Systematic evaluation of patient-reported outcome measures for hot flashes in women: A COSMIN-based review

Objectives To systematically evaluate the methodological quality and measurement properties of Patient-Reported Outcome Measures (PROMs) for women experiencing hot flashes, based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines, and to provide evidence for selecting reliable assessment tools in clinical and research settings. Methods A comprehensive search was conducted in CNKI, Wanfang, VIP, PubMed, Web of Science, and the Cochrane Library from inception to July 2025, and was updated in March 2026. Eligible studies on PROMs designed to assess hot flashes in women were included. Methodological quality and measurement properties were appraised using the COSMIN Risk of Bias checklist and quality criteria. At the same time, the certainty of evidence and recommendation level were graded using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Eight studies met the inclusion criteria, covering eight different PROMs. None of the instruments reported measurement error or cross-cultural validity. The Hot Flash Beliefs Scale (HFBS) demonstrated the most balanced psychometric performance and achieved an A-level recommendation. The remaining tools were rated as B due to insufficient or unclear content validity and low-to-moderate certainty of evidence. Conclusions Current PROMs for evaluating hot flashes in women vary considerably in methodological rigor and psychometric quality. The HFBS shows the strongest evidence and can be provisionally recommended for use, though further validation of its measurement properties is required. Existing studies suffer from insufficient content validity, inadequate assessment of certain measurement properties (e.g., cross-cultural validity and measurement error), and non-standardized methodological designs. Future research should focus on improving content validity, testing measurement error, and verifying cross-cultural applicability to enhance the scientific robustness of hot-flash assessment tools.