How can I assess vaginal blood loss based on history?
Taking a menstrual flow history is not easy. The studies by Hallberg and Cole referred to above had women collect all sanitary products during one or more cycles and then quantitatively analyzed them for blood. This is not practical for clinical practice. Also, some women may not normally pay attention to their flow. Or they may change sanitary products solely for cleanliness. And most women don’t know what flow is normal. Remember that women may be frightened by heavy flow and passing clots—this may cause them to become quite dramatic. If a woman seems to be anxious and to exaggerate her flow but is normally matter-of-fact, don’t discount her report. Ask your patient to be specific in telling you about her flow—you need to know how many normal-sized pads and tampons she soaks on the first day, the heaviest day and a usual day of flow. Also you need to know how many days she bleeds. (This can be prospectively assessed if she will keep the Menstrual Cycle Diary or Daily Perimenopause Di
