Background/Aims: The pictorial blood assessment chart (PBAC) is a method for evaluation of menstrual blood loss (MBL). This study was conducted to evaluate the accuracy of the PBAC score in diagnosing MBL compared to alkaline hematin as a gold standard. Methods: Two cohorts were constructed: 30 women who reported ‘normal’ menses and 170 who reported ‘heavy’ menses. Evaluation of menstruation was performed using the PBAC score and by alkaline hematin. Results: Women who reported normal menses were younger (p = 0.071), had lower parity [median parity of 3 (range 1–6) vs. 4 (range 1–12), p < 0.001] and higher hemoglobin levels (11.1 ± 1.1 vs. 10.1 ± 1.6 g/dl, p < 0.001). PBAC scores and MBL by alkaline hematin were significantly correlated (Spearman r = 0.600, p < 0.001). The PBAC score of 150 had a ĸ of 0.593 (95% CI 0.480–0.687) and an area under the curve of 0.796 (95% CI 0.770–0.821). In a multivariable regression PBAC score >150, presence of blood clots and period duration >7 days were independent predicators of heavy menstrual bleeding with an overall area under the curve of 0.858 (95% CI 0.835–0.879). Conclusions: The PBAC score is a simple and accurate tool for semiobjective of MBL that can be used in clinical practice to aid the decision about treatment and follow-up.

Journal Section:
Original Article
Keywords:
Heavy menstrual bleeding, Menstrual blood loss
1.
Higham JM, O’Brien PM, Shaw RW: Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol 1990;97:734–739.
[PubMed]
https://doi.org/10.1111%2Fj.1471-0528.1990.tb16249.x
2.
Janssen CA, Scholten PC, Heintz AP: A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss. Obstet Gynecol 1995;85:977–982.
[PubMed]
https://doi.org/10.1016%2F0029-7844%2895%2900062-V
3.
Janssen CAH: A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss. Eur J Obstet Gynecol Reprod Biol 1996;70:21–22.
[PubMed]
https://doi.org/10.1016%2FS0301-2115%2896%2902570-5
4.
Deeny M, Davis JA: Assessment of menstrual blood loss in women referred for endometrial ablation. Eur J Obstet Gynecol Reprod Biol 1994;57:179–180.
[PubMed]
https://doi.org/10.1016%2F0028-2243%2894%2990297-6
5.
Barr F, Brabin L, Agbaje O: A pictorial chart for managing common menstrual disorders in Nigerian adolescents. Int J Gynaecol Obstet 1999;66:51–53.
[PubMed]
https://doi.org/10.1016%2FS0020-7292%2899%2900025-9
6.
Reid PC, Coker A, Coltart R: Assessment of menstrual blood loss using a pictorial chart: a validation study. Br J Obstet Gynaecol 2000;107:320–322.
https://doi.org/10.1111%2Fj.1471-0528.2000.tb13225.x
7.
Wyatt KM, Dimmock PW, Hayes-Gill B, et al: Menstrual symptometrics: a simple computer-aided method to quantify menstrual cycle disorders. Fertil Steril 2002;78:96–101.
[PubMed]
https://doi.org/10.1016%2FS0015-0282%2802%2903161-8
8.
Von Elm E, Altman DG, Egger M, et al: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806–808.
[PubMed]
https://doi.org/10.1136%2Fbmj.39335.541782.AD
9.
Bossuyt PM, Reitsma JB, Bruns DE, et al: Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD Initiative. Ann Intern Med 2003;138:40–44.
[PubMed]
10.
Shaaban MM, Zakherah MS, El-Nashar SA, Sayed GH: Levonorgestrel-releasing intrauterine system compared to low dose combined oral contraceptive pills for idiopathic menorrhagia: a randomized clinical trial. Contraception 2011;83:48–54.
[PubMed]
https://doi.org/10.1016%2Fj.contraception.2010.06.011
11.
Sayed GH, Zakherah MS, El-Nashar SA, Shaaban MM: A randomized clinical trial of a levonorgestrel-releasing intrauterine system and a low-dose combined oral contraceptive for fibroid-related menorrhagia. Int J Gynaecol Obstet 2010 (in press).
12.
Hallberg L, Nilsson L: Determination of menstrual blood loss. Scand J Clin Lab Invest 1964;16:244–248.
[PubMed]
13.
Shaw ST, Aaronson DE Jr, Moyer DL: Quantitation of menstrual blood loss – further evaluation of the alkaline hematin method. Contraception 1972;5:497–513.
[PubMed]
https://doi.org/10.1016%2F0010-7824%2872%2990015-7
14.
Dinnes J, Deeks J, Kirby J, Roderick P: A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy. Health Technol Assess 2005;9:1–113, iii.
[PubMed]
15.
Glas AS, Lijmer JG, Prins MH, et al: The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 2003;56:1129–1135.
[PubMed]
https://doi.org/10.1016%2FS0895-4356%2803%2900177-X
© 2011 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2011
You do not currently have access to this content.