Evaluation of menstrual blood loss (MBL) by self-perception and pictorial methods and correlation to uterine myometrial pathology

Purpose Evaluating 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).

We 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.

Of 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.

Self-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. Similar content being viewed by others Data availability The 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.

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Arch Gynecol Obstet 309(6):2347–2365. https://doi.org/10.1007/s00404-024-07479-1 Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author information Authors and Affiliations Contributions Russo: 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. Corresponding author Ethics declarations Conflict of interest The authors have no relevant financial or non-financial interests to disclose. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer 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. About this article Cite this article Russo, 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 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-024-07729-2