Tool type
Symptom signal check
Not a medical device
Regulatory scope
Outside MHRA Class I
Educational framing only
This page documents the methodology behind SUMM's symptom signal check. It explains the 15 questions, the scoring logic, the clinical frameworks used, and the regulatory position.
The 15 questions and how they are scored
Each question targets a specific symptom dimension. The evidence basis column explains why that question exists and which clinical framework informs the scoring weight.
| # | Question | Screens for | Evidence basis |
|---|---|---|---|
| 1 | How old are you? | Age-based risk | STRAW+10 staging (perimenopause typically 38–55, thyroid risk increases 40+) |
| 2 | Energy levels | Fatigue type | Burnout: improves with rest (Maslach 2016). Hormonal/thyroid: persistent regardless (EMAS 2024, NICE NG23) |
| 3 | Sleep | Disruption type | Physical waking = vasomotor = perimenopause (NICE NG23). Racing thoughts = burnout. Excessive unrefreshed = hypothyroid (EMAS 2024) |
| 4 | Temperature | Regulation | Feeling cold = hypothyroid hallmark (EMAS 2024). Hot flushes = perimenopause. Critical differentiator. |
| 5 | Weight | Changes pattern | Abdominal gain = perimenopause (STRAW+10). Whole body puffy = hypothyroid. Loss while eating = hyperthyroid (EMAS 2024) |
| 6 | Mood | Type of change | Situational anxiety = burnout (Maslach 2016). Unprovoked anxiety/rage = perimenopause (MRS). Jittery = hyperthyroid (EMAS 2024) |
| 7 | Cognition | Fog type | Workload-tied = burnout. Consistent = perimenopause or hypothyroid. Processing slowness = hypothyroid (EMAS 2024, Maki 2024) |
| 8 | Periods | Cycle changes | Heavy = early perimenopause (STRAW+10). Light/missed = later perimenopause or thyroid. Both conditions affect cycle (EMAS 2024) |
| 9 | Hair and skin | Changes | Hair + dry skin + cold = hypothyroid triad (EMAS 2024, ATA guidelines). Perimenopause causes milder changes. |
| 10 | Palpitations | Type | Hot flush-associated = perimenopause vasomotor (NICE NG23). Frequent + tremor = hyperthyroid (EMAS 2024). Stress-linked = burnout. |
| 11 | Appetite/weight | Combined | Eating more, losing weight = hyperthyroid. No appetite, gaining = hypothyroid. Sugar cravings = perimenopause (STRAW+10) |
| 12 | Stress relationship | KEY DIFFERENTIATOR | Improves on holiday = burnout (Maslach 2016). Does not improve = hormonal/thyroid. Cyclical = perimenopause (STRAW+10) |
| 13 | Physical symptoms | Specific markers | Vaginal dryness = perimenopause (Monash/Lancet 2025). Constipation = hypothyroid. Throat = thyroid investigation. |
| 14 | Nutrition | Deficiency screen | Iron, D, B12 deficiency mimic burnout and perimenopause. NICE differential diagnosis guidance. |
| 15 | Blood tests | History | TSH not checked = thyroid signal weighted higher. Normal + ongoing symptoms = diagnose on symptoms over 45 (NICE NG23) |
How results are calculated
Each answer contributes weighted points to one or more of four scores: Perimenopause (P), Thyroid (T), Burnout (B), and Nutritional (N). The final result type is determined by the combination of scores that cross threshold.
| Result type | Trigger condition | Meaning |
|---|---|---|
| HIGH_PERI | P ≥ 7, T < 5 | Strong perimenopause signal. Recommend GP conversation about HRT eligibility and symptom management. |
| HIGH_THYROID | T ≥ 7, P < 5 | Strong thyroid signal. Recommend TSH, FT4, and thyroid antibody testing. |
| HIGH_BURNOUT | B ≥ 7, P < 4, T < 4 | Strong burnout signal. Symptoms likely stress-driven. Recommend lifestyle and occupational health review. |
| PERI_THYROID | P ≥ 5 AND T ≥ 5 | Overlapping perimenopause and thyroid signals. Both pathways should be investigated. |
| MIXED_ALL | All scores 3–6 | No single dominant signal. Multiple contributing factors likely. Broad-spectrum investigation recommended. |
| NUTRITIONAL | N ≥ 5, others < 4 | Nutritional deficiency signal dominant. Screen iron, vitamin D, B12, folate before hormonal investigation. |
Clinical frameworks
Symptom measurement
Menopause Rating Scale (MRS)
Heinemann K, et al. The Menopause Rating Scale (MRS): a methodological review. Health Qual Life Outcomes. 2004;2:45.
doi:10.1186/1477-7525-2-45Staging framework
STRAW+10 Staging Criteria
Harlow SD, et al. Executive summary of the Stages of Reproductive Aging Workshop +10. Menopause. 2012;19(4):387-395.
doi:10.1097/gme.0b013e31824d8f40Differential framework
EMAS 2024 Thyroid-Menopause Position
Mintziori G, et al. EMAS position statement: Thyroid disease and menopause. Maturitas. 2024.
doi:10.1016/j.maturitas.2024.00086Burnout differentiation
Maslach & Leiter 2016 + NICE NG23
Maslach C & Leiter MP. Understanding the burnout experience. World Psychiatry. 2016;15(2):103-111. NICE NG23 Menopause: diagnosis and management. 2015 (updated 2019).
What the tool does and does not do
Does not
- Diagnose any medical condition
- Match symptoms to named conditions
- Indicate the seriousness of symptoms
- Provide triage recommendations
- Output a probability of diagnosis
- Recommend specific treatments
- Store or transmit personal health data
Does
- Collect self-reported symptom data entered by the user
- Organise responses into four signal areas
- Present general health information relevant to midlife women
- Generate a structured summary for GP conversations
- Signpost to relevant clinical tests and professional support
MHRA regulatory position
Under MHRA guidance on Software as a Medical Device (SaMD, 2023), software that collects and organises self-reported data without performing diagnostic matching, clinical decision support, or triage signposting falls outside the definition of a medical device. SUMM has been designed specifically to remain within this boundary. The tool does not interpret, weight, or match symptoms against diagnostic criteria in a way that constitutes clinical decision support. It organises user input into thematic areas for the user's own reference.
MHRA guidance: Medical devices — software applications (apps)The information on this page is provided for transparency and does not constitute a formal regulatory submission. SUMM is a self-reported symptom signal check. It does not diagnose, treat, or assess any medical condition. All citations link to publicly available peer-reviewed sources. Last reviewed April 2026.