Menorrhagia-Specific Screening Tool
Authors/developersPhilipp CS, Faiz A, Dowling NF, Beckman M, Owens S, Ayers C, Bachmann G
N.B.: These scores are posted with the permission of the developers.
A short, easy-to-use tool to help identify women with unexplained menorrhagia who require further laboratory investigations. The target population is women with menorrhagia.
CS Philipp: [email protected]
Date of this review: August 26, 2013
Updated: April, 2014
- Useful in the clinical setting of stratifying those with menorrhagia complaints that need further laboratory evaluation
- Could be improved by incorporating the pictoral blood assessment chart (PBAC)
- Poor specificity, therefore a lot of subjects would be tested that do not have an underlying disorder.
- Difficult to assess validity as studies done to date do not contain a control population (no menorrhagia) and the prevalence of underlying bleeding disorders in the study populations was very high (higher than the normal population).
1 . Time to complete: 5–10 minutes
2. Equipment/space required: None
3. Training required: Not identified
4. Cost: None
5. Scoring/scaling/interpretation of results:
- Scale of 0 or 1 for each of 8 symptoms
- Possible range of total score 0–8
- Abnormal bleeding score (BS) if 1 of the following 4 criteria were met:
a) The duration of menses was ≥7 days and the woman reported either “flooding” or impairment of daily activities with most periods;
b) A history of treatment of anemia;
c) A family history of a diagnosed bleeding disorder;
d) A history of excessive bleeding with tooth extraction, delivery or miscarriage, or surgery.
1. Construct validity:
- The initial tool was made from a larger set of questions. Only questions that had a high proportion of concordance with an underlying bleeding disorder and overall good sensitivity were added to the final screening tool.1
2. Criterion validity:
- The screen was able to identify the majority of VWD cases through an abnormal bleeding score (BS).1
- No studies identified
- Abnormal BS can be used to identify those with/without a laboratory-defined bleeding disorder with a sensitivity of 82%, a specificity of 24%, a positive predictive value (PPV) of 71%, and a negative predictive value (NPV) of 38%. More specifically for VWD, sensitivity was 83% and specificity was 20%. When the Pictorial Blood Loss Assessment Chart (PBAC) score ≥100 and abnormal PFA-100 testing were added to the BS, the sensitivity increased to 95% and the specificity was similar at 16%, for a diagnosis of a laboratory-defined bleeding disorder.1
- A second study showed a similar sensitivity of 89% and specificity of 16% (PPV of 72%, NPV of 37%) that again could be improved mostly with the addition of an abnormal PBAC >185, increasing the sensitivity to 95% for the diagnosis of an underlying bleeding disorder.2
Languages studied: English
Groups tested: Adolescent and adult women with menorrhagia1
Age: Adolescents and adults
- Philipp CS Evaluation of a screening tool for bleeding disorders in a US multisite cohort of women with menorrhagia. Am J Obstet Gynecol 2011; 204: 209.e1-7.
- Philipp CS Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. Am J Obstet Gynecol 2008; 98: 163.e1-163.e8.