Usefulness of the Heavy Menstrual Bleeding Diagnostic Tools SAMANTA Questionnaire and Heavy Menstrual Bleeding–Visual Analog Scale Tool for Iron Deficiency Screening: An Exploratory Analysis from the COLIBRI Study

TL;DR

This study explores how well two tools for diagnosing heavy menstrual bleeding can also help screen for iron deficiency and assess quality of life.

Contribution

The study evaluates the potential of the SAMANTA questionnaire and HMB-VAS tool for iron deficiency screening in women with heavy menstrual bleeding.

Findings

Ferritin levels showed stronger inverse correlation with HMB diagnostic tool scores than hemoglobin.

The SAMANTA questionnaire had better sensitivity and specificity for identifying iron deficiency at a ferritin threshold of <10 ng/mL.

Both HMB diagnostic tools correlated inversely with EQ-VAS scores, indicating their impact on quality of life.

Abstract

The SAMANTA questionnaire and the Heavy Menstrual Bleeding–Visual Analog Scale (HMB-VAS) tool have been validated for diagnosing heavy menstrual bleeding (HMB). We assessed their value for screening iron deficiency (ID).

Post hoc analysis of the prospective, randomized, phase 4 Cooper and Levonorgestrel Intrauterine Device (IUD) Barcelona Research Iniciative (COLIBRI) study, which assessed the bleeding profile of two intrauterine devices. We used information collected during the last follow-up visit (month 36): sociodemographics, hemoglobin/ferritin levels, SAMANTA questionnaire, HMB-VAS tool, and EuroQoL five-dimension five-level scores. The primary outcome was the accuracy of these diagnostic tools in identifying ID. We also assessed their relationship with EQ-5D-5L.

We analyzed information from 57 women, 18 (31.6%) and 14 (24.6%) with HMB according to the SAMANTA questionnaire and the HMB-VAS tool, respectively. Ferritin levels showed better inverse correlation than hemoglobin with these HMB diagnostic tools’ scores: r = −0.539 and r = −0.557, respectively, both p < 0.001. In women with HMB according to these tools, the ferritin threshold showing the best sensitivity and specificity to identify ID was <10 ng/mL with the SAMANTA questionnaire (71.4% [Confidence Interval (CI) 95% 35.2–93.5] and 78% [CI 95% 65.2–87.7], respectively) and <15 ng/mL for the HMB-VAS tool (58.3% [CI 95% 31.2–87.7] and 82.2% [CI 95% 69.2–91.2], respectively). Only the EQ-VAS scores correlated inversely with the scores of both HMB diagnostic tools (r = −0.308, p = 0.02, and r = −0.294, p = 0.026, respectively).

This exploratory analysis shows the SAMANTA questionnaire’s good potential for ID screening. The scores of both HMB diagnostic tools correlated with the EQ-VAS, demonstrating their value in capturing the HMB impact on quality of life.

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