Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review

Table 1 Diagnostic accuracy of pictorial methods to determine heavy menstrual bleeding

Reference	N subjects (cycles)	Study population	HMB cut-off score	Sanitary products	Sensitivity, %	Specificity, %	LR+ ratio	LR− ratio	DOR
Higham et al. (1990) [29]	28 (55)	NR	100	Kotex Simplicity 2 Tampax/Kotex Fems Super Plus	86	89	7.8	0.16	49.7
Deeny et al. (1994) [30]	53 (53)	DUB	100	Not specified	88	52	1.8	0.23	7.9
Janssen et al. (1995) [31]	288 (489)	HMB or unexplained anemia	185	Kotex Maxi Long Tampax Super	62	95.5	13.8	0.40	34.6
Barr et al. (1999) [32]	281 (281)	Normal MBL	50	Not specified	58	75	2.3	0.56	4.1
Reid et al. (2000) [33]	103 (103)	Self-reported HMB	100	Kotex Simplicity 2 Tampax Super	97	7.5	1.1	0.40	2.6
Wyatt et al. (2001) [34]	108 (108)	Self-reported normal or HMB	80 mL	Kotex Maxi Day & Night Tampax Regular/Super/Super Plus	86	88	7.2	0.16	45.0
Zakherah et al. (2011) [35]	197(241)	Self-reported normal or HMB	150	Always Ultra No tampons	83	77	3.6	0.22	16.3
Larsen et al. (2013) [36]	170 (256)	UF with HMB	80 mL	Kotex Maxi Day & Night Tampax Regular/Super/Super Plus	88	87	6.8	0.14	49.1
Magnay et al. (2014) [5]	119 (235)	Self-reported light, normal or HMB	80 mL	Always Ultra Normal/Long/Night No tampons	82	92	10.3	0.20	52.4

N is the number of study subjects (number of menstrual cycles) for which data are available. DOR diagnostic odds ratio, DUB dysfunctional uterine bleeding, HMB heavy menstrual bleeding, LR likelihood ratio, MBL menstrual blood loss, NR not reported, UF uterine fibroids

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