The 21-item Australasian Menopause Society (AMS) symptom score, in its current Modified Greene Scale revision. Scores the four symptom groups so you can see which is doing the most work, and track change over time.
The current AMS card (February 2025) is titled Symptom Score (Modified Greene Scale). The AMS says plainly it can be used to document symptoms and monitor response to treatment, and should not be used to diagnose perimenopause or menopause. The symptoms listed are not necessarily oestrogen deficiency symptoms — so a high score is a reason to talk, not to prescribe.
Where a cut-off comes from: the AMS’s earlier Diagnosing Menopause information sheet described a score of 15 or over as “usually indicates oestrogen deficiency that is intrusive enough to require treatment, but this is only a guideline”, with scores of 20 to 50 common in symptomatic women. On adequate treatment the score was expected to roughly halve by 2–3 months and drop to 10 or under by 3–6 months. We include that history as context, not as a line in the sand — the current card does not publish any threshold.
The AMS groups the symptoms into vasomotor (hot flushes, light-headed feelings, headaches), psychological (brain fog, irritability, depression, feeling unloved, anxiety, mood changes, sleeplessness, unusual tiredness), locomotor (backache, joint pains, muscle pains) and urogenital (less sexual feelings, dry vagina, uncomfortable intercourse, urinary frequency). New facial hair, dry skin and crawling feelings under the skin sit in an “other” group because they are commonly reported but not always oestrogen-driven.
The AMS teaching is: “If one group does not respond to HRT, look for other causes and specific treatments for that group.” Depression, anaemia and hypothyroidism are the most common conditions that mimic or occur alongside menopausal symptoms — hair loss, for example, may be iron deficiency or thyroid, not menopause.
For most women with symptoms at the normal age for menopause (over 45) the AMS Diagnosing Menopause sheet says FSH, LH, oestradiol and testosterone levels should not be checked, because the results are unlikely to change management: “the indications for intervention are clinical.” The one time FSH is helpful is suspected premature menopause (under 40) — measured on day 2 or 3 of a cycle, to differentiate from other causes of secondary amenorrhoea.
A simple work-up for alternative diagnoses is often helpful — a full blood count, iron studies and ferritin, and a TSH will usually catch the common mimics (anaemia, hypothyroidism).
The AMS suggests the score is well suited to monitoring response: “Generally there is a halving of the symptom score after 2–3 months on HRT, and if the woman is still experiencing a lot of symptoms, she may require a dose increase. If symptoms still persist, changing from the oral route to transdermal may help if the problem is oestrogen malabsorption.”
Use the Save today’s score button to keep a timeline on your own device — a before-treatment baseline, then follow-ups at 2–3 months and 6 months are the pattern the AMS describes. The Email to my GP and Copy buttons produce a short summary with the total, the four category scores and the date.