Development and Initial Psychometric Validation of the Multidimensional Menopausal Burden Questionnaire (MMBQ-44) in a Sample of Romanian Women.

Background/Objectives: Current menopause assessment instruments primarily evaluate vasomotor, somatic, and urogenital symptoms, with limited attention to oral, sensory, and integrated psychological domains. Evidence that oral tissues are estrogen-responsive suggests that oral symptoms may represent an important but underrecognized component of menopausal burden. This study aimed to develop and provide initial psychometric validation of the Multidimensional Menopausal Burden Questionnaire (MMBQ-44), a 44-item instrument integrating systemic, oral, and psychological symptoms. Methods: A cross-sectional validation study was conducted in 308 women aged 45-65 years (perimenopausal n = 66, menopausal n = 40, postmenopausal n = 202). The MMBQ-44 combined items from the Menopause Rating Scale (MRS), Xerostomia Inventory (XI), Oral Health Impact Profile-14 (OHIP-14), and psychological measures derived from the PHQ-9, GAD-7, and HADS. Instrument development included expert review, cognitive interviewing, and field testing. Psychometric evaluation assessed item performance, internal consistency, factor structure, discriminant validity, and known-groups validity. Exploratory factor analysis used principal axis factoring with promax rotation, with factor retention determined by parallel analysis. Results: Internal consistency was good to excellent across domains (Cronbach's α: 0.813-0.941; McDonald's ω: 0.864-0.953). All corrected item-total correlations exceeded 0.30. The questionnaire showed strong factorability (KMO = 0.931; Bartlett's χ2 = 9006.2, p < 0.001). Parallel analysis identified four factors explaining 48.6% of total variance. Psychological and OHIP domains emerged clearly, whereas several MRS and XI items cross-loaded onto related factors. Most HTMT ratios were below 0.85, supporting discriminant validity. Floor effects were observed for OHIP (37.0%) and XI (23.4%). Known-groups validity was modest, with OHIP scores differing significantly across menopausal stages. Conclusions: The MMBQ-44 demonstrates strong reliability and acceptable construct validity as an integrative screening instrument for menopausal burden. Further confirmatory studies and refinement of oral symptom items are warranted.