Regular periodic menstruation is an indication of normal ovarian function and the smoothness of the female reproductive tract. The amount of menstrual flow is also a sign of normal hormone levels for ovulation, endometrial thickness, systemic immune function, and blood clotting mechanisms. Ladies assess the amount of menstruation generally by comparing it with their previous volume and comparing it with scientific standards, not with others, because the volume of menstruation is the label of their own menstruation.
Self-assessment of the amount of menstruation
Under the influence of the cyclical estrogen and progesterone changes in follicle development, the endometrium undergoes cyclical proliferation, shedding, and the formation of a fluid blood mixture that is expelled from the body, called “menstruation”.
The menstrual period of a healthy woman is usually 3 to 7 days, with more menstrual blood on the second to third day, then gradually decreasing to the sixth to seventh day when the menstruation is “clean” on its own. The menstrual cycle is usually 28 to 30 days. The amount of menstrual flow is related to race, ethnicity, region, nutrition and other factors.
Generally speaking, Chinese women have a single menstrual blood volume of about 20 to 60 ml, less than 20 ml is too little, if more than 80 ml is too much.
I. How to determine the amount of menstruation
It can be estimated by how many menstrual pads a woman changes during her period. In general, it is basically normal to change menstrual pads 3 to 5 times per day and night; not more than two packs per cycle (10 packs per pack).
If you need to change your menstrual pad so often that 3 packs of sanitary napkins are not enough for each menstrual period, and almost every sanitary napkin is wet, you have too much menstrual blood; if you see only a little blood on your menstrual pad and only need to change it once or twice a day, you have too little menstrual blood.
The method of assessing the amount of menstrual blood using the number of menstrual pad changes is less accurate. Because the hygiene habits of each woman are different, the quality of the pads used varies, and many other conditions limit and influence it, this rough assessment method is only used for clinical reference.
Currently, the Pictorial Blood Loss Assessment Chart (PBAC) proposed by Higham JM in 1990 is commonly used internationally to assess menstrual volume.
1. Menstrual blood loss
The menstrual blood loss chart is given different scores depending on the degree of blood staining of each sanitary napkin.
Mild (1 point), blood staining < 1/3 of the whole sanitary napkin.
Moderate (5 points): blood-stained area of 1/3 to 3/5 of the whole sanitary napkin.
Severe (20 points): the blood-stained area is basically the whole sanitary napkin.
2. Assessment of blood clot size.
Those with <1 dollar coin are small blood clots and are rated 1 point.
Those with >$1 coin are considered large blood clots and scored 5 points.
If the blood volume could not be expressed in clots, it was estimated as a fraction of the recorded volume recorded. The score for each sanitary napkin, the number of sanitary napkins, and the number of days were recorded, and finally the total score was calculated. A total score >100 is considered too much menstruation (approximately more than 80 ml), and a total score <25 is considered too little menstruation (approximately less than 20 ml).
This method is relatively objective and reproducible. Both self-assessment of menstrual flow can be performed and a health worker can be asked to assess it on behalf of the patient. Despite the differences in this scoring method, this method correlates well with the gold standard method (alkaline whole iron hemoglobin method) and can provide a quick and easy and more accurate diagnosis of excessive or scanty menstruation.
II. Significance of abnormal menstrual flow
Abnormal menstrual flow often indicates ovulatory function, endocrine background, endometrial thickness, or cervical lesions in women. The diagnosis needs to be combined with the patient’s medical history and further investigations such as basal endocrine level, uterine adnexal ultrasound (3D ultrasound if necessary), diagnostic curettage, or hysteroscopy.
(1) Low menstrual flow and disordered cycles, with basal endocrine findings of elevated FSH and LH and low E2, accompanied by a decrease in the number of ovarian sinus follicles, suggest hypovarianism; if hormonal tests suggest high LH, high androgens, and the ovaries show the PCO phenomenon of multiple small follicles, it suggests polycystic ovary syndrome and persistent anovulation resulting in endometrial bleeding, rather than menstruation.
(2) Low menstrual flow, regular cycle, history of uterine operation, need to check uterine adnexal ultrasound (3D ultrasound if necessary) to check if the endometrium is too thin, if uterine adhesions or scarring is suspected, hysteroscopy should be performed, those without fertility requirements can be left alone.
(3) Excessive menstrual flow and regular cycles need to be further investigated for.
(i) Abnormal coagulation mechanisms, e.g. immune platelet drop, abnormal liver function, hematologic disorders.
②Uterine cavity factors, such as submucosal myoma, endometrial polyp, adenomyosis, adenomyoma, interstitial myoma, multiple myomas, etc.
(4) In cases of excessive menstruation and disordered cycles, after excluding coagulation disorders and uterine cavity factors, diagnostic scraping is feasible to stop bleeding and send the scraped out endometrial tissue for pathological examination to clarify the presence of endometrial lesions.
Normal menstruation is a response and expression of the health of a woman’s reproductive system. When you feel that your menstrual flow is too much or too little, or differs greatly from the previous one, you should first use the above methods to self-evaluate your menstrual flow and come to the hospital promptly if it is abnormal.