# Association between menstrual pad usage, self-reported symptoms, and menstrual blood loss measured by the alkaline hematin method

## TL;DR

This study found that self-reported heavy menstrual bleeding does not always match objective measurements, highlighting the need for accurate blood loss assessment methods.

## Contribution

The study reveals a discrepancy between self-reported and objectively measured menstrual blood loss, emphasizing the limitations of self-reporting.

## Key findings

- Only 25.3% of participants exceeded the 120 mL heavy menstrual bleeding threshold.
- Participants with heavy bleeding used more pads per cycle but there was overlap in pad usage with those with normal bleeding.
- Self-reported measures may not reliably identify heavy menstrual bleeding.

## Abstract

Accurate assessment of heavy menstrual bleeding is necessary to determine effectiveness of therapeutic interventions. There are limited quantitative methods for evaluating heavy menstrual bleeding, as the validated alkaline hematin method has practical limitations, so alternative methods are needed.

To evaluate the correlation between self-reported heavy menstrual bleeding, pad usage, and menstrual blood loss measured using the alkaline hematin method.

In this multicenter, prospective cohort study, 79 participants aged 18–50 years, who self-reported heavy menstrual bleeding, were recruited from February to November 2023. Participants provided demographic and medical history details and used study-provided pads during one menstrual cycle. Study outcomes were number of pads used per cycle and quantified menstrual blood loss measured using the alkaline hematin method. Data were analyzed using descriptive statistics.

The median menstrual blood loss per cycle was 66.1 mL (IQR 28.7–122.5 mL), with only 25.3 % (20/79) of participants exceeding the heavy menstrual bleeding threshold of 120 mL. Participants with heavy menstrual bleeding used a median of 21.5 pads per cycle (IQR 15.8–25.3 pads) while those with normal menstrual blood loss only used 11 pads per cycle (IQR 8–15 pads).

This study found a discrepancy between self-reported and objectively measured heavy menstrual bleeding. Heavy menstrual bleeding is associated with greater pad usage per cycle, however there is overlap in pad usage between participants with normal and heavy menstrual bleeding. Accurate quantification of menstrual blood is crucial for clinical management and research, as self-reported measures may not reliably identify heavy menstrual bleeding.