulletin — ACOG — American College of Obstetricians and Gynecologists (guideline, retrieved 2026-05-18)
- Duration of menopausal vasomotor symptoms over the menopause transition (SWAN study) — Avis NE, Crawford SL, Greendale G, et al. — JAMA Intern Med (2015) (peer reviewed, retrieved 2026-05-18)