Page 11 - EVALUATION OF TREATMENT FOR HEAVY MENSTRUAL BLEEDING by Herman, Malou

The gold standard for the measurement of MBL is alkaline hematin extraction. Women need to collect all of their menstruation blood including all used towels or tampons. This method is not practical for daily use and is only used in research. Another simplified method involves counting the number of used towels or tampons, but Fraser et al. did not find a correlation between the numbers and the volume of blood loss. Therefore, this method is not used anymore. Higham et al. developed a subjective method to determine whether or not women meet the diagnosis of HMB: the Pictorial Blood Assessment Chart (PBAC). The PBAC is a measurement tool used to reliably predict HMB. The self-assessed PBAC consists of diagrams representing towels and tampons soiled to various degrees. Women are instructed to count their number of used towels or tampons each day and then divide them by the level of soiling. The chart is scored using the scoring system devised by Higham et al. This measurement method has a specificity and sensitivity of 80-90% when compared to the gold standard. 14,15 Other studies have confirmed the accuracy of the PBAC compared to the alkaline haematin extraction method for the diagnosis of HMB. Higham found that a PBAC score of >100 correlated with 80mL blood loss. For the definition of HMB, Janssen et al. recommended a cut-off of 185 points, while Zakherah recommended a cut-off at 150 points. A PBAC score of >150 points is most often used as an inclusion criterion in HMB studies. Therefore, the PBAC is said to be a useful measurement tool for accurately diagnosing HMB (when we use the 80mL criteria) and it is also a frequently chosen outcome parameter in HMB studies. However, little is known about the meaning of the PBAC score, before and after treatment, or about its relation with success rate after treatment. In order to evaluate treatments, predict their effectiveness and inform patients about these predictions, clinicians need to know more about this measurement tool.
Treatment
In view of its high prevalence, an optimal treatment for heavy menstrual bleeding is of utmost importance. After exclusion of intracavitary pathology, many treatments can be considered to reduce the amount of blood loss. Treatment options for HMB include medicinal therapies and surgical procedures, such as endometrial ablation and hysterectomy.
Hormonal treatment with the oral contraceptive pill, or non-hormonal treatment with tranexamic acid or non-steroidal anti-inflammatory drugs (NSAID) are recommended as treatments of first choice by the Dutch guidelines and Royal
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Introduction
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