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Menstrual Assessment Chart

This document provides a menstrual assessment chart for tracking menstrual bleeding over the course of a menstrual cycle. It includes directions for tallying the number and level of saturation of pads and tampons used each day and noting any clots. Different levels of saturation and clot size are assigned point values, with a total score of 100 or more points indicating probable menorrhagia or heavy menstrual bleeding which should be discussed with a doctor.

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499 views1 page

Menstrual Assessment Chart

This document provides a menstrual assessment chart for tracking menstrual bleeding over the course of a menstrual cycle. It includes directions for tallying the number and level of saturation of pads and tampons used each day and noting any clots. Different levels of saturation and clot size are assigned point values, with a total score of 100 or more points indicating probable menorrhagia or heavy menstrual bleeding which should be discussed with a doctor.

Uploaded by

sqvk747shs
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Menstrual Assessment Chart

Date of start ______________________


Directions
Day 1 2 3 4 5 6 7 8 9 10 11 12 Keep a tally of the number of pads
or tampons you use each day of
Pads your cycle and their level of
saturation. Also take note of clots
Lightly soaked
or overflow. Clots >1 cm in size
are considered large.

Moderately soaked Scoring


Pads (score per pad)
Lightly soaked: 1 point
Moderately soaked: 5 points
Heavily soaked Heavily soaked: 20 points
Tampons (score per tampon)
Lightly soaked: 1 point
Clots Moderately soaked: 5 points
(small or large) Heavily soaked: 10 points

Tampons Clots
Small: 1 point
Lightly soaked Large: 5 points

INTERPRETATION
Moderately soaked A score of ≥ 100 points indicates
probable menorrhagia.
Contact your doctor or the
nearest bleeding disorder
Heavily soaked
treatment centre if you are
concerned about your menstrual
bleeding.
Clots (www.hemophilia.ca/en/treatment‐
centres)
(small or large)
Score

Total score: __________


Source: Jenny M. HIGHAM, P. M. S. O’BRIEN, R.W. SHAW, Assessment of menstrual blood loss using a pictorial chart,
British Journal of Obstetrics and Gynaecology, August 1990, Vol. 97, pp. 734‐739

Canadian Hemophilia Society 2015

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