Reference values of the MRS in the “normal population”
Understanding the MRS score requires some background understanding of the prevalence of climacteric complaints or problems in the background population. Initial standardized values and definitions for the MRS were published as a single table 2. These values were based on the German population.
Are these reference values applicable to other countries/cultures?
Mean values (SD) of the MRS total score and the three domains are depicted in the attached table.
The mean values of the total score and the 3 domain scores do not show a statistically significant difference between populations. Therefore, there is no evidence to exclude direct comparisons of MRS values between Europe and the USA.
However, the total psychological and somatic scores were systematically higher in Latin America and systematically (significantly) lower in Asia (Indonesia) than in Europe/North America. The urogenital scores were significantly lower in Latin America/Indonesia than in Europe/US. It is unclear whether the symptoms and pathophysiology differ across groups or if the subject perception of some symptoms varies due to cultural factors. However, a direct comparison of MRS scores between Europe/North America on the one side and regions in Latin America and Asia should be considered cautiously.
How are mean values affected by country and culture?
Mean values also show a different distribution across the four categories of complaint severity (no symptoms, mild, moderate, and severe symptoms) depending on where the scale is used. The attached table shows the prevalence of symptoms populating the four severity scores by region. The comparison of the prevalence (and 95% confidence interval) showed that the above-discussed differences between Europe/US and Latin America or Indonesia very much depend on the severity of complaints.
When the data is analyzed by sub-domain, differences seen in the psychological domain appear less impressive. The urogenital and somatic domains show the largest differences across regions. It is unclear whether this is due to different perceptions of identical symptoms, differences in the appearance of symptoms, or both. However, it needs to be considered when direct comparisons among different cultures are intended.
The prevalence of different “degrees of severity” of menopausal symptoms measured with the MRS was found to be almost identical in the aggregate of Europe and North America.
Intra-individual comparisons
Differences between regions, however, do not affect intra-individual comparison (e.g., pre-/post- therapy), and it may also have minimal effect on the comparison of time-related changes between countries. Although definitive research on this topic is missing.
2. Potthoff P, Heinemann LAJ, Schneider HPG, Rosemeier HP, Hauser GA. Menopause-Rating Skala (MRS): Methodische Standardisierung in der deutschen Bevölkerung. Zentralbl Gynakol 2000; 122:280-286.
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