title: A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss.
abstract: OBJECTIVE
  To validate a simple, highly predictive test to discriminate between menorrhagia and normal menstrual blood loss.
  
  
  METHODS
  The sanitary wear of 489 menstrual bleeding episodes was collected by 288 women for objective measurement of menstrual blood loss (alkaline hematin method); the women made a subjective assessment of the volume and, based on a pictorial chart, recorded the amount of and the degree to which their sanitary wear was soiled. Based on that degree, a score was calculated for each episode and a suitable cutoff point was chosen, above which the presence of menorrhagia was likely and below which it was unlikely.
  
  
  RESULTS
  Using a score of 185 as the cutoff point, the predictive values of positive and negative tests were almost equally high, 85.9 and 84.8%, respectively. Whether or not the presence of clots was recorded, these values did not change. The predictive value of a woman's complaint of heavy bleeding for the presence of menorrhagia was 55.9% and that of anemia (hemoglobin less than 12.0 g/dL) was 74.4%.
  
  
  CONCLUSIONS
  We validated and refined a new, simple, visual assessment technique and demonstrated that it is superior to a woman's subjective assessment of menstrual blood loss and the occurrence of anemia for predicting menorrhagia, even if it is performed only once. We also demonstrated that the volume that clots contribute to menstruation is not as large as many clinicians believe. With this technique, the quality of therapy can be enhanced by making it more adequate and rational.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Utrecht, The Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Janssen
authors.forename: P C
authors.initials: PC
authors.lastname: Scholten
authors.forename: A P
authors.initials: AP
authors.lastname: Heintz
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000175:diagnosis*; D008598:Menstruation; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity