• Patient Advocacy
• Patient Rights
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• research design
• Reproductive Health

Dear Editor,

We have reviewed the article by DeLoughery et al,1 and express our gratitude for the findings as medical students passionate about women’s health.

The study reviewed a range of menstrual products and worked to quantify their absorbency.

The study’s experimental design accounted for the functional differences inherent in different menstrual products. Testing protocols were tailored for each product variant, thereby facilitating the precise quantification of absorption capacity. Moreover, the investigation featured a comparison of high versus low absorbency product categories, for both tampons and pads.

Furthermore, the study’s primary objective was to highlight the implications of differential absorbency between volumes reported by manufacturers compared with what was tested and its impact on prevailing diagnostic criteria for heavy menstrual bleeding (HMB). Given its reliance on self-reported product utilisation, this criterion could be compromised by these volume discrepancies.

However, there were limitations to this study. The anecdotal claim of the prevalence of discs and cups among individuals experiencing HMB was unsubstantiated, as it lacked empirical support within the research or in its references. Integrating a survey that scrutinised product preferences among individuals with and without heavy menstrual bleeding could have provided valuable insights into usage trends.

Additionally, the study acknowledged the dissimilarity between aged red blood cells (RBCs) and actual menstrual blood. However, it highlighted that the RBC samples obtained were of different ages (33 days old and 48 days old.) This raises the question of whether discrepant coagulation rates could have influenced the outcomes. The potential divergence in blood absorption between in vivo menstrual usage and ex vivo laboratory testing also introduces a factor that has an impact on the broader applicability of the findings.

This research has raised potential questions. First, how could the actual composition of menstrual blood be replicated experimentally? This study is a fantastic start, but as it mentions, how could other components of menstrual blood affect absorption?

Women typically lose 48 mL of blood during their period, compared with >80 mL with HMB.2 The research states HMB is often associated with flooding.1 Future work could focus on further characterising ‘flooding’, a hallmark of HMB, and what this means for testing period products used by patients with HMB.2

There is massive potential for follow-up of this study. The study aims to improve the diagnosis of HMB. HMB is a common symptom of gynaecological conditions such as polycystic ovary syndrome (PCOS)3 and endometriosis.4 If HMB diagnosis is improved in a clinical setting, then it might help doctors identify more cases of PCOS and endometriosis, which typically go under-recognised, with long waits for diagnosis5

Furthermore, there is opportunity for testing of a larger range of products. Different brands could be compared to verify their absorbency claims. This could highlight discrepancies between brands. Do brands claiming to be super absorbent, for example, absorb similar amounts of blood? If different brands have different capacities, it shows an issue with the Pictorial Blood Loss Assessment Chart, when asking how many products are bled through for diagnosis.

Vitally, the research reveals an industry-wide issue with the market regulation of these products. It demonstrates that testing with water has led to inaccurate absorbency claims, which ultimately will affect how women choose their products.

To conclude, we have analysed some of the study’s key findings about period product absorbency. This study shows that HMB diagnosis guidelines need reviewing as well as menstrual product regulations. We are optimistic that this study could change the landscape of women’s health.