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Menstrual and Uterine Disorders
Quantification of Menstrual Cycle Disorders
a report by
Tracy M Nevatte, PhD, Julia L Magnay, CSci and Shaughn O’Brien, MD, FRCOG
Keele Menstrual Disorders Laboratory, Institute for Science and Technology in Medicine, University Hospital North Staffordshire/Keele University
Disorders of the menstrual cycle include heavy menstrual bleeding (HMB), considered to be the ‘gold standard,’ it measures menstrual blood loss only,
pre-menstrual syndrome (PMS), pre-menstrual dysphoric disorder (PMDD), not total menstrual fluid loss. Menstrual fluid is a combination of whole
and dysmenorrhea. There are numerous potential symptoms, making the blood (30–50%) and endometrial transudate, although there is evidence to
diagnosis of these conditions difficult. Therefore, no single test exists for use suggest that when bleeding is heavy the ratio of blood to menstrual fluid
in either the clinical or research setting, and feedback from the patient is increases.
6,7
However, it is the total menstrual fluid loss that is of most
sometimes the only information available. Quantification of a disorder helps concern to the patient. For a menstrual fluid loss assessment to become
to confirm or refute diagnosis, and thus the appropriate treatment regimen widely used both clinically and for research purposes, a robust, simple
can be instigated. This article will present a brief overview of the current protocol is required that does not involve the collection of soiled sanitary
methods available for diagnosis or quantification of these menstrual disorders. towels/tampons and technical expertise or equipment.
Heavy Menstrual Bleeding One such methodology was published in 1990, and was called the Pictorial
For many years HMB was defined as a blood loss of more than 80ml per Blood Loss Assessment Chart (PBAC).
8
It consisted of three pictorial icons
cycle, and this definition is still used for research purposes.
1
Recently, National depicting sanitary towels with progressively increasing stained areas that
Institute for Health and Clinical Excellence (NICE) guidelines redefined HMB represented known volumes of menstrual fluid loss.
8
However, with only
as “excessive menstrual blood loss that interferes with a woman’s physical, three icons, the range of interpretation was too wide and inaccurate for
emotional, social, and material quality of life, and can occur alone or in practical use. In 2001, the PBAC was replaced by the Menstrual Pictogram,
combination with other symptoms.”
2
Even with this qualitative definition, it with the addition of two further icons.
9
Like the alkaline hematin method,
is still necessary to quantify menstrual fluid loss, whether in the research the Menstrual Pictogram was developed using cotton–cellulose sanitary
setting to investigate the efficacy of a drug designed to reduce menstrual
fluid loss or in the clinical setting to provide reassurance to a woman that her
Tracy M Nevatte, PhD, is a Post-doctoral Research Scientist in the
periods are in fact ‘normal.’
3
A patient’s opinion of her own menstrual fluid
Keele Menstrual Disorders Laboratory of the Institute for Science
loss is not reliable for diagnostic purposes.
4
and Technology in Medicine, University Hospital North
Staffordshire. Her research focuses on the quantification of
menstrual disorders. Dr Nevatte is interested in the non-
Neither duration of menstruation nor the number of tampons/sanitary
reproductive issues of polycystic ovary syndrome (PCOS), and is a
towels used are reliable diagnostic markers for quantifying menstrual loss.
3
Research Officer for the PCOS charity Verity.
A colorimetric biochemical technique, the alkaline hematin method
E:
t.nevatte@pmed.keele.ac.uk
developed in the 1960s, is still used in the research setting to measure total
menstrual blood loss.
5
This procedure involves treating soiled sanitary
Julia L Magnay, CSci, is a Senior Research Biomedical Scientist
at the Institute for Science and Technology. She is a Fellow of
towels with sodium hydroxide solution, which converts hemoglobin to
the Institute of Biomedical Science (IBMS) and a registered
hematin. The alkaline hematin method is not used in the clinical setting Chartered Scientist of the Science Council. Her areas of
due to several limitations. First, it is a cumbersome, labor-intensive, and
expertise are clinical biochemistry and molecular biology, and
her areas of research include the investigation of disorders of
time-consuming technique. Second, there are health and safety
the menstrual cycle.
implications due to the large volumes of sodium hydroxide required and
the risk for blood-borne viral infections. Third, because all towels/tampons
are processed together, the data are unable to provide any information
Shaughn O’Brien, MD, FRCOG, is a Professor of Obstetrics and
regarding the patient’s menstrual bleeding pattern over her menstrual
Gynecology and a Consultant Obstetrician and Gynecologist at
period. Lastly, the technique was originally developed using towels and
the University Hospital of North Staffordshire. He is Past Vice
President of the Royal College of Obstetricians and
tampons composed of cotton–cellulose fibers, which readily release
Gynaecologists (RCOG), having been elected Fellows’
hemoglobin into the sodium hydroxide solution; however, the current
Representative on its Council for the previous six years.
generation of sanitary products now includes ultra-slim sanitary towels that
Professor O’Brien’s research and practice increasingly focuses
on gynecological endocrinology, particularly disorders of the
use superabsorbent polymers as the absorptive agent. These slimline
menstrual cycle. He has published over 200 papers and 38
towels are more acceptable to patients, but the reliability of using the
book chapters and is Senior Editor of 17 textbooks, the most
alkaline hematin method with these new sanitary products has not yet
recent being The Premenstrual Disorders: PMS and PMDD.
been validated. Furthermore, although the alkaline hematin method is
© TOUCH BRIEFINGS 2008
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