The purpose of the study was to determine comparability of an Internet format to a Pen-and-Pencil (PP) format of the Midlife Women's Symptom Index (MSI). This study utilized a cross-sectional comparative design with three sections: (a) a PP survey among 77 middle-aged women; (b) an Internet survey among 81 middle-aged women; and (c) an expert review among 20 women's health experts. Both of the PP and the Internet surveys included sociodemographic questions, the MSI, and the Menopausal Symptom Checklist. Data were analyzed using descriptive statistics, K-R20, and correlation coefficients. The findings supported the reliability and validity of both Internet and PP formats of the MSI.