The MENO-D is a 12-item rating scale designed to assess depression in perimenopausal women. The menopause transition is a time when women experience increased risk for new onset depression and relapse, and research indicates perimenopausal depression may be a distinct subtype of depression with characteristic symptoms.
The MENO-D is designed to measure and rate the severity of perimenopausal depression symptoms over a previous two-week interval, with comparison to their pre-menopausal level (Kulkarni et al., 2018). The scale can be administered as either a self-report measure or be clinician-rated. The MENO-D was developed to address a significant gap in clinical assessment tools, as existing depression measures were designed primarily to capture the cognitive and affective symptoms typical of major depressive disorder. This approach did not adequately assess the characteristic somatic and physical symptoms that are prominent in the clinical presentation of perimenopausal depression. Women experiencing depression during the menopause transition often report pronounced physical complaints including energy depletion, sleep disturbances, somatic pain, weight changes, and sexual dysfunction alongside mood symptoms. These physical manifestations are frequently the presenting concerns in clinical settings, yet their prominence may paradoxically contribute to perimenopausal depression being overlooked or misdiagnosed when assessed with traditional depression scales.
MENO-D Example Item
The menopause transition represents a period of heightened vulnerability for depression in women, with research indicating approximately twice the risk of developing new-onset depression or experiencing relapse during perimenopause (Kulkarni, 2017; Bromberger & Kravitz, 2011). Whilst depression occurring during the menopause transition shares features with major depressive disorder, emerging evidence suggests that perimenopausal depression may constitute a distinct subtype of depression characterised by a unique constellation of symptoms, aetiology, and clinical course (Gibbs et al., 2015).
The scale is comprised of five subscales:
Research examining perimenopausal symptoms has identified the most common complaints as irritability, headache, body ache, sleep disturbance, and joint pain (Jagtap et al., 2016). The MENO-D was specifically designed to capture these physical aspects of perimenopausal depression alongside traditional mood symptoms, addressing the multidimensional nature of distress during this transition.
Clinicians can use the MENO-D for screening, assessment, and monitoring of perimenopausal depression. The scale’s comprehensive coverage of both physical and psychological symptoms makes it particularly valuable for identifying depression in women who may present primarily with somatic complaints. The subscale structure allows clinicians to identify specific symptom domains requiring targeted intervention, whilst the total score provides an overall index of depression severity. The scale can be used to establish baseline symptom profiles, monitor treatment response, and track symptom changes across the menopause transition. For instance, a woman presenting with fatigue and sleep disturbance may complete the MENO-D, revealing elevated scores across multiple domains including isolation and self-esteem difficulties, thereby highlighting the fuller extent of depressive symptoms that might otherwise remain unrecognised.
A total score ranging from 0 to 48 is produced, with higher scores indicating greater severity of perimenopausal depression symptoms. Five subscale scores with differing ranges are also produced:
Subscale scores are expressed as average scores (dividing the raw subscale score by the number of items in that subscale), ranging from 0 to 4, to enable direct comparison across subscales with differing numbers of items.
Severity category score ranges for the total have been established by the scale authors based on clinical experience and observed treatment needs to aid in interpretation (Kulkarni et al., 2018):
On first administration, a bar graph displaying the total raw score and a bar graph showing subscale average scores are presented.
When the assessment is administered multiple times, longitudinal line graphs are generated to track changes in both the total raw score and subscale average scores over time.
Interpretation at the subscale level may also be clinically useful. For example, elevated scores for both Cognitive and Sleep subscales may suggest that reported memory and concentration difficulties are secondary to sleep disruption rather than representing independent cognitive decline. In such cases, interventions that target sleep quality such as addressing night sweats or establishing sleep hygiene may lead to improvements across multiple symptom domains including cognitive functioning.
The MENO-D demonstrates strong construct validity as a measure of perimenopausal depression. The scale’s theoretical foundation aligns with emerging conceptualisations of perimenopausal depression as a distinct subtype characterised by prominent somatic features alongside traditional mood symptoms. Convergent validity is supported by the scale’s ability to capture symptoms that align with established clinical presentations of perimenopausal depression, including the physical complaints frequently reported by women during the menopause transition. Discriminant validity was established through heterotrait-monotrait ratio of correlations analysis, with all values falling below the conservative threshold of .85. This finding confirms that the five subscales measure distinct aspects of perimenopausal depression rather than redundant constructs. Convergent validity was supported by average variance extracted values exceeding .50 for all subscales: Self (.72), Sexual (.71), Somatic (.76), Cognitive (.79), and Sleep (.69). These values indicate that the items within each subscale share substantial common variance, providing evidence of cohesive subscale construction.
The scale exhibits excellent internal consistency across its five subscales, with composite reliability values exceeding the threshold of .70 for all domains. The Self subscale demonstrated a composite reliability of .91, the Sexual subscale .83, the Somatic subscale .86, the Cognitive subscale .88, and the Sleep subscale .82. These values indicate strong internal coherence within each subscale, suggesting that the items comprising each domain measure a unified construct.
Research on the MENO-D has shown positive correlations with related constructs such as menopausal symptom severity and aging anxiety (Aslan & Önal, 2025). The authors also found that scale scores demonstrated negative correlations with health-related quality of life measures, including both physical and mental health components, confirming that perimenopausal depression is associated with diminished overall well-being.
Regarding dimensionality, confirmatory factor analysis was conducted comparing a five-factor model against a single-factor solution. The five-factor model demonstrated superior fit to the data across multiple indices. The model achieved a comparative fit index of .98, a Tucker-Lewis Index of .96, and a root mean square error of approximation of .04, all indicating excellent model fit. These fit indices exceeded those of the single-factor model, which yielded inadequate fit statistics. All item-factor loadings in the five-factor model were statistically significant, with most items demonstrating factor loadings exceeding .70. Importantly, no cross-loadings were observed, confirming clear item assignment to subscales.
Confirmatory factor analysis supported the five-factor structure comprising the Self (paranoid thinking, self-esteem, isolation, anxiety), Sexual (sexual interest, low energy), Somatic (somatic symptoms, weight changes), Cognitive (memory, concentration), and Sleep (sleep disturbances, irritability) subscales.” This theoretically and empirically derived structure meaningfully organises the symptoms of perimenopausal depression into clinically interpretable domains, each reflecting a distinct aspect of the condition.
Severity category cut scores have been established to aid in the interpretation of MENO-D total scores:
The MENO-D is specifically designed for perimenopausal women. Traditional depression scales like the PHQ-9 or BDI-II focus primarily on cognitive and affective symptoms, which may miss the prominent physical complaints that characterise perimenopausal depression, including fatigue, sleep disturbances, somatic pain, and sexual changes. The MENO-D was developed to capture this unique symptom profile.
The MENO-D’s subscale structure provides valuable information for targeting interventions. High scores on the Sleep subscale might indicate a need for sleep hygiene interventions or medical assessment of night sweats, whilst elevated Sexual subscale scores could suggest hormone therapy or relationship counselling may be beneficial.
Even when the total score suggests minimal depression, individual items scored as 3 or 4 warrant attention. The interpretive report flags these high-scoring items to ensure they’re not overlooked. For example, a woman might score low overall but report severe difficulties with self-esteem or sexual interest – symptoms that significantly impact quality of life and deserve therapeutic attention. Item D (self-esteem) is particularly important to examine closely, as the interpretive text specifically flags concerning responses on this item as potentially indicating self-harm risk, necessitating immediate risk assessment regardless of the total score.
The MENO-D asks respondents to rate symptoms in comparison to their pre-menopausal level. This comparative approach helps differentiate new or worsening symptoms from pre-existing conditions. For instance, a woman who has always experienced mild anxiety may report this differently than someone experiencing anxiety for the first time during perimenopause. This baseline comparison supports more accurate diagnosis of perimenopausal depression and helps clinicians understand whether symptoms represent a change associated with the menopause transition or reflect ongoing mental health concerns requiring different treatment considerations.
Kulkarni, J., Gavrilidis, E., Hudaib, A., Bleeker, C., Worsley, R., & Gurvich, C. (2018). Development and validation of a new rating scale for perimenopausal depression—the MENO-D. Translational Psychiatry, 8(1), 123. https://doi.org/10.1038/s41398-018-0172-0
Aslan, B., & Önal, Ö. (2025). Prevalence of depressive symptoms during the menopausal transition in Türkiye: impact of symptom severity, aging anxiety and health-related quality of life. Climacteric, 28(5), 607–615. https://doi.org/10.1080/13697137.2025.2507909
Bromberger, J. T., & Kravitz, H. M. (2011). Mood and menopause: findings from the Study of Women’s Health Across the Nation (SWAN) over 10 years. Obstetrics and Gynecology Clinics of North America, 38(3), 609–625. https://doi.org/10.1016/j.ogc.2011.05.011
Gibbs, Z., Lee, S., & Kulkarni, J. (2015). The unique symptom profile of perimenopausal depression. Clinical Psychologist, 19(2), 76-84. https://doi.org/10.1111/cp.12035
Jagtap, B., Prasad, S., & Srivastava, D. (2016). Study of prevalence, pattern and predictors of psychiatric morbidity in menopausal women. Journal of Mid-life Health, 7(4), 178-182. https://doi.org/10.4103/0976-7800.195695
Kulkarni, J., Gavrilidis, E., Hudaib, A., Bleeker, C., Worsley, R., & Gurvich, C. (2018). Development and validation of a new rating scale for perimenopausal depression—the MENO-D. Translational Psychiatry, 8(1), 123. https://doi.org/10.1038/s41398-018-0172-0
