The Greene Climacteric Scale (GCS)
A 21-item questionnaire that captures the symptoms that occur in perimenopause.
Provided by
EVAL FoundationInstructions
The Greene Climacteric Scale provides a brief measure of menopause symptoms. It can be used to assess changes in different symptoms, before and after menopause treatment. This questionnaire asks about symptoms you may have experienced over the past month.
For each of the 21 questions, please select the answer that best describes how much you have been bothered by that symptom.
- Select 'Not at all' if the symptom has not been present.
- Select 'A little', 'Quite a bit', or 'Extremely' to indicate the severity of the symptom.
The Greene Climacteric Scale (GCS)
- This questionnaire asks about symptoms you may have experienced over the past month.
- For each of the 21 questions, please select the answer that best describes how much you have been bothered by that symptom.
Purpose and Use
The Greene Climacteric Scale (GCS) is a standardized self-report questionnaire designed to measure the severity of symptoms commonly experienced by women during perimenopause and menopause. Developed by Dr. John G. Greene in 1976, it is widely used in clinical practice and research to assess the impact of menopausal symptoms on a woman's well-being and to evaluate the effectiveness of treatments. The GCS was developed based on factor analysis of symptoms reported by women in the climacteric period. Its structure and use are well-documented in medical literature.
The Greene Climacteric Scale is a twenty-one–item, self-administered questionnaire that captures the symptoms that occur in perimenopause. Each item is rated on a Likert-style scale from “Not at all” (0) to “Extremely” (3). Scores can be derived in six symptom categories: Psychological, Anxiety, Depressed Mood, Vasomotor, Somatic, and Sexuality.
Scale Composition and Scoring
The scale consists of 21 items. The respondent rates how much she has been bothered by each symptom over the past month on a 4-point Likert scale:
- 0 = Not at all
- 1 = A little
- 2 = Quite a bit
- 3 = Extremely
The total score is calculated by summing the scores for all 21 items, with a possible range from 0 to 63. Higher scores indicate greater symptom severity.
Subscales
The items are grouped into subscales to provide a more detailed assessment of different symptom clusters:
- Psychological (11 items): This is the largest subscale and is further divided into two components:
- Anxiety (items 1-7): e.g., feeling tense or nervous, difficulty in concentrating, feeling tired or lacking in energy.
- Depression (items 8-11): e.g., crying spells, loss of interest in most things.
- Somatic (7 items): These are general physical symptoms (items 12-18), such as headaches, breathing difficulties, and dizziness.
- Vasomotor (2 items): This subscale specifically addresses hot flushes (item 19) and sweating at night (item 20).
- Sexual Function (1 item): This consists of a single item, 'loss of interest in sex' (item 21), and is often analyzed separately.
Scores are calculated for each subscale by summing the relevant item scores. This allows for a nuanced understanding of the patient's primary complaints, whether they are psychological, physical, or vasomotor in nature.
Interpretation
While there are no universally established cutoff scores, the total score and subscale scores provide a quantitative measure of symptom severity. A higher score on a particular subscale suggests that the symptoms in that category are most troublesome for the individual. The scale is valuable for initiating discussions about treatment options and for tracking symptom changes over time in response to therapy.
All questions & possible results
The Greene Climacteric Scale (GCS)
- This questionnaire asks about symptoms you may have experienced over the past month.
- For each of the 21 questions, please select the answer that best describes how much you have been bothered by that symptom.
1. Heart beating quickly or strongly
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
2. Feeling tense or nervous
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
3. Difficulty in sleeping
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
4. Excitable
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
5. Attacks of anxiety, panic
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
6. Difficulty in concentrating
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
7. Feeling tired or lacking in energy
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
8. Loss of interest in most things
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
9. Feeling unhappy or depressed
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
10. Crying spells
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
11. Irritability
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
12. Feeling dizzy or faint
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
13. Pressure or tightness in head or body
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
14. Parts of body feel numb or tingling
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
15. Headaches
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
16. Muscle and joint pains
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
17. Loss of feeling in hands or feet
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
18. Breathing difficulties
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
19. Hot flushes
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
20. Sweating at night
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
21. Loss of interest in sex
Select one option:
- Not at all
- A little
- Quite a bit
- Extremely
Possible results
Psychological Score
- This score reflects the severity of psychological symptoms such as anxiety, depression, and irritability.
- A higher score indicates more severe symptoms.
- Represents questions # 1-11.
According to Menopause Matters, Dr, Anita Houghton states, “Psychological and emotional symptoms are common around the menopause, but the causes are complex. Anxiety, depression, sadness, difficulty concentrating, overreacting to minor upsets, anger and irritability, forgetfulness and mood swings are all typical psychological problems. Hormonal changes are thought to be responsible for a proportion of these symptoms, but it is hard to be certain which symptoms are hormonal in origin, and which are due to other changes in a woman’s life around that time.”
Please discuss with your health care provider. Further assessment may still be needed depending on your clinical presentation.
Menopause Matters. (n.d.). Psychological symptoms. Retrieved [February 5, 2026], from https://www.menopausematters.co.uk/psychological.php
Total GCS Score
Please discuss with your health care provider. Further assessment may still be needed depending on your clinical presentation.
- This score reflects the severity of all psychological, somatic (physical) and vasomotor symptoms
- A higher score indicates more severe symptoms and may reflect low estrogen/progesterone.
- Studies have shown that women who score over 12 on the GCS are more likely to be menopausal but a lower score does not rule out a menopause transition.
Medical Disclaimer & Terms of Use
- This assessment is for educational and informational purposes only. It is not a diagnostic tool and does not constitute medical advice, a professional diagnosis, an opinion, or a plan of treatment.
- Consult Your Doctor: The results of this electronic assessment are intended to be a starting point for a conversation with a qualified healthcare professional. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
- No Doctor-Patient Relationship: Use of this electronic tool does not create a doctor-patient relationship between you and the developers of this assessment. If you are experiencing a medical emergency, please stop and call your local emergency services or go to the nearest emergency room immediately.
- Accuracy of Data: By using this tool, you acknowledge that self-reported data is subjective. While this assessment utilizes validated scoring logic (such as the FSFI or DSDS), the interpretation of these scores requires clinical context that can only be provided by a licensed medical provider.
Sexual Dysfunction Score
- This score reflects the severity of loss of interest in sex.
- A higher score indicates a more significant loss of interest.
- A score > 1 may indicate a testosterone deficiency.
- Represents question 21.
Somatic (Physical) Score
- This score reflects the severity of physical (somatic) symptoms like headaches, dizziness, and palpitations.
- A higher score indicates more severe symptoms.
- Represents questions 12-18
Vasomotor Score
- This score reflects the severity of vasomotor symptoms, specifically hot flushes and night sweats.
- A higher score indicates more severe symptoms.
- A vasomotor score > 4 may indicate an estrogen deficiency.
- Represents questions 19-20
Depressed Mood Score
- This score reflects your level of depressed mood
- A higher score indicates more severe symptoms
- A depressed mood score > 9 may indicate you are clinically depressed
- Represents questions 7-11
Anxiety Score
- This score reflects your anxiety level
- A higher score indicates more severe symptoms
- An anxiety score > 9 may indicate clinical anxiety and a progesterone deficiency.
- Represents questions 1-6
Citation
Greene JG. A factor analytic study of climacteric symptoms. J Psychosom Res. 1976;20(5):425-30. doi: 10.1016/0022-3999(76)90005-2. PMID: 1003364.
Literature
- A factor analytic study of climacteric symptoms. J Psychosom Res. 1976;20(5):425-30. doi: 10.1016/0022-3999(76)90005-2. PMID: 1003364. — Greene JG.
- Correlates of palpitations during menopause: A scoping review. Women’s Health, 18. https://doi.org/10.1177/17455057221112267 — Carpenter, J. S., Sheng, Y., Pike, C., Elomba, C. D., Alwine, J. S., Chen, C. X., & Tisdale, J. E. (2022)
- Assessment of the climacteric syndrome: A narrative review. Archives of Gynecology and Obstetrics, 304(4), 855–862. https://doi.org/10.1007/s00404-021-06139-y — Sourouni, M., Zangger, M., Honermann, L., Foth, D., & Stute, P. (2021).
