Transcranial Electrical Stimulation for Noninvasive Study of Menopausal/Perimenopausal Symptoms

Depression

Menopause related depression will be queried using the Menopause Depression Rating Scale (Meno-D) questionnaire as well as the CES-D inventory prior to and at the end of each arm. The Meno-D is a 12-item self-report or clinician-rated scale specifically developed to assess depression during the perimenopausal transition. It captures unique symptom clusters such as irritability, memory issues, low energy, and somatic complaints not typically addressed in general depression scales. The minimum score is 0 and the maximum is 48 points.Between 20-24 points is considered to denote mild perimenopausal depression, needing onward monitoring. Between 24-32 points suggests moderate perimenopausal depression needing treatment. At 32 points and above, the woman is considered to have severe perimenopausal depression needing treatment.

Sleep Quality

Sleep quality will be measured using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is a widely used self-report questionnaire that assesses overall sleep quality and disturbances over the past month. It includes 19 items grouped into seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Total global score ranges from 0 to 21. Higher scores indicate poorer sleep, with a total score above 5 suggesting significant sleep impairment.

Menopause Quality of Life

Quality of life will be measured using the Menopause rating scale (MRS) survey. The MRS is a validated, self-administered tool designed to assess health-related quality of life in midlife women. It measures the severity of 11 common menopausal symptoms across three domains: psychological, somato-vegetative, and urogenital to evaluate symptom burden and changes over time, including before and after treatment. Scores range from 0 to 44 with 0 being no menopausal symptoms and 44 being severe menopausal symptoms.

Center for Epidemiological Studies-Depression Inventory (CES-D)

General depressive symptoms will be measured with the Center for Epidemiological Studies-Depression Inventory (CES-D). The CES-D is a 20-item self-report measure designed to assess depressive symptoms experienced over the past week. Items cover mood, somatic complaints, and interpersonal difficulties, with responses rated on a 4-point scale. Higher total scores reflect more severe depressive symptoms, with a score of 16 or above suggesting risk for clinical depression. The scale ranges from a minimum of 0 (indicating very low depression) to a maximum of 60 (indicating high depressive symptoms).

Pain Catastrophizing Scale

Measures of catastrophic thinking related to pain will be measured with the Pain Catastrophizing Scale (PCS). The PCS is a 13-item self-report questionnaire widely used self-report tool that measures catastrophic thinking related to pain. It assesses three domains-rumination, magnification, and helplessness based on thoughts and feelings about pain, even when not currently in pain. Total scores range from 0-52, where higher scores indicate greater catastrophizing; a total score above 30 indicates a clinically significant level.

Impulsive Behavior Scale

Measures of impulsivity will be measured with the UPPS Inventory. The UPPS is a 59-item self-report questionnaire developed to assess four distinct facets of impulsivity: urgency, lack of premeditation, lack of perseverance, and sensation-seeking. Grounded in the Five Factor Model of personality, it integrates items from multiple established impulsivity scales. Responses are rated on a 4-point Likert scale, with higher scores indicating greater impulsive tendencies. Higher scores indicate greater impulsivity, with subscale minimums/maximums ranging from 4 to 16.

Brief Pain Inventory

Daily pain severity will be measured with the Brief Pain Inventory (BPI). The BPI is a self-report questionnaire assessing pain severity and its interference with daily functioning. Respondents rate pain intensity (worst, least, average, current) and interference with activities (e.g., mood, work, sleep) on 0-10 scales. Scores yield severity and interference indices, with higher values indicating greater pain impact. The BPI demonstrates strong reliability, validity, and sensitivity across diverse clinical populations.

Electromyography Recording

High density electromyography (HD-EMG) will be recorded in response to transcranial electrical stimulation (TES) throughout the study period. HD-EMG and/or bipolar EMG electrodes will be placed on the participant's limbs or torso muscles to record resulting activity. EMG activity is recorded in microvolts and resulting motor evoked potentials (MEPs) will be quantified in terms of changes in amplitude (root mean square ratio), shape, and latency.