Magnay, JL, Brien, SO, Gerlinger, C and Seitz, C (2018) A systematic review of methods to measure menstrual blood loss. BMC Women's Health, 18. ISSN 1472-6874

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Abstract

Background
Since the publication over 50 years ago of the alkaline hematin method for quantifying menstrual blood loss (MBL) many new approaches have been developed to assess MBL. The aim of this systematic review is to determine for methods of measuring MBL: ability to distinguish between normal and heavy menstrual bleeding (HMB); practicalities and limitations in the research setting; and suitability for diagnosing HMB in routine clinical practice.

Methods
Embase®™, MEDLINE®, and ClinicalTrials.gov were screened for studies on the development/validation of MBL assessment methods in women with self-perceived HMB, actual HMB or uterine fibroids, or patients undergoing treatment for HMB. Studies using simulated menstrual fluid and those that included women with normal MBL as controls were also eligible for inclusion. Extracted data included study population, results of validation, and advantages/disadvantages of the technique.

Results
Seventy-one studies fulfilled the inclusion criteria. The sensitivity and/or specificity of diagnosing HMB were calculated in 16 studies of methods involving self-perception of MBL (11 pictorial), and in one analysis of the menstrual-fluid-loss (MFL) method; in 13 of these studies the comparator was the gold standard alkaline hematin technique. Sensitivity and specificity values by method were, respectively: MFL model, 89, 98%; pictorial blood loss assessment chart (PBAC), 58–99%, 7.5–89%; menstrual pictogram, 82–96%, 88–94%; models/questionnaires, 59–87%, 62–86%, and complaint of HMB, 74, 74%. The power of methods to identify HMB was also assessed using other analyses such as comparison of average measurements: statistical significance was reported for the PBAC, MFL, subjective complaint, and six questionnaires. In addition, PBAC scores, menstrual pictogram volumes, MFL, pad/tampon count, iron loss, and output from three questionnaires correlated significantly with values from a reference method in at least one study. In general, pictorial methods have been more comprehensively validated than questionnaires and models.

Conclusions
Every method to assess MBL has limitations. Pictorial methods strike a good balance between ease of use and validated accuracy of MBL determination, and could complement assessment of HMB using quality of life (QoL) in the clinical and research setting.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It first appeared online via BioMed Central at https://doi.org/10.1186/s12905-018-0627-8 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Alkaline hematin, Alkaline haematin, Heavy menstrual bleeding, HMB, Menorrhagia, Menstrual blood loss, MBL, Menstrual pictogram, PBAC, Pictorial blood loss assessment chart
Subjects: R Medicine > RG Gynecology and obstetrics
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 10 Sep 2018 10:12
Last Modified: 10 Sep 2018 10:14
URI: http://eprints.keele.ac.uk/id/eprint/5298

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