From the Research
The Pictorial Blood Assessment Tool (PBAT) is a validated method for quantifying menstrual blood loss by having patients visually compare their sanitary products to reference images, with a score above 100-150 typically indicating heavy menstrual bleeding (menorrhagia) 1.
Key Components of the PBAT
- Patients record the number of pads or tampons used during menstruation and rate the degree of saturation for each product on a scale (typically 1-5 or 1-10), comparing to standardized images.
- The total score is calculated by multiplying the number of products by their respective saturation ratings and summing these values.
- This tool is more practical than direct blood measurement methods while being more objective than patient self-reporting alone.
Clinical Application of the PBAT
- Healthcare providers should instruct patients to document their bleeding patterns for at least one complete menstrual cycle, noting both the number and saturation of products used.
- The PBAT helps standardize assessment of menstrual blood loss, facilitates diagnosis of bleeding disorders, and allows for monitoring treatment effectiveness over time.
- Its visual nature makes it accessible to patients with varying literacy levels and provides a common reference point for patient-provider communication about menstrual bleeding.
Evidence Supporting the PBAT
- A study published in 2021 found that the PBAT can be used to differentiate self-perceived heavy and normal menstrual bleeding in Asian women in Hong Kong, with good pairwise associations of self-perceived symptoms with PBAT score and haemoglobin level 1.
- Another study published in 2017 found that PBAT scores at 12 months after treatment are significantly associated with satisfaction and reintervention rates, and proposed using the PBAT in research as a primary end point in studies on heavy menstrual bleeding (HMB) and in clinical practice as a measure to assess the effectiveness of treatment 2.
- A systematic literature review published in 2020 found that pictorial blood loss assessment charts (PBACs) represent the most widely used method to assess menstrual blood loss (MBL) in clinical trials, and that the PBAT is a simple and accurate tool for semiobjective assessment of MBL that can be used in clinical practice to aid the decision about treatment and follow-up 3.