Validation of menstruation score in the diagnosis of iron deficiency anemia

validation of menstruation score


  • Saranya Pongudom
  • Yingyong Chinthammitr
  • Phichayut Phinyo
  • Kanyaporn Charoenprasert
  • Jindarath Chaipokhum
  • Sutthakaew Hunsringam
  • Duangkamon Wanalertsakul
  • Natthanan Rachadech
  • Rushanai Lerssupsin
  • Chinchutha Ochongphian


l Iron deficiency anemia, Menstruation score


Background: Iron deficiency anemia (IDA) is a common problem, especially among women with hypermenorrhea. From a related study, menstruation score was developed using 2 questions (using more than 5 pads daily and fully-soaked pad or having clotted blood).

Objective: The study aimed to validate the performance of the menstruation score to diagnose IDA.

Methods: A cross-sectional multicenter study was conducted in primary, secondary and tertiary care hospitals. We enrolled female healthcare staff presenting Hb < 12 g/dL and MCV < 80 fL from annual checkups. All participants completed questionnaires and took iron tablets orally for 3 months before repeating the complete blood count. The area under receiver operating characteristic curve (AuROC), sensitivity, specificity and positive likelihood ratios were analyzed using STATA15.

Results: In this study, 130 subjects with a mean age of 36.7 years were included for analysis. The AuROC of the menstruation score was 0.71 (95%CI: 0.62-0.79) in this validation dataset, comparable to the related development dataset. At a score of 2, the sensitivity and specificity were 54.5 and 80%, respectively. At a score of 1, the sensitivity and specificity were 91.1 and 29.4%, respectively. Adding the red cell distribution width (RDW) significantly increased the AuROC to 0.79 (95%CI: 0.71 to 0.87) (p-value < 0.001).

Conclusion: Menstruation score showed acceptable performance to diagnose IDA. We recommended its use as an initial diagnostic tool during annual health checkups. Adding the RDW to menstruation score significantly increased the performance when diagnosing IDA.


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Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013;121:2607-17.

De Andrade Cairo RC, Rodrigues Silva L, Carneiro Bustani N, Ferreira Marques CD. Iron deficiency anemia in adolescents; a literature review. Nutr Hosp. 2014;29:1240-9.

Alton I. Iron deficiency anemia. Guidelines for adolescent nutrition services; 2005:101-8.

Brittenhan GM. Disorders of iron metabolism: iron deficiency and iron overload. In: Hoffman R, Benz EJ, Shattil SJ, et al., eds. Hematology basic principles and practice. 5th. Philadelphia: Churchill livingstone; 2009. p.453-74.

Miller JL. Iron Deficiency Anemia: A Common and Curable Disease. Cold Spring Harb Perspect Med. 2013; Jul 1;3(7). Pii: a011866. Doi:10.1101/cshperspect.a011866.

Stoltzfus RJ. Iron deficiency: global prevalence and consequences. Food Nutr Bull. 2003;24(4 Suppl):S99-103.

Pongudom S. Prevalence and Risk Factors of Iron Deficiency Anemia amongst Female Health Care Workers in Udonthani Hospital. J Hematol Transfus Med. 2016;26:35-4





นิพนธ์ต้นฉบับ (Original article)