{"paper_id":"a18466b7-26e3-4044-ac4d-a0a897d73d55","body_text":"Abstract\nPurpose\nEvaluating menstrual blood loss (MBL) in primary healthcare is challenging. Our study aimed to assess MBL using two methods: self-perception and pictograms (Pictorial Blood Assessment Chart—PBAC and Menstrual Pictogram superabsorbent polymer-c version—MP) in women undergoing transvaginal ultrasound (TVS).\nMethods\nWe enrolled 221 premenopausal women with spontaneous menstruation, no hormonal therapy, and no ongoing pregnancy. They were divided into four age groups (12–20, 21–30, 31–40, and 41–55 years). Women self-reported normal (NMB) or heavy menstrual bleeding (HMB) and filled out PBAC and MP. A PBAC score ≥ 150 and MP score ≥ 80 ml indicated HMB. TVS was conducted on all patients, recording any pelvic pathologies. We compared self-perception with pictograms across the cohort, age groups, and ultrasound findings.\nResults\nOf the cohort, 50.2% reported normal periods and 49.8% heavy periods. No significant differences were found between self-perception and pictograms in identifying NMB and HMB across all groups. However, significant differences were observed between PBAC and MP scores for NMB (56.1% vs 41.2%, p = 0.001) and HMB (43.9% vs 58.8%, p = 0.001), particularly in the 31–40 age group. Significant differences in PBAC and MP scores were noted between age groups 12–20 and 41–55, and 31–40 and 41–55. No significant differences were found between self-perception and pictograms regarding ultrasound findings like adenomyosis, fibroids, endometrial pathology, and uterine congenital malformations.\nConclusion\nSelf-perception could be a reliable method for describing MBL across all age groups and ultrasound findings. Given the complexity and potential errors in using pictograms, clinicians should consider relying on self-perception for assessing menstrual cycle quantity.\nSimilar content being viewed by others\nData availability\nThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\nReferences\nPai M, Chan A, Barr R (2013) How I manage heavy menstrual bleeding. Br J Haematol 162(6):721–729. https://doi.org/10.1111/bjh.12447\nMunro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders (2011) FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113(1):3–13. https://doi.org/10.1016/j.ijgo.2010.11.011\nMunro MG, Critchley HOD, Fraser IS, FIGO Menstrual Disorders Committee (2018) The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet 143(3):393–408. https://doi.org/10.1002/ijgo.12666\nHallberg L, Högdahl AM, Nilsson L, Rybo G (1966) Menstrual blood loss—a population study. Variation at different ages and attempts to define normality. Acta Obstet Gynecol Scand 45(3):320–351. https://doi.org/10.3109/00016346609158455\nFraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A, Petraglia F (2015) Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynaecol Obstet 128(3):196–200. https://doi.org/10.1016/j.ijgo.2014.09.027\nMagnay JL, O’Brien S, Gerlinger C, Seitz C (2018) A systematic review of methods to measure menstrual blood loss. BMC Womens Health 18(1):142. https://doi.org/10.1186/s12905-018-0627-8\nHigham JM, O’Brien PM, Shaw RW (1990) Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol 97(8):734–739. https://doi.org/10.1111/j.1471-0528.1990.tb16249.x\nWyatt KM, Dimmock PW, Walker TJ, O’Brien PS (2001) Determination of total menstrual blood loss. Fertil Steril 76(1):125–131. https://doi.org/10.1016/s0015-0282(01)01847-7\nMagnay JL, Nevatte TM, O’Brien S, Gerlinger C, Seitz C (2014) Validation of a new menstrual pictogram (superabsorbent polymer-c version) for use with ultraslim towels that contain superabsorbent polymers. Fertil Steril 101(2):515–522. https://doi.org/10.1016/j.fertnstert.2013.10.051\nWarner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD (2004) Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol 190(5):1216–1223. https://doi.org/10.1016/j.ajog.2003.11.015\nKo JKY, Lao TT, Cheung VYT (2021) Pictorial blood loss assessment chart for evaluating heavy menstrual bleeding in Asian women. Hong Kong Med J 27(6):399–404. https://doi.org/10.12809/hkmj208743\nVannuccini S, Jain V, Critchley H, Petraglia F (2022) From menarche to menopause, heavy menstrual bleeding is the underrated compass in reproductive health. Fertil Steril 118(4):625–636. https://doi.org/10.1016/j.fertnstert.2022.07.021\nVan den Bosch T, Dueholm M, Leone FP, Valentin L, Rasmussen CK, Votino A, Van Schoubroeck D, Landolfo C, Installé AJ, Guerriero S, Exacoustos C, Gordts S, Benacerraf B, D’Hooghe T, De Moor B, Brölmann H, Goldstein S, Epstein E, Bourne T, Timmerman D (2015) Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol 46(3):284–298. https://doi.org/10.1002/uog.14806\nHarmsen MJ, Van den Bosch T, de Leeuw RA, Dueholm M, Exacoustos C, Valentin L, Hehenkamp WJK, Groenman F, De Bruyn C, Rasmussen C, Lazzeri L, Jokubkiene L, Jurkovic D, Naftalin J, Tellum T, Bourne T, Timmerman D, Huirne JAF (2022) Consensus on revised definitions of morphological uterus sonographic assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol 60(1):118–131. https://doi.org/10.1002/uog.24786\nLeone FP, Timmerman D, Bourne T, Valentin L, Epstein E, Goldstein SR, Marret H, Parsons AK, Gull B, Istre O, Sepulveda W, Ferrazzi E, Van den Bosch T (2010) Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol 35(1):103–112. https://doi.org/10.1002/uog.7487\nTimmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I, International Ovarian Tumor Analysis (IOTA) Group (2000) Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 16(5):500–505. https://doi.org/10.1046/j.1469-0705.2000.00287.x\nGuerriero S, Condous G, van den Bosch T, Valentin L, Leone FP, Van Schoubroeck D, Exacoustos C, Installé AJ, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Gonçalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D (2016) Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 48(3):318–332. https://doi.org/10.1002/uog.15955\nMagnay JL, Nevatte TM, Seitz C, O’Brien S (2013) A new menstrual pictogram for use with feminine products that contain superabsorbent polymers. Fertil Steril 100(6):1715-1721.e4. https://doi.org/10.1016/j.fertnstert.2013.08.028\nEl-Nashar SA, Shazly SAM, Famuyide AO (2015) Pictorial blood loss assessment chart for quantification of menstrual blood loss: a systematic review. Gynecol Surg 12:157–163. https://doi.org/10.1007/s10397-015-0893-5\nBarr F, Brabin L, Agbaje O (1999) A pictorial chart for managing common menstrual disorders in Nigerian adolescents. Int J Gynaecol Obstet 66(1):51–53. https://doi.org/10.1016/s0020-7292(99)00025-9\nÖzcan H, Burger NB, Dulmen-den Broeder EV, van Baal MW, den Boogaard EV, De Leeuw RA, Huirne JAF (2024) Instruments to identify menstrual complaints and their impact on adolescents: a systematic review. J Pediatr Adolesc Gynecol 37(2):106–120. https://doi.org/10.1016/j.jpag.2023.11.011\nBarcelos RS (2013) Menstrual disorders among women 15 to 54 years of age in Pelotas, Rio Grande do Sul State, Brazil: a population-based study. Cad Saude Publica 29(11):2333–2346. https://doi.org/10.1590/0102-311x00002813\nToxqui L, Pérez-Granados AM, Blanco-Rojo R, Wright I, Vaquero MP (2014) A simple and feasible questionnaire to estimate menstrual blood loss: relationship with hematological and gynecological parameters in young women. BMC Womens Health 30(14):71. https://doi.org/10.1186/1472-6874-14-71\nMartire FG, Piccione E, Exacoustos C, Zupi E (2023) Endometriosis and adolescence: the impact of dysmenorrhea. J Clin Med 12(17):5624. https://doi.org/10.3390/jcm12175624\nKluska J, Malinowska E, Kowalski J (2024) A pilot longitudinal study of decrease in cognitive functions during the most painful day of the period among women with primary dysmenorrhea. Arch Gynecol Obstet. https://doi.org/10.1007/s00404-024-07617-9\nKhan I, Khare BK (2024) Exploring the potential of machine learning in gynecological care: a review. Arch Gynecol Obstet 309(6):2347–2365. https://doi.org/10.1007/s00404-024-07479-1\nFunding\nThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\nAuthor information\nAuthors and Affiliations\nContributions\nRusso: Manuscript Writing and editing, Palumbo: Manuscript Writing, Reppuccia: Data collection, Iorio: Statistical analysis, Nocita: Data collection, Monaco: Data collection, Iacobini: Data collection, Soreca: Data collection, Exacoustos: Project development, Manuscript Writing and editing.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors have no relevant financial or non-financial interests to disclose.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nRusso, C., Palumbo, M., Reppuccia, S. et al. Evaluation of menstrual blood loss (MBL) by self-perception and pictorial methods and correlation to uterine myometrial pathology. Arch Gynecol Obstet 310, 3121–3129 (2024). https://doi.org/10.1007/s00404-024-07729-2\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-024-07729-2","source_license":"public-domain-us","license_restricted":false}