Self-report Measures
Tools that assess hotflashes via participant self-report can be categorized into three
categories: (1) symptom scales based on retrospective reporting over weeks and/or
months, (2) daily diaries typically completed retrospectively at the end of the day,
and (3) hotflash reports provided via diaries or event markers at the time of the
event.
Symptom Scales
Initial investigations into hotflashes primarily involved symptom scales, which
assess hotflash frequency, severity, or perceived bother retrospectively over the last
2 or 4 weeks. Given their minimal participant burden, ease of administration, and
low cost, these symptom scales are commonly used in large epidemiological trials.
In these scales, hotflashes are typically assessed as one factor of the larger construct
of menopausal symptomology. Many large epidemiologic studies have developed
their own symptom scales (e.g., the Women’s Health Initiative:http://www.nhlbi.
nih.gov/whi/; the Study of Women’s Health Across the Nation:www.swanstudy.
org). Others use published scales such as the Greene Climacteric Scale, in which
bother associated with hotflashes (vasomotor symptoms) is assessed as one factor
of a constellation of menopausal symptoms [psychological and somatic symptoms
being the other factors (Greene 1976 )]. Other common menopause symptom
questionnaires assessing hotflashes include the Kupperman Index (Kupperman
et al. 1953 ), the Women’s Health Questionnaire (Hunter 1992 ), the Menopause
Symptom Checklist (Perz 1997 ), the Menopause Rating Scale (Hauser et al. 1994 ),
and the Everyday Complaint List (Avis et al. 1993 ). Yet other questionnaires
specifically assess the impact of hotflashes on daily activities and/or quality of life,
such as the Hot Flash Related Daily Interference Scale (HFRDIS; Carpenter 2001 )
and the Menopause Quality of Life Scale (Hilditch et al. 1996 ).
Although these symptom scales are low cost, simple to analyze, and associated
with minimal participant burden, they do have limitations. Many of these scales
lack psychometric data. They variously inquire about hotflash frequency, severity,
or bother. Additionally, these measures require women to recall their symptoms
over weeks or months, a process which typically involves women reconstructing
their hotflash experience (Bradburn et al. 1987 ; Stone and Shiffman 2002 ). In fact,
research indicates that people tend to estimate a base rate based on a small epoch of
time and then extrapolate those results to the time period queried (Bradburn et al.
1987 ). Additionally, although these scales have the advantage of low cost, minimal
subject burden, and high face validity, these measures’typically unidimensional
assessment of the hotflash experience (i.e., frequency, severity, or bother) and the
heterogeneity of measures used in the literature limit comparisons between studies
(Crawford 2007 ). Furthermore, symptom scales run the risk of reporting bias,
236 W.I. Fisher and R.C. Thurston