Day 4 - Analyzing Research Papers
“Red blood cell capacity of modern menstrual products: considerations for assessing heavy menstrual bleeding”
Paper Objective/Rationale:
Currently, tampons are the sole menstrual tools that undergo industry-mediated testing for absorption efficiency. While tampons were, at one point, the primary menstrual tool used for menstrual hygiene; however, there is now a diversity of products that are often used, which calls for further study regarding the blood retention/efficacy of each.
Heavy Menstrual Bleeding Worsens Quality of Life:
Heavy menstrual bleeding is usually diagnosed through a robust clinical protocol, in which the true scope of bleeding is guaged through detailed menstrual histories so that the extent of bleeding is better defined. However, because heavy menstrual bleeding is often quite cumbersome to deal with, a simple assessment/self-report of worsening of quality of life can lead to beginning treatment for the disorder.
Pictoral Blood Loss Assessment Chart (PBAC):
The ability to precisely quantify blood loss is imperative to determine steps for medical treatment. The PBAC is the current primary cliical tool used to measure menstrual blood loss; however, only menstrual pads and tampons have been incorporated to the PBAC, thus far.
Current Industry Limitations:
Currently, only tampons have undergone capacity testing, as associations between absorbance and toxic shock syndrome have recently been drawn. Generally, period products on the market are tested using saline solution, as a proxy. However, the results derived from such testing are not completely accurate because menstrual blood is essentially a solution of blood, vaginal discharge, and endometrial cells.
While using actual menstrual blood would likely not be a feasible alternative to saline to test the collection capacity of menstrual products, blood is certainly a more viable option.
Novelty & Study Implications:
This study is the first of its kind. Prior to this study, blood had never been used to assess absorbence capacity of the plethora of currently-available menstrual products. The results of this study are critical in enabling physicians to diagnose and characterize heavy/abnormal bleeding conditions more accurately.
Methodology:
The methodology for this study was rather simple. The tampons, pads, menstrual cups and discs, and period underwear were tested in the laboratory using expired human red blood cells, and the max blood volume retention was recorded.
The authors obtained expired human blood cells that were no longer viable for clinical care from the Oregon Health & Science University.
The study was conducted in two distinct trials for pads specifically:
O+ blood was obtained for the tampon, menstrual cup, menstrual disc, and the first trial of the pad experiments. The O+ blood had expired 33 days prior to experimentation.
A second unit of O+ blood was used for the second trial of pad experiments.
The process of measuring collection capacity was methodically adapted to each tool used:
Pads & Period Underwear: The expired red blood cells were poured onto the product until blood started pooling off, and the item was considered oversaturated.
Tampons: Tampons were placed in containers containing 50 mL of red blood cells (one tampon/container)
Tampons were kept in the box until either 1) 30 minutes had elapsed or 2) the blood had reached the wick of the tampon. Blood absorbed was then calculated.
Menstrual Cups and Menstrual Discs:
Products were filled with expired red blood cells to the rim, decanted, and measured using a graduated cylinder.
21 products were tested. 1 trial per product was conducted.
Discussion, Implications, and Future Directions:
All in all, the study elucidated great variability in the capacity of different menstrual products. Menstrual discs held the most expired blood cells, but menstrual underwear held the least. The results of this study were largely contradictory to previous “industry” testing conducted on the products, which reported greater capacities than the ones reported in this study. This discrepancy is likely due to product testing with non-blood liquids. Menstrual blood is more viscous as compared to saline and water.
Limitations:
This research study successfully tested the product capacity using a better alternative to menstrual blood; however, the nature of the ex vivo testing that was performed on the lab bench simply cannot approximate the capacity of products for patients with high speed bleeding, which has an inherent adverse impact on collection capacity; likewise, ex vivo testing simply cannot replicate in vivo conditions in which the products are used in real-time.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10847380/
