Higham score calculator for menstrual blood loss

The Higham score is based on a multi-day scorecard including the menstrual period. A printout can be given to the patient by following the following link and printing the grid on a full page:
download menstruation evaluation grid

Total number of tampons or towels...

Total number of clots...

Score :

Menstruation is a natural phenomenon that women experience, but excessive menstrual blood loss can be disruptive to their well-being. To assess the severity of menstrual bleeding, healthcare professionals often employ the Higham score, a widely recognized tool. This score helps determine whether a woman's menstrual bleeding falls within normal parameters or if further evaluation and treatment are required. In this article, we will delve into the intricacies of the Higham score, examining its components, interpretation, and significance in evaluating menstrual blood loss. Equipped with knowledge about the Higham score, women can engage in informed conversations with their healthcare providers and explore appropriate management options. By understanding and utilizing this assessment tool, women can take control of their menstrual health and improve their overall quality of life.

The Higham Score: Overview and Components

The Higham score is a widely used tool in assessing menstrual blood loss. It helps healthcare professionals determine the severity of menstrual bleeding and whether it falls within normal ranges or requires further evaluation and treatment. The score was developed by Higham et al. and provides a quantitative measure of menstrual blood loss.

The Higham score takes into account several components to assess the volume of menstrual blood loss. These components include:

  1. Pictorial Blood Loss Assessment Chart (PBAC): The PBAC is a visual chart that allows women to estimate the amount of blood loss during their menstrual cycle. It uses pictorial representations of different levels of bleeding, ranging from "spotting" to "very heavy bleeding." Women mark the level that best corresponds to their bleeding patterns on each day of their menstrual cycle.

  2. Duration of menstrual bleeding: The Higham score also considers the duration of menstrual bleeding. A shorter duration may indicate less overall blood loss compared to a longer duration.

  3. Number of tampons or pads used: The number of tampons or pads used during the menstrual cycle is another factor in the Higham score. A higher number suggests increased blood loss.

  4. Presence of clots: The presence of clots in menstrual blood is taken into account. Larger or more frequent clots may indicate heavier bleeding.

Each component of the Higham score is assigned a score ranging from 0 to 3, depending on the severity. These scores are then summed to give a total score, which helps classify menstrual blood loss into different categories:

  • Score of 0-5: Normal menstrual blood loss.
  • Score of 6-10: Mildly increased blood loss.
  • Score of 11-20: Moderately increased blood loss.
  • Score of 21 or higher: Severely increased blood loss.

By using the Higham score, healthcare professionals can assess the severity of menstrual bleeding and guide appropriate management options for women experiencing excessive blood loss. It provides an objective measure to quantify and track changes in menstrual blood loss over time, helping to identify potential underlying causes and tailor treatment plans accordingly.

Interpreting the Higham Score

Interpreting the Higham score involves analyzing the total score obtained from the different components and understanding its implications in assessing menstrual blood loss. Here's how the Higham score is typically interpreted:

  1. Normal menstrual blood loss (Score 0-5): A total score within this range indicates that the woman's menstrual bleeding falls within the expected and normal range. It suggests that the amount of blood loss, duration, number of tampons or pads used, and presence of clots are all within the expected parameters for a regular menstrual cycle.

  2. Mildly increased blood loss (Score 6-10): If a woman's Higham score falls within this range, it suggests a mild increase in menstrual blood loss. While it may not be a cause for immediate concern, it is worth monitoring for any further changes or symptoms. Healthcare professionals may recommend lifestyle modifications, such as iron supplementation to prevent iron deficiency anemia, and encourage the use of non-hormonal interventions to manage bleeding.

  3. Moderately increased blood loss (Score 11-20): A total score within this range indicates a moderate increase in menstrual blood loss. It suggests that the woman is experiencing a significant amount of blood loss during her menstrual cycle. Healthcare professionals may consider further evaluation and treatment options, such as hormonal therapies (e.g., combined oral contraceptives, progestogens) or minimally invasive procedures (e.g., endometrial ablation) to manage the heavy bleeding.

  4. Severely increased blood loss (Score 21 or higher): A total score of 21 or higher indicates a severe increase in menstrual blood loss. This suggests that the woman is experiencing excessive and potentially debilitating bleeding during her menstrual cycle. Healthcare professionals may recommend more extensive investigations, such as ultrasound imaging, hysteroscopy, or endometrial biopsy, to identify and address any underlying causes. Treatment options may include hormonal therapies, minimally invasive procedures, or in some cases, surgical interventions like hysterectomy.

It is important to note that the Higham score is just one tool used in the assessment of menstrual blood loss. Healthcare professionals consider the score alongside the individual's symptoms, medical history, and physical examination findings to make a comprehensive evaluation. Each person's experience with menstrual bleeding may vary, and personalized management plans are tailored to address specific needs.

Women who are concerned about their menstrual blood loss should discuss their symptoms and the Higham score with a healthcare professional. Open communication and collaboration with healthcare providers are essential in determining the appropriate management options and ensuring optimal menstrual health.

Significance of the Higham Score

The Higham score holds significant importance in assessing menstrual blood loss and guiding appropriate management options. Here are some key reasons why the Higham score is significant:

  1. Quantitative assessment: The Higham score provides a quantitative measure of menstrual blood loss. It allows healthcare professionals to objectively evaluate the severity of bleeding by considering various components such as bleeding patterns, duration, tampon/pad usage, and clots. This standardized scoring system helps ensure consistency in assessing and tracking menstrual blood loss over time.

  2. Identification of abnormal bleeding: Excessive menstrual blood loss can be a sign of an underlying condition or hormonal imbalance. The Higham score helps distinguish between normal and abnormal bleeding patterns. By interpreting the score, healthcare professionals can identify women who may benefit from further evaluation and treatment for conditions such as uterine fibroids, endometriosis, adenomyosis, or bleeding disorders.

  3. Treatment guidance: The Higham score aids in determining appropriate management options based on the severity of menstrual blood loss. Women with mild to moderately increased blood loss may benefit from lifestyle modifications, non-hormonal interventions, or hormonal therapies. For those with severely increased blood loss, more extensive evaluations and interventions may be necessary, including minimally invasive procedures or, in severe cases, surgical interventions. The Higham score guides healthcare professionals in selecting the most suitable treatment strategies.

  4. Monitoring treatment effectiveness: The Higham score is a useful tool for monitoring the effectiveness of interventions or treatments aimed at reducing menstrual blood loss. By assessing the Higham score over time, healthcare professionals can track changes in bleeding patterns and determine if the chosen management approach is effective or if adjustments need to be made.

  5. Patient communication and empowerment: The Higham score allows for effective communication between women and their healthcare providers. By understanding their Higham score and its interpretation, women can actively participate in discussions about their menstrual health, ask relevant questions, and make informed decisions regarding their treatment options. This empowers women to take control of their health and advocate for their well-being.

  6. Research and epidemiological studies: The Higham score serves as a valuable tool in research and epidemiological studies focused on menstrual blood loss and related conditions. It enables researchers to categorize and analyze data consistently, contributing to a better understanding of menstrual health patterns and the impact of interventions.

Seeking Medical Evaluation

If you have concerns about your menstrual blood loss, it is important to seek medical evaluation, especially if you suspect it is excessive or interfering with your daily life. Here are some reasons to consider consulting a healthcare professional:

  1. High Higham score: If you have calculated your Higham score and it falls within the range of mildly, moderately, or severely increased blood loss, it is advisable to seek medical evaluation. A high score may indicate the need for further investigation and management.

  2. Impact on daily life: If your menstrual bleeding is significantly affecting your quality of life, causing excessive pain, fatigue, or interfering with your ability to carry out daily activities, it is essential to consult a healthcare professional. Excessive blood loss can lead to anemia, which can further exacerbate symptoms and impact overall well-being.

  3. Changes in menstrual patterns: If you have noticed a sudden change in your menstrual patterns, such as a significant increase in bleeding or irregular cycles, it is advisable to seek medical evaluation. Changes in menstrual patterns can be a sign of an underlying condition that requires assessment and appropriate management.

  4. Bleeding disorders or family history: If you have a known bleeding disorder or a family history of bleeding disorders, it is important to consult with a healthcare professional. They can evaluate your symptoms, medical history, and recommend appropriate investigations to determine the cause of excessive bleeding.

  5. Concerns about hormonal imbalance or reproductive health: If you have concerns about hormonal imbalances or reproductive health issues that may be related to your menstrual bleeding, it is recommended to seek medical evaluation. A healthcare professional can conduct a thorough assessment, perform necessary investigations, and provide appropriate treatment options.

In conclusion, the Higham score is a useful tool in evaluating menstrual blood loss and guiding appropriate management decisions. Understanding the components and interpretation of the Higham score empowers women to actively engage in discussions with healthcare providers and seek necessary interventions. If you are experiencing abnormal menstrual bleeding, tracking your blood loss using the Higham score can aid in diagnosis and facilitate personalized treatment. Remember to maintain open communication with healthcare professionals to ensure effective management and prioritize your overall well-being.