{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:59:37Z","timestamp":1791478777474,"version":"4.3.4"},"reference-count":39,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Menorrhagia is defined as a blood loss of more than 80 mL, which is significant enough to cause anemia. Previously known methods for evaluating menorrhagia, such as the alkalin-hematin method, pictograms, and measuring the weight of sanitary products, were all impractical, complex, and time-consuming. Therefore, this study aimed to determine which item among menstrual history taking was most associated with menorrhagia and devised a simple evaluating method for menorrhagia through history taking that can be applied clinically. Materials and Methods: The study was conducted from June 2019 to December 2021. A survey was conducted on premenopausal women who underwent outpatient treatment or surgery and those who underwent a gynecologic screening test, and their blood tests were analyzed. The presence of iron deficiency anemia was identified with a Hb level of less than 10 g\/dL with microcytic hypochromic anemia on a complete blood count performed within one month of the survey. A questionnaire survey was conducted on six items related to menorrhagia to investigate whether each item was related to \u201csignificant menorrhagia\u201d. Results: There were 301 participants in the survey during the period. In univariate analysis, the results revealed a statistically significant association between significant menorrhagia and the following items: self-judgement of menorrhagia; menstruation lasting over 7 days; total pad counts in a single menstrual period; Number of sanitary products changed per day; and leakaging of menstrual blood and presence of coagulated menstrual blood. In multivariate analysis, only the \u201cself-judgement of menorrhagia\u201d item showed a statistically significant result (p-value = 0.035; an odds ratio = 2.217). When the \u201cself-judgement of menorrhagia\u201d item was excluded, the \u201cpassage of clots larger than one inch in diameter\u201d item showed a statistically significant result (p-value = 0.023; an odds ratio = 2.113). Conclusions: \u201cPatient self-judgement of menorrhagia\u201d is a reliable item for evaluating menorrhagia. Among several symptoms indicating menorrhagia, determining the presence of the \u201cpassage of clots larger than one inch in diameter\u201d during the menstrual period is the most useful item for evaluating menorrhagia in clinical history taking. This study suggested using these simple menstrual history taking items to evaluate menorrhagia in real clinical practice.<\/jats:p>","DOI":"10.3390\/medicina59050874","type":"journal-article","created":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T13:54:46Z","timestamp":1682949286000},"page":"874","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association between Patients\u2019 Self-Judgement, Coagulated Menstrual Blood, and Menorrhagia: Results from a Questionnaire Survey and Blood Test Analysis"],"prefix":"10.3390","volume":"59","author":[{"given":"Eun Ji","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Eun","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0125-9754","authenticated-orcid":false,"given":"Jung Min","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7434-4541","authenticated-orcid":false,"given":"Yoon Young","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8901-9434","authenticated-orcid":false,"given":"Youn Seok","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,1]]},"reference":[{"key":"ref_1","first-page":"1813","article-title":"Treatment of menorrhagia","volume":"75","author":"Apgar","year":"2007","journal-title":"Am. Fam. Physician"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1034\/j.1600-0412.2003.00097.x","article-title":"Menorrhagia: An update","volume":"82","author":"Oehler","year":"2003","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.3109\/09513590.2012.637341","article-title":"Menometrorrhagia during the premenopause: An overview","volume":"27","author":"Donnez","year":"2011","journal-title":"Gynecol. Endocrinol."},{"key":"ref_4","unstructured":"Berek, J.S., and Berek, D.L. (2020). Berek & Novak\u2019s Gynecology, Wolters Kluwer. [16th ed.]."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"320","DOI":"10.3109\/00016346609158455","article-title":"Menstrual blood loss\u2014A population study. Variation at different ages and attempts to define normality","volume":"45","author":"Hallberg","year":"1966","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1016\/j.ajog.2003.11.016","article-title":"Menorrhagia II: Is the 80-mL blood loss criterion useful in management of complaint of menorrhagia?","volume":"190","author":"Warner","year":"2004","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_7","unstructured":"Walker, M.H., Coffey, W., and Borger, J. (2023). StatPearls, Treasure Island."},{"key":"ref_8","first-page":"806","article-title":"Estimating menstrual blood loss in women with normal and excessive menstrual fluid volume","volume":"98 Pt 1","author":"Fraser","year":"2001","journal-title":"Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/0028-2243(86)90124-3","article-title":"The alkaline hematin method for measuring menstrual blood loss\u2014A modification and its clinical use in menorrhagia","volume":"22","author":"Scholten","year":"1986","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.fertnstert.2011.05.096","article-title":"Validation of a rapid alkaline hematin technique to measure menstrual blood loss on feminine towels containing superabsorbent polymers","volume":"96","author":"Magnay","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2742","DOI":"10.1016\/j.fertnstert.2010.03.061","article-title":"Menstrual blood loss measurement: Validation of the alkaline hematin technique for feminine hygiene products containing superabsorbent polymers","volume":"94","author":"Magnay","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s41687-020-00263-0","article-title":"Validation of a menstrual pictogram and a daily bleeding diary for assessment of uterine fibroid treatment efficacy in clinical studies","volume":"4","author":"Haberland","year":"2020","journal-title":"J. Patient Rep. Outcomes"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"399","DOI":"10.12809\/hkmj208743","article-title":"Pictorial Blood Loss Assessment Chart for evaluating heavy menstrual bleeding in Asian women","volume":"27","author":"Ko","year":"2021","journal-title":"Hong Kong Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Magnay, J.L., O\u2019Brien, S., Gerlinger, C., and Seitz, C. (2018). A systematic review of methods to measure menstrual blood loss. BMC Womens Health, 18.","DOI":"10.1186\/s12905-018-0627-8"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.fertnstert.2013.10.051","article-title":"Validation of a new menstrual pictogram (superabsorbent polymer-c version) for use with ultraslim towels that contain superabsorbent polymers","volume":"101","author":"Magnay","year":"2014","journal-title":"Fertil. Steril."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Magnay, J.L., O\u2019brien, S., Gerlinger, C., and Seitz, C. (2020). Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: A systematic literature review. BMC Womens Health, 20.","DOI":"10.1186\/s12905-020-0887-y"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Schumacher, U., Schumacher, J., Mellinger, U., Gerlinger, C., Wienke, A., and Endrikat, J. (2012). Estimation of menstrual blood loss volume based on menstrual diary and laboratory data. BMC Womens Health, 12.","DOI":"10.1186\/1472-6874-12-24"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1177\/1933719113477492","article-title":"Improving the objective quality of large-scale clinical trials for women with heavy menstrual bleeding: Experience from 2 multi-center, randomized trials","volume":"20","author":"Fraser","year":"2013","journal-title":"Reprod. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.bpobgyn.2016.09.009","article-title":"Menstrual questionnaires for clinical and research use","volume":"40","author":"Matteson","year":"2017","journal-title":"Best. Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1097\/AOG.0000000000005126","article-title":"Menstrual Technology Innovations and the Implications for Heavy Menstrual Bleeding","volume":"141","author":"Liberty","year":"2023","journal-title":"Obstet. Gynecol"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Toxqui, L., P\u00e9rez-Granados, A.M., Blanco-Rojo, R., Wright, I., and Vaquero, M.P. (2014). A simple and feasible questionnaire to estimate menstrual blood loss: Relationship with hematological and gynecological parameters in young women. BMC Womens Health, 14.","DOI":"10.1186\/1472-6874-14-71"},{"key":"ref_22","first-page":"483","article-title":"Heavy Menstrual Bleeding-Visual Analog Scale, an Easy-to-Use Tool for Excessive Menstrual Blood Loss That Interferes with Quality-of-Life Screening in Clinical Practice","volume":"3","author":"Pujol","year":"2022","journal-title":"Womens Health Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/BF00434381","article-title":"Assessment of patients with menorrhagia: How valid is a structured clinical history as a measure of health status?","volume":"4","author":"Ruta","year":"1995","journal-title":"Qual. Life Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e294","DOI":"10.3399\/BJGP.2022.0460","article-title":"Women\u2019s experiences of heavy menstrual bleeding and medical treatment: A qualitative study in primary care","volume":"73","author":"Dutton","year":"2023","journal-title":"Br. J. Gen. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lancastle, D., Kallner, H.K., Hale, G., Wood, B., Ashcroft, L., and Driscoll, H. (2023). Development of a brief menstrual quality of life measure for women with heavy menstrual bleeding. BMC Womens Health, 23.","DOI":"10.1186\/s12905-023-02235-0"},{"key":"ref_26","unstructured":"Taylor, H.S., Pal, L., and Sell, E. (2020). Speroff\u2019s Clinical Gynecologic Endocrinology and Infertility, Wolters Kluwer. [9th ed.]."},{"key":"ref_27","unstructured":"Jameson, J.L., Kasper, D.L., Longo, D.L., Fauci, A.S., Hauser, S.L., and Loscalzo, J. (2018). Harrison\u2019s Principles of Internal Medicine, McGraw-Hill Education. [20th ed.]. Principles of Internal Medicine."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s12325-020-01564-y","article-title":"A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding","volume":"38","author":"Mansour","year":"2021","journal-title":"Adv. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Munro, M.G., Mast, A.E., Powers, J.M., Kouides, P.A., O\u2019brien, S.H., Richards, T., Lavin, M., and Levy, B.S. The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. Am. J. Obstet. Gynecol., 2023.","DOI":"10.1016\/j.ajog.2023.01.017"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jpag.2016.10.010","article-title":"Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding","volume":"30","author":"Cooke","year":"2017","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s12185-022-03401-0","article-title":"Intravenous ferric derisomaltose versus saccharated ferric oxide for iron deficiency anemia associ-ated with menorrhagia: A randomized, open-label, active-controlled, noninferiority study","volume":"116","author":"Kawabata","year":"2022","journal-title":"Int. J. Hematol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1016\/j.ajog.2003.11.015","article-title":"Menorrhagia I: Measured blood loss, clinical features, and outcome in women with heavy periods: A survey with follow-up data","volume":"190","author":"Warner","year":"2004","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1159\/000496608","article-title":"Normality Ranges of Menstrual Fluid Volume During Reproductive Life Using Direct Quantification of Menses with Vaginal Cups","volume":"84","author":"Donoso","year":"2019","journal-title":"Gynecol. Obstet. Invest."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1080\/00016340802673162","article-title":"Quantification of menstrual flow by weighing protective pads in women with normal, decreased or increased menstruation","volume":"88","author":"Gudmundsdottir","year":"2009","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/0010-7824(72)90015-7","article-title":"Quantitation of menstrual blood loss--further evaluation of the alkaline hematin method","volume":"5","author":"Shaw","year":"1972","journal-title":"Contraception"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"hoac048","DOI":"10.1093\/hropen\/hoac048","article-title":"Clinical perspectives on the menstrual pictogram for the assessment of heavy menstrual bleeding","volume":"2022","author":"Singh","year":"2022","journal-title":"Hum. Reprod. Open."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1159\/000320336","article-title":"Pictorial blood loss assessment chart in the evaluation of heavy menstrual bleeding: Diagnostic accuracy compared to alkaline hematin","volume":"71","author":"Zakherah","year":"2011","journal-title":"Gynecol. Obstet. Invest."},{"key":"ref_38","first-page":"21","article-title":"Outcome measures for heavy menstrual bleeding","volume":"12","author":"Quinn","year":"2016","journal-title":"Womens Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/0002-9378(71)90470-4","article-title":"Observations on the clotting of menstrual blood and clot formation","volume":"111","author":"Beller","year":"1971","journal-title":"Am. J. Obstet. Gynecol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/5\/874\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:27:53Z","timestamp":1760124473000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/5\/874"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,1]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["medicina59050874"],"URL":"https:\/\/doi.org\/10.3390\/medicina59050874","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,1]]}}}