Peri-SS shows reliability for tracking perimenopause symptoms

A 16-item instrument built to measure perimenopause symptom burden through digital self-assessment performed reliably and validly among women aged 35 to 59 years in the United States, according to a validation study published in Menopause.

The investigators noted that existing tools, including the Menopause Rating Scale (MRS), were designed around postmenopausal women and paper-based administration. Those tools often leave out symptoms that tend to surface during perimenopause, such as digestive issues and sexual health concerns. The Perimenopause Symptom Scale (Peri-SS) was created to fill that gap.

How was the Peri-SS developed and tested?

Gynecologists who specialize in perimenopause and menopause care proposed an initial pool of 25 items. Exploratory factor analysis in a separate sample of 948 women in the United States who self-reported as perimenopausal trimmed the pool to 16 items across 4 domains: vasomotor symptoms (2 items), psychological and emotional stress (5 items), sexual health (3 items), and physical and somatic changes (6 items). Patients rate each item from 0 (none) to 4 (very severe) based on the past 30 days, and the total score is scaled from 0 to 100.

For the validation cohort, the team recruited 1255 women through the online research platform Prolific between February 27 and March 16, 2025; 633 of them self-identified as perimenopausal. Participants completed the Peri-SS, the MRS, and the EuroQol 5-Dimension, 5-Level (EQ-5D-5L) questionnaire at baseline and again 7 to 14 days later, with analyses following COSMIN guidelines.

Reliability, validity, and responsiveness

Among perimenopausal participants, confirmatory factor analysis supported the 4-domain structure (CFI = 0.932, RMSEA = 0.069). Internal consistency was excellent overall (standardized Cronbach α = 0.90), ranging from 0.73 in the vasomotor domain to 0.86 in the psychological domain. In the 552 participants who completed both surveys within the 7- to 14-day window, test-retest reliability for the total score was high, according to the findings (ICC = 0.82; 95% CI: 0.70-0.88).

Peri-SS scores tracked closely with MRS total scores (Pearson r = 0.88, P < 0.001) and moved in the opposite direction from EQ-5D utility values (Spearman ρ = −0.50, P < 0.001), meaning greater symptom burden accompanied poorer health-related quality of life. Scores also differed by age group (χ² = 31.4, P < 0.001), with women aged 45 to 54 years reporting greater burden than those aged 35 to 44. They differed by reproductive stage as well (χ² = 71.2, P < 0.001), with perimenopausal participants scoring higher than premenopausal participants and those unsure of their stage.

“These results show that Peri-SS outperformed MRS in reliability among women who self-identified as perimenopausal,” the authors stated in Menopause.

The scale picked up symptom changes over the short follow-up. Participants whose MRS scores improved (n = 195) saw Peri-SS scores fall by a mean of −9.5 points (SD = 8.9). Those who worsened (n = 42) had a mean increase of +8.1 points (SD = 8.7), a large effect size overall (η² = 0.277).

The authors acknowledged several limitations:

• Online recruitment limits generalizability to people with lower digital literacy or limited internet access.
• Reproductive stage was self-reported rather than clinically confirmed.
• Headache, fatigue, and brain fog were dropped during development because of poor psychometric performance, and menstrual cycle changes are not a scored domain.
• The scale has been validated only in English among participants in the United States.

Overall, the authors concluded that the “Peri-SS is a reliable, valid, responsive tool for assessing perimenopausal symptom burden. Its concise format and strong psychometric performance make it well-suited for research, clinical care, and digital health applications.”

Reference:

Xu Y, Ilyich I, Prentice C, et al. Validation of the Perimenopause Symptom Scale (Peri-SS) for digital self-assessment: psychometric evaluation among US women aged 35 to 59 years. Menopause. 2027;34(12). doi:10.1097/GME.0000000000002948