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How to Assess Menstrual Bleeding
Recall the formal definition of heavy menstrual bleeding as exceeding 80 mL per cycle. But how can our patient measure that? How can we? Is this helpful in clinical practice?
Here are some alternative approaches to assess for heavy menstrual bleeding:
Keep it simple and patient-centred:
Menstrual blood loss that affects a patient’s quality of life
Offer direct yes/no questions:
Passing clots?
Soaking through a pad or tampon especially if it is a high absorbency product?
Having to change pads during the night or sleep on towels?
Focus on what you CAN quantify:
Changing pads or tampons every 1-2 hours because they are soaked
Using 2 types of menstrual products at the same time (e.g. pad and tampon)
If you use a menstrual cup, how many milliliters of blood do you lose daily or over your entire period?
Number of days of heavy menstrual bleeding in addition to the length of their period
Sometimes patients will feel a “flooding sensation” of vaginal blood. Try asking them:
Have you felt blood gushing out during your periods where you needed to immediately change your menstrual product or clothes?
Through these questions, we can get a sense of whether our patient is experiencing heavy vaginal bleeding.
You can ask patients to track how much blood is in their menstrual products in a printable chart called the Pictorial Blood Loss Assessment Chart (PBAC).
How much blood do different types of menstrual products use?
This graph from research by DeLoughery et al shows the average volume of red blood cells absorbed by each menstrual product category.
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