What happens in a menopause assessment, and the Greene Climacteric Scale

Knowing what an assessment involves takes some of the uncertainty out of booking one. A menopause assessment is a structured conversation built around your symptoms, your history, and what you want from treatment, plus a couple of safety checks.

This article walks through each step, including the symptom questionnaire we use and why a number is more useful than it sounds.

Before the appointment: the questionnaire

Care starts before you see anyone, with an online form. It captures your symptoms, your menstrual history, what you have tried before, and a set of safety questions. Filling it in at your own pace, rather than trying to remember everything in a short appointment, means the clinician opens your consultation already knowing your picture, so the time you have together is spent on you rather than on form-filling.

The Greene Climacteric Scale

Part of that form is the Greene Climacteric Scale, a validated questionnaire used in menopause clinics worldwide. It asks you to rate twenty-one symptoms across five areas: anxiety, low mood, physical symptoms, vasomotor symptoms like flushes, and sexual symptoms. The result is a score, from zero to sixty-three, that captures how you are across all five domains at once.

The value of a number is that we can repeat it. By scoring you at the start and again at every review, we can see what is changing and where, for example flushes settling while sleep lags behind. That is far more reliable than trying to remember in March how you felt in January, and it stops a dose being left too low simply because progress is hard to recall.

The conversation

The consultation itself, by video, phone, or in person, goes through how your symptoms affect daily life, your menstrual pattern, your medical and family history, and your own preferences, including any worries about HRT. There is no script you need to prepare; the questionnaire has done the groundwork. This is also where we talk honestly about whether HRT is the right route for you, or whether a non-hormonal approach fits better.

The safety checks

Two checks matter before starting systemic HRT. The first is your blood pressure, which must be known and acceptable; in person we measure it there and then, and remotely we use a recent home or pharmacy reading or arrange one. The second is a short safety screen for things that change the decision, such as a history of breast cancer, blood clots, unexplained bleeding, or migraine with aura. Blood tests are not usually needed to diagnose menopause over forty-five, and where they do add something the clinician will arrange the right ones.

What you leave with

You finish with a plan: whether HRT is suitable, which type and form if so, or a non-hormonal plan if that fits better, along with written information on what to expect and when. You will know your baseline Greene score and when your first review will be, usually around three months in, because the first prescription is a starting point to refine, not a final answer.

After your assessment: reviews and adjustments

The assessment is the start of a process, not a one-off. The first review usually comes at around three months, because that is long enough to judge the effect: flushes and sweats often ease within a few weeks, while sleep, mood and energy take longer. At that review we repeat the Greene score, check your blood pressure, ask about any side effects, and adjust the dose or form if needed. Mild breast tenderness, bloating or irregular bleeding in the first few months is common and usually settles.

After things have settled, reviews move to roughly once a year, covering symptoms, blood pressure, your screening status, and whether continuing still makes sense for you. The aim is a treatment that keeps pace with you rather than one that is set once and forgotten.

Coming prepared

You do not need to do much, but a few things help: a note of your worst symptoms, the dates or pattern of your recent periods, a recent blood pressure reading if you have one, and a list of any medicines you take. If you have tried HRT before, knowing what it was and how it went is useful. Everything else, we will ask.

Ready to start?

If you want to move from reading to acting, the next step is a short assessment with a doctor on the GMC GP Register. It takes about ten minutes and tells you whether HRT is right for you.

Begin your assessment at this link. Online or in person at Westfield London.