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Mackenzie ACL, Chung S, Hoppes E, Mickler AK, Cartwright AF. Measurement of changes to the menstrual cycle: A transdisciplinary systematic review evaluating measure quality and utility for clinical trials. PLoS One 2024; 19:e0306491. [PMID: 39052601 PMCID: PMC11271926 DOI: 10.1371/journal.pone.0306491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Despite the importance of menstruation and the menstrual cycle to health, human rights, and sociocultural and economic wellbeing, the study of menstrual health suffers from a lack of funding, and research remains fractured across many disciplines. We sought to systematically review validated approaches to measure four aspects of changes to the menstrual cycle-bleeding, blood, pain, and perceptions-caused by any source and used within any field. We then evaluated the measure quality and utility for clinical trials of the identified instruments. We searched MEDLINE, Embase, and four instrument databases and included peer-reviewed articles published between 2006 and 2023 that reported on the development or validation of instruments assessing menstrual changes using quantitative or mixed-methods methodology. From a total of 8,490 articles, 8,316 were excluded, yielding 174 articles reporting on 94 instruments. Almost half of articles were from the United States or United Kingdom and over half of instruments were only in English, Spanish, French, or Portuguese. Most instruments measured bleeding parameters, uterine pain, or perceptions, but few assessed characteristics of blood. Nearly 60% of instruments were developed for populations with menstrual or gynecologic disorders or symptoms. Most instruments had fair or good measure quality or clinical trial utility; however, most instruments lacked evidence on responsiveness, question sensitivity and/or transferability, and only three instruments had good scores of both quality and utility. Although we took a novel, transdisciplinary approach, our systematic review found important gaps in the literature and instrument landscape, pointing towards a need to examine the menstrual cycle in a more comprehensive, inclusive, and standardized way. Our findings can inform the development of new or modified instruments, which-if used across the many fields that study menstrual health and within clinical trials-can contribute to a more systemic and holistic understanding of menstruation and the menstrual cycle.
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Affiliation(s)
- Amelia C. L. Mackenzie
- Global Health and Population, FHI 360, Washington, District of Columbia, United States of America
| | - Stephanie Chung
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Emily Hoppes
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
| | - Alexandria K Mickler
- Research, Technology and Utilization Division, United States Agency for International Development and the Public Health Institute, Office of Population and Reproductive Health, Bureau for Global Health, Washington, District of Columbia, United States of America
| | - Alice F. Cartwright
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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Özcan H, Burger NB, Dulmen-den Broeder EV, van Baal MW, den Boogaard EV, De Leeuw RA, Huirne JAF. Instruments to Identify Menstrual Complaints and Their Impact on Adolescents: A Systematic Review. J Pediatr Adolesc Gynecol 2024; 37:106-120. [PMID: 38104798 DOI: 10.1016/j.jpag.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
STUDY OBJECTIVE The aim of this review was to create an overview of available instruments used to evaluate the menstrual complaints of dysmenorrhea and heavy menstrual bleeding (HMB) in adolescents. METHODS The search was conducted in PubMed, Web of Science, Embase, and PsycINFO on December 1, 2022. Studies published in English reporting on menstrual complaints among girls aged 10-19 were included. The quality and bias risk was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. RESULTS Of 8994 identified studies, 57 were included. In these studies, 19 instruments were described, of which 8 were validated in adolescents. One was difficult to use in daily practice, 1 had low sensitivity and specificity in the detection of HMB, 2 were validated by face validity, and 2 were not specifically developed to evaluate (the impact of) menstrual complaints. Therefore, only 2 were validated and feasible to measure adolescent menstrual complaints: the Period ImPact and Pain Assessment (PIPPA) and the Adolescent Menstrual Bleeding Questionnaire (aMBQ). Remarkably, the Pictorial Blood Loss Assessment Chart (PBAC) was the most frequently used instrument in adolescents. There was one modified version of the PBAC for adolescents, which had a lower cutoff value for HMB and low sensitivity and specificity. CONCLUSION We found that the PIPPA and aMBQ are suitable for assessing menstrual complaints and their impact on daily activities and health-related quality of life in adolescents. The PBAC, which is used frequently in adults, needs to be further assessed specifically for adolescents. In particular, the clinical relevance of the PBAC cutoff value for HMB should be determined for this age group. Considering the different interpretations, experiences, and limited knowledge of menstrual complaints, instruments suitable for adults may not be suitable for adolescents.
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Affiliation(s)
- Habibe Özcan
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Marchien W van Baal
- Department of Obstetrics and Gynaecology, Flevo Hospital, Almere, The Netherlands
| | - Emmy van den Boogaard
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Robert A De Leeuw
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands.
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Magnay JL, O'Brien S, Gerlinger C, Seitz C. Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review. BMC WOMENS HEALTH 2020; 20:24. [PMID: 32041594 PMCID: PMC7011238 DOI: 10.1186/s12905-020-0887-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/16/2020] [Indexed: 12/15/2022]
Abstract
Background Pictorial blood loss assessment charts (PBACs) represent the most widely used method to assess menstrual blood loss (MBL) in clinical trials. The aims of this review were to: (1) determine the diagnostic accuracy of PBACs that have been validated against the reference alkaline hematin technique; (2) categorize the pitfalls of using obsolete and nonvalidated charts; (3) provide guidelines for development of a new PBAC or use of an existing chart to measure MBL in clinical trials; and (4) consider the feasibility of using pictorial charts in primary care. Methods A literature review was conducted using Embase and MEDLINE databases. The review identified reports of women with self-perceived or actual heavy menstrual bleeding (HMB), bleeding disorders, abnormal uterine bleeding, leiomyomata (uterine fibroids) or endometriosis, and women undergoing treatment for HMB, as well as those with normal menstrual periods. Data were reviewed from studies that focused on the development and validation of PBACs and from those that used derivative noncertified charts to assess HMB. Results Nine studies reported validation of PBAC scoring systems against the alkaline hematin technique. Across these studies, the sensitivity was 58–97%, the specificity was 7.5–95.5%, the positive and negative likelihood ratios were 1.1–13.8 and 0.14–0.56, respectively, and the diagnostic odds ratio was 2.6–52.4. The cut-off score above which the diagnosis of HMB was made ranged from 50 to 185. Several modifications of these PBACs were used in other studies; however, objective confirmation of their validity was not reported. Overall, there was widespread inconsistency of chart design, scoring systems, diagnostic cut-off limits and post-treatment outcome measures. Conclusions PBACs are best suited to the controlled and specific environment of clinical studies, where clinical outcome parameters are defined. The current lack of standardization precludes widespread use of the PBAC in primary care. Review registration number PROSPERO international prospective register of systematic reviews: CRD42016030083.
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Affiliation(s)
- Julia L Magnay
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK
| | - Shaughn O'Brien
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK.,Department of Obstetrics & Gynaecology, Keele University School of Medicine, Stoke-on-Trent, UK
| | - Christoph Gerlinger
- Bayer AG, Building P300, 13342, Berlin, Germany.,Gynaecology, Obstetrics and Reproductive Medicine, University of Saarland Medical School, Homburg, Saar, Germany
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Magnay JL, O'Brien S, Gerlinger C, Seitz C. A systematic review of methods to measure menstrual blood loss. BMC WOMENS HEALTH 2018; 18:142. [PMID: 30134884 PMCID: PMC6106944 DOI: 10.1186/s12905-018-0627-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/27/2018] [Indexed: 11/10/2022]
Abstract
Background Since the publication over 50 years ago of the alkaline hematin method for quantifying menstrual blood loss (MBL) many new approaches have been developed to assess MBL. The aim of this systematic review is to determine for methods of measuring MBL: ability to distinguish between normal and heavy menstrual bleeding (HMB); practicalities and limitations in the research setting; and suitability for diagnosing HMB in routine clinical practice. Methods Embase®™, MEDLINE®, and ClinicalTrials.gov were screened for studies on the development/validation of MBL assessment methods in women with self-perceived HMB, actual HMB or uterine fibroids, or patients undergoing treatment for HMB. Studies using simulated menstrual fluid and those that included women with normal MBL as controls were also eligible for inclusion. Extracted data included study population, results of validation, and advantages/disadvantages of the technique. Results Seventy-one studies fulfilled the inclusion criteria. The sensitivity and/or specificity of diagnosing HMB were calculated in 16 studies of methods involving self-perception of MBL (11 pictorial), and in one analysis of the menstrual-fluid-loss (MFL) method; in 13 of these studies the comparator was the gold standard alkaline hematin technique. Sensitivity and specificity values by method were, respectively: MFL model, 89, 98%; pictorial blood loss assessment chart (PBAC), 58–99%, 7.5–89%; menstrual pictogram, 82–96%, 88–94%; models/questionnaires, 59–87%, 62–86%, and complaint of HMB, 74, 74%. The power of methods to identify HMB was also assessed using other analyses such as comparison of average measurements: statistical significance was reported for the PBAC, MFL, subjective complaint, and six questionnaires. In addition, PBAC scores, menstrual pictogram volumes, MFL, pad/tampon count, iron loss, and output from three questionnaires correlated significantly with values from a reference method in at least one study. In general, pictorial methods have been more comprehensively validated than questionnaires and models. Conclusions Every method to assess MBL has limitations. Pictorial methods strike a good balance between ease of use and validated accuracy of MBL determination, and could complement assessment of HMB using quality of life (QoL) in the clinical and research setting. Trial registration PRISMA registration number: CRD42016032956. Electronic supplementary material The online version of this article (10.1186/s12905-018-0627-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia L Magnay
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK
| | - Shaughn O'Brien
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK.,Department of Obstetrics & Gynaecology, Keele University School of Medicine, Stoke-on-Trent, UK
| | - Christoph Gerlinger
- Bayer AG, 13342, Berlin, Germany.,Gynecology, Obstetrics and Reproductive Medicine, University of Saarland Medical School, Homburg/Saar, Germany
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Pictorial blood loss assessment chart for quantification of menstrual blood loss: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s10397-015-0893-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Magnay JL, Nevatte TM, O'Brien S, Gerlinger C, Seitz C. Validation of a new menstrual pictogram (superabsorbent polymer-c version) for use with ultraslim towels that contain superabsorbent polymers. Fertil Steril 2014; 101:515-22. [DOI: 10.1016/j.fertnstert.2013.10.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/22/2013] [Accepted: 10/26/2013] [Indexed: 11/26/2022]
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Davidson BR, DiPiero CM, Govoni KD, Littleton SS, Neal JL. Abnormal Uterine Bleeding During the Reproductive Years. J Midwifery Womens Health 2012; 57:248-54. [DOI: 10.1111/j.1542-2011.2012.00178.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Zakherah MS, Sayed GH, El-Nashar SA, Shaaban MM. Pictorial Blood Loss Assessment Chart in the Evaluation of Heavy Menstrual Bleeding: Diagnostic Accuracy Compared to Alkaline Hematin. Gynecol Obstet Invest 2011; 71:281-4. [DOI: 10.1159/000320336] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 08/16/2010] [Indexed: 11/19/2022]
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Wilkinson JP, Kadir RA. Management of abnormal uterine bleeding in adolescents. J Pediatr Adolesc Gynecol 2010; 23:S22-30. [PMID: 20869283 DOI: 10.1016/j.jpag.2010.08.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 08/11/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Jeffrey P Wilkinson
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.
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Evaluation and treatment of menorrhagia in an adolescent population. J Minim Invasive Gynecol 2009; 15:682-8. [PMID: 18971130 DOI: 10.1016/j.jmig.2008.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 08/18/2008] [Accepted: 08/23/2008] [Indexed: 11/21/2022]
Abstract
Bleeding in adolescence is a common but, potentially, difficult condition to manage. Adolescents present with unique issues related to their age, involvement of family members, different differential diagnosis when compared to an older populations, and challenges associated with their evaluation and treatment.
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Abnormal uterine bleeding: a review of patient-based outcome measures. Fertil Steril 2008; 92:205-16. [PMID: 18635169 DOI: 10.1016/j.fertnstert.2008.04.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 04/11/2008] [Accepted: 04/11/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To summarize and evaluate the patient-based outcome measures (PBOMs) that have been used to study women with abnormal uterine bleeding (AUB). DESIGN Systematic review. SETTING Original articles that used at least one PBOM and were conducted within a population of women with AUB. PATIENT(S) Women with AUB. INTERVENTION(S) The titles, abstracts, and studies were systematically reviewed for eligibility. The PBOMs used in eligible studies were summarized. Essential psychometric properties were identified, and a list of criteria for each property was generated. MAIN OUTCOME MEASURE(S) "Quality" of individual PBOMs as determined using the listed criteria for psychometric properties. RESULT(S) Nine hundred eighty-three studies referenced AUB and patient-reported outcomes. Of these, 80 studies met the eligibility criteria. Fifty different instruments were used to evaluate amount of bleeding, bleeding-related symptoms, or menstrual bleeding-specific quality of life. The quality of each of these instruments was evaluated on eight psychometric properties. The majority of instruments had no documentation of reliability, precision, or feasibility. There was no satisfactory evidence that any one instrument completely addressed all eight psychometric properties. CONCLUSION(S) Studies of women with AUB are increasingly using PBOMs. Many different PBOMs were used; however, no single instrument completely addressed eight important measurement properties.
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