The Cervantes Scale (CS) was developed and validated between 2001 and 2002 for use in Spanish pre- and perimenopausal women. It is a self-administered instrument that assesses QOL and the factors that may influence it during those periods [17]. Initially, the instrument was composed of 94 questions distributed into eight domains; however, its final version only included 31 questions, divided into the following four domains: menopause and health (15 items), sexuality (4 items), relationship with partner (3 items), and psychological (9 items) [17, 18].

The “menopause and health” domain assesses changes in QOL due to signs and symptoms that are common in women between the ages of 45 and 64 years and is the most susceptible to improvement through treatment interventions. It comprises the following three subdomains: vasomotor symptoms (three items), health (five items), and aging (seven items). The “sexuality” domain assesses sexual satisfaction and interest, as well as changes in the frequency of sexual relationships. The “relationship with partner” domain assesses marital satisfaction and the patient’s role in her relationship. The “psychological” domain assesses changes in QOL due to anxiety and depression. Responses are scored on a scale of 0–5. Since the CS is a negative scale, its “positive items” (numbers 4, 8, 13, 15, 20, 22, 26, and 30) should be reverse scored before statistical analysis. The total score may range from 0 to 155, where higher scores are indicative of worse quality of life [17].

In Brazil, Lima and colleagues [19] conducted a cross-sectional study in which the scale was translated to Brazilian Portuguese and adapted both culturally and psychometrically for use in the local population. The study involved 180 women aged between 45 and 64 years, recruited from outpatient clinics in university hospitals (68.3 %) or from private clinics (31.7 %) in a city in southern Brazil. Participants had a mean age of 52.3 ± 5 years and most were Caucasian individuals (90.0 %) with primary level education (52.2 %) who earned up to four minimum wages per month (47.3 %). Women who were illiterate, had significant visual impairment and severe and/or untreated illnesses, or used antidepressants were excluded from the study. The translation and cultural adaptation of the scale were performed according to Wild et al. [3]. Sociodemographic, clinical, and behavioral data were collected from all participants, and individuals were administered the following questionnaires: the Brazilian Portuguese version of the CS, the WHQ, and the WHOQOL-bref. The latter two instruments were used as comparative standards for the newly adapted scale, as they had already been validated for use in the Brazilian population. The psychometric assessment of the Brazilian version of the CS was conducted using Cronbach’s alpha to investigate internal consistency, the intraclass correlation coefficient to assess reproducibility, and correlations between the CS and other QOL assessment instruments to verify construct, convergent, criterion, and concurrent validity. Discriminant validity was assessed based on the use of t-tests and ANOVA to analyze population characteristics. Sixty-six women (36.6 %) were also readministered the scale after a 2-week interval. Most women were not being treated for any chronic illnesses (53.3 %), but among those who were undergoing such treatment, the most commonly reported illness was hypertension (66.6 % of women receiving chronic treatment). Only 15 % of participants were smokers, and 28.3 % reported to drinking alcoholic beverages. A significant portion of participants was sedentary (49.4 %). A total of 33.9 % of the women interviewed menstruated without the need for any treatment, while 25.6 % of participants were receiving hormone treatment (a total of 47.7 % of postmenopausal participants were in the latter group). Natural menopause was reported by 26.1 % of women. Their mean menopausal age was 48.1 ± 4.1 years. Surgical menopause (hysterectomy) was reported by 22.2 % of women, while 12.8 % were uncertain of when menopause occurred, and 38.9 % were still menstruating regularly. Of the 85 % of women who reported to having climacteric symptoms, 51 % reported hot flashes. The Cronbach’s alpha for the total scale score was 0.83, and the internal consistency of each of the four domains was as following: menopause and health (0.81), psychological (0.84), sexuality (0.79), and relationship with partner (0.73). The intraclass correlation coefficient for the test-retest reliability of the CS was r = 0.94; 95% CI: 0.89 – 0.96 (p < 0.001). Most of the correlations between total CS scores and scores on its domains and subdomains were statistically significant. However, no correlations were found between the sexuality domain and the vasomotor symptoms and health subdomains, the relationship with partner and menopause and health domains, and the vasomotor symptoms and health subdomains. The strongest correlations were identified between total CS score and the menopause and health and psychological domains (Table 29.2). The Pearson’s correlation coefficient between total CS scores and scores on the WHQ and WHOQOL-bref was r = 0.79 and r = −0.71, respectively, significant at p < 0.001 (Table 29.3). These results show the construct, convergent, criterion, concurrent, and discriminant validity of the Brazilian version of the CS. No part of the instrument had to be modified for cultural appropriateness. In conclusion, this study produced a version of the CS that was very similar to the original instrument and was easily understood by all participants.