title: A new menstrual pictogram for use with feminine products that contain superabsorbent polymers.
abstract: OBJECTIVE
  To determine whether the menstrual pictogram (the superabsorbent polymer-c or SAP-c version) can reliably estimate blood and total menstrual fluid volumes on prestained Always Ultra slim feminine towels (Proctor & Gamble) that contain superabsorbent polymers.
  
  
  METHODS
  Randomized blinded study using simulated menstrual fluid (SMF: 50% blood, 50% saline mixture).
  
  
  METHODS
  Gynecology research clinic.
  
  
  METHODS
  12 premenopausal women with regular menstrual cycles who had not previously used a graphical method to assess menstrual loss.
  
  
  METHODS
  None.
  
  
  METHODS
  Assignment of 135 prestained towels containing known volumes of 0.5-25.0 mL of SMF to five pictorial icons of the menstrual pictogram, and correlation of pictogram scores to blood recovered from towels by the alkaline hematin method and total fluid applied to towels by measurement of soiled towel weight.
  
  
  RESULTS
  There was a high level of agreement between individual scores. For 112 (83%) of 135 towels, the participants' readings either completely concurred or differed by only a single icon. There was a statistically significant correlation between the volume of blood applied (SMF/2) and that recovered by alkaline hematin, and volume of fluid applied and soiled towel weight.
  
  
  CONCLUSIONS
  The menstrual pictogram (SAP-c version) is a potential diagnostic tool for heavy menstrual bleeding and would be suitable for testing in a clinical trial.
authors.affiliation: Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, United Kingdom. Electronic address: j.l.magnay@keele.ac.uk.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Magnay
authors.forename: Tracy M
authors.initials: TM
authors.lastname: Nevatte
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.forename: Shaughn
authors.initials: S
authors.lastname: O'Brien
mesh_terms: D000042:Absorption; D000328:Adult; D001296:Audiovisual Aids; D001811:Blood Volume Determination / Q000295:instrumentation*; D059026:Diagnostic Self Evaluation; D004311:Double-Blind Method; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000175:diagnosis*; D052576:Menstrual Hygiene Products; D008875:Middle Aged; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D011933:Reagent Kits, Diagnostic
keywords: Alkaline hematin; heavy menstrual bleeding; menstrual pictogram; pictorial blood loss assessment chart; superabsorbent polymer granules