Table 1.

Review of methods to quantify HMB

GoalsMLB assessment methodAdvantagesDisadvantages
Good for clinical trials focused specifically and strictly on volume of menstrual blood
Minimal clinical utility 
AH method • “Gold standard” • Collection of pads is laborious
• Breakthrough bleeding is lost 
Menstrual fluid weight • Simple • Collection of pads is laborious
• Fluid evaporation can affect measurement 
Measurement of iron/
labeled red blood cells 
• Great accuracy • Technically challenging 
Good for clinic patients with focus on numbers/data
Use in clinical trials for estimated volume assessment 
Pictorial bleeding assessments • Simple and easy to learn
• Semiquantitative 
• Validated for specific products
• Participant assessment of soiling 
Nonpictorial assessment tools • Variability • Poorly validated 
Good for clinical assessment of presence or absence of HMB and effect on QOL
Often secondary outcomes for clinical trials 
QOL assessment • Insight into effect of menstrual bleeding • Lack of volume
• Individual variation 
Self-perception • Simple
• Helpful for clinical impact 
• Lack of volume of MBL assessment
• Individual variation 
GoalsMLB assessment methodAdvantagesDisadvantages
Good for clinical trials focused specifically and strictly on volume of menstrual blood
Minimal clinical utility 
AH method • “Gold standard” • Collection of pads is laborious
• Breakthrough bleeding is lost 
Menstrual fluid weight • Simple • Collection of pads is laborious
• Fluid evaporation can affect measurement 
Measurement of iron/
labeled red blood cells 
• Great accuracy • Technically challenging 
Good for clinic patients with focus on numbers/data
Use in clinical trials for estimated volume assessment 
Pictorial bleeding assessments • Simple and easy to learn
• Semiquantitative 
• Validated for specific products
• Participant assessment of soiling 
Nonpictorial assessment tools • Variability • Poorly validated 
Good for clinical assessment of presence or absence of HMB and effect on QOL
Often secondary outcomes for clinical trials 
QOL assessment • Insight into effect of menstrual bleeding • Lack of volume
• Individual variation 
Self-perception • Simple
• Helpful for clinical impact 
• Lack of volume of MBL assessment
• Individual variation 

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