Instruments to identify menstrual complaints and their impact in adolescents; a systematic review

STUDY OBJECTIVE: This review aims to create an overview of available instruments used to evaluate the menstrual complaints of dysmenorrhea and heavy menstrual bleeding (HMB) in adolescents.

METHODS: The search was conducted in Pubmed, Web of Science, Embase and Psychinfo on the 1st of December 2022. Studies published in English reporting on menstrual complaints among girls aged 10 to 19 were included. The quality and bias risk was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2.

RESULTS: Of 8994 identified studies, 57 were included. In these studies, 19 instruments were described, of which eight were validated in adolescents. One was difficult to use in daily practice, one had low sensitivity and specificity in the detection of HMB, two were validated by face validity, and two were not specifically developed to evaluate (the impact of) menstrual complaints. Therefore, only two were validated and feasible to measure adolescent menstrual complaints: the Period ImPact and Pain Assessment (PIPPA) and the Adolescent Menstrual Bleeding Questionnaire (aMBQ). Remarkably, the Pictorial Blood loss Assessment Chart (PBAC) was the most frequently used instrument in adolescents. There was one modified version of the PBAC for adolescents, which had a lower cut-off value for HMB and a low sensitivity and specificity.

CONCLUSION: We found that the PIPPA and aMBQ are suitable to assess menstrual complaints and their impact on daily activities and health-related quality of life in adolescents. The PBAC which is used frequently in adults needs to be further assessed specifically for adolescents. In particular, the clinical relevance of the PBAC cut-off value for HMB should be determined for this age group. Considering the different interpretations, experiences and limited knowledge of menstrual complaints, instruments suitable for adults may not be suitable for adolescents.