How do you know if your symptoms are related to perimenopause? The Greene Climacteric Scale explained

What you will find on this page

Perhaps you have been wondering for a while whether what you are feeling has anything to do with perimenopause. Maybe a doctor has already examined you and found nothing. In both cases, the Greene Climacteric Scale (GCS) can help.

On this page, we explain what the GCS is, what it maps, and what your score means. You will find the questionnaire itself at the bottom. Completing it takes five minutes. Your results will be sent to your email address so you can save them or bring them to a consultation.

The GCS does not make a diagnosis. It is a way to structure what you experience, both for yourself and for a healthcare provider.

In short

• The Greene Climacteric Scale (GCS) is an internationally recognized questionnaire used by doctors and menopause consultants worldwide to map perimenopausal symptoms.
• The standard GCS asks 21 questions across four domains: psychological complaints, physical complaints, vasomotor complaints, and sexual function.
• The modified version that you can fill out on this page has been supplemented with a fifth domain: vulvovaginal complaints. These are complaints that are often (but not always) closely linked to declining estrogen but are rarely discussed.
• A score above 12 generally indicates a significant burden of symptoms, in which case specialist advice is advisable.
• The GCS does not make a diagnosis. It provides structure to the conversation with a healthcare provider.
• You can enter the custom GCS below. Your results will be sent to your email address.

The questions we get most often

Does the GCS make a diagnosis?

No, and that is important to know before you begin. The GCS maps your symptom pattern. A doctor uses your score together with your complete symptom history to arrive at an assessment. The questionnaire is a starting point, not a final judgment.

Can I fill out this questionnaire if my menstruation is still regular?

Yes. This is one of the most common misconceptions about perimenopause. Hormonal fluctuations often begin years before anything changes in the cycle, and the associated symptoms do as well. Therefore, the GCS does not ask about your menstruation. That is deliberate!

What is the difference compared to a blood test?

If you have had a blood test and were told that everything was normal, that is frustrating, but not surprising. During perimenopause, hormone levels fluctuate constantly. A measurement at a single point in time says little about how you feel on a daily basis. The GCS maps your pattern of symptoms over time.

What if my GCS score is low, but I still don't feel well?

Trust that feeling. A low score with persistent symptoms is still a reason to have a conversation with a healthcare provider specializing in perimenopause. A questionnaire has limits. Your experience does not.

What does perimenopause look like in practice?

Perimenopause is the transitional period before menopause. On average, it begins in the early to mid-forties, sometimes as early as age 35. The ovaries begin to produce less estrogen and progesterone. This process is gradual and uneven.

What surprises many women: menstruation can still be completely normal. There is no starting signal, no clear moment when perimenopause begins. That makes it difficult to recognize, for women themselves and for doctors.

Mood swings, sleep problems, joint complaints, heart palpitations, concentration problems. The pattern of symptoms is broad and overlaps strongly with stress and burnout. Women who consult their GP are told that their blood values are normal. That is correct. But it does not tell the whole story.

The GCS is valuable at three moments. If you are just starting to wonder whether what you are feeling has anything to do with perimenopause, it helps to structure your symptoms. If you have already seen a doctor without a clear outcome, it helps to make the conversation more concrete at a subsequent consultation.

What is the Greene Climacteric Scale, and why is it used?

The Greene Climacteric Scale was developed by British researcher JG Greene and is used worldwide by doctors and menopause counselors. It is used in clinical research into perimenopause and in the preparation of consultations.

The questionnaire consists of 21 questions. For each question, you indicate the extent to which you suffer from a specific complaint, on a scale of 0 to 3:

• 0: absent
• 1: occasionally, not bothersome
• 2: often, annoying
• 3: very often, activities are interrupted by it

What the GCS does: it gives language to complaints that you might have found difficult to put into words, and it offers a starting point for the conversation with a healthcare provider.

What does the GCS map?

The questionnaire covers five domains. Some are familiar. Others are surprising.

Psychological complaints

Irritability that seems to come from nowhere. A shorter fuse. A sense of worry about everyday things that doesn't quite fit with who you are. A despondency that isn't exactly depression, but isn't nothing either. These symptoms are rarely immediately linked to hormones, and that is precisely why they remain unnamed for so long.

Physical complaints

Joint pain, headaches, palpitations, dizziness, tingling in the hands or feet. These are the symptoms that most often lead to unnecessary medical examinations, because they are not linked to hormonal fluctuations. They are, in fact, a normal part of the process.

Vasomotor complaints

Hot flashes and night sweats. The best-known symptoms, yet they are often absent in early perimenopause. The absence of hot flashes does not mean you are not experiencing perimenopause.

Sexual function

Changes in libido, reduced arousal, discomfort during sex. Common and treatable. They are rarely discussed spontaneously during a standard GP visit. The GCS identifies them, so that you can identify them too.

Vulvovaginal complaints

Vaginal dryness, irritation, itching, recurrent infections, changes in bladder or urinary function. These symptoms are closely linked to declining estrogen. They are among the most underdiagnosed aspects of perimenopause, and among the most concealed.

Many women walk around with it for years. Not because it doesn't bother them, but because they didn't know it was part of the process, or because they didn't know how to bring it up. Dr. William Declerck, physician and co-founder of Uma, routinely includes this domain in his assessments. Otherwise, it slips the screen too easily and remains untreated.

The GCS does not make a diagnosis and does not replace medical advice. It gives you an overview of what you are experiencing. That is the starting point.

Complete the modified GCS questionnaire

The quiz below is based on the Greene Climacteric Scale, supplemented with the vulvovaginal domain. It takes an average of five minutes to complete. Your results will be sent to your email address so you can save them or bring them to a consultation. If you have a Uma account, you will also find them there.

A completed questionnaire is not a diagnosis. What it is, however, is a concrete starting point for a conversation that would otherwise be difficult to get started.

What your score means

Suppose you get a score of 15. That means you regularly experience symptoms across multiple domains that affect your daily functioning. That is not something to downplay. Nor is it a reason to panic. It is information.

Research associates a score above 12 on the full GCS with a significant symptom burden. Women in this range typically benefit from a conversation with a healthcare provider specializing in perimenopause, someone who takes the time to examine the complete symptom picture.

What the score does most: it provides structure. You no longer walk into a consultation with a vague feeling that is difficult to describe. You have an overview. That makes the conversation more concrete for you and for the healthcare provider.

What now?

Your score is low, but you still don't feel well.

If your symptoms persist but your score is low, that says something about the limits of a questionnaire, not about the validity of what you are experiencing. It may still be perimenopause, but there might be something underlying. In any case, it may be worthwhile to speak with a healthcare provider who views your situation from a perimenopause perspective.

Your score is average

Your symptoms are present and affect your daily life. This is worth discussing in detail. Take your results to a doctor and ask for a full discussion about your symptoms.

Your score is high

Your symptoms are significantly present across multiple domains. You do not have to live with this. Take your results to a doctor familiar with perimenopause. You do not have to start the conversation from scratch; you now have a concrete overview.

Do you not yet have a doctor or healthcare provider to discuss this with? Through Uma, you can find healthcare providers with specific expertise in perimenopause. An intake consultation lasts an average of 30 minutes, and you leave with a plan.

The information on this page is based on peer-reviewed scientific literature and recognized clinical guidelines. The clinical interpretations have been reviewed by Dr. William Declerck, MD.

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3. Rozenberg, S. & Belgian Menopause Society. (2026). Menopause GuidelinesBelgian Menopause Society https://www.menopausesociety.be/wp-content/uploads/2026/01/Richtlijnen-Menopauze_WL_A6_NL_ZONDERPAS.pdf
4. Faubion, SS et al. (2017). Genitourinary syndrome of menopause: management strategies for the clinician. Mayo Clinic Proceedings, 92(12), 1842–1849. https://pubmed.ncbi.nlm.nih.gov/29202940/
5. Gandhi, J. et al. (2016). Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. American Journal of Obstetrics & Gynecology, 215(6), 704–711. https://www.ajog.org/article/S0002-9378(16)30518-X/fulltext

The content of this page is intended for information and does not replace medical advice. Consult a doctor for a personal assessment.