Today I review, link to, and excerpt from an article on how to take a menstrual history, Discussing menstrual health in family medicine. [No PupMed Abstract] [Full-Text HTML] [Full-Text PDF]. Fam Med Community Health. 2024 Apr 10;12(2):e002149. doi: 10.1136/fmch-2023-002149.
There are 100 similar articles in PubMed.
Alll that follows is from the above resource.
Family medicine clinicians and menstrual health
The scope of menstruation and menstrual wellness is expansive, with connections to family planning, sexual wellness, diet and exercise habits, and mental health.6 Patients can feel more in control of their bodies by understanding their menstrual cycle and its full-body impacts overall.1
*See also #471 Iron Deficiency Anemia with Dr. Tom DeLoughery
February 17, 2025 | By Sai Achi
Achi SS, DeLoughery T, Williams PN, Watto MF. “#471 Iron Deficiency Anemia”. The Curbsiders Internal Medicine Podcast. thecurbsiders.com/category/curbsiders-podcast 17 February 2025.
“History Take for Anemia in Menstruating Women”
“Don’t forget a thorough menstrual history! This is a crucial part of the history in menstruating women– heavy menstrual bleeding affects up to 50% of women of the reproductive age. Per the WHO (World Health Organization), iron deficiency anemia is the most common micronutrient deficiency worldwide and affects more than about 20% of reproductive age women- some studies have found that 34% of the reproductive age women were iron deficiency and others found that 30-70% women were iron deficient based on the ferritin cutoff. (Munro 2023), (McLean 2008, Tawfik 2024, Weyand 2023). Menstrual history questions to ask include: age of menarche, length of cycles, if cycles are heavy, number of pads/tampons, etc. Taking a good history is always important because almost 75-90% of women often view their symptoms as normal and cope with their symptoms and don’t usually mention these symptoms to their doctors (Casola 2024). Dr. DeLoughery mentions that there is an immense imbalance especially in women between the required iron supplementation and that which is obtained from the diet.” Menstrual history taking is well covered in today’s main resource: Discussing menstrual health in family medicine.
Resuming excerpts from Discussing menstrual health in family medicine
Menstrual products
The choice of a menstrual product that fits best with a patient’s lifestyle can impact their quality of life.4 Products such as tampons and menstrual cups/discs might allow a patient to be more active. Cups and discs can allow for much longer wear without changing compared with tampons and pads. Period underwear allows the patient to essentially free bleed without fear of leakage. A period tracker app, though not a traditional menstrual product, can be useful for both patient and clinician to notice changes in a patient’s menstrual cycle throughout their life as well as predict when any symptoms may start regardless of whether it aligns with bleeding. Below is a table of available period products as well as some discussion points for talking to patients about each one (table 1).
CONVERSATION STARTERS
Asking a patient when their last menstrual period was is fairly common practice to gauge regularity and risk of pregnancy. It should not be assumed that because a patient does not bring up their menstrual cycle it is not negatively affecting their life.9
For example, premenstrual dysphoric symptoms affect 75%–90% of women3–6 and are often seen as normal and something that people who menstruate just cope with. However, many of the symptoms can be treated with hormonal contraceptive options, anti-inflammatory medications or even just general counselling from a clinician. Despite this, menstrual historytaking varies among primary care clinicians and is often
incomplete.3 Detailed history-taking can help assess how
a patient’s menstrual cycle is affecting their life. Here are
several such questions that you can ask any menstruating
patient to assess whether they have any symptoms that you
can help treat (table 2).
With these simple conversation starters, it is possible to identify patients with menstrual concerns that may not have otherwise been reported. Each of these prompts could segue into an opportunity for counselling and/or medical treatment that can easily be provided and improve the patient’s quality of life. These questions can be incorporated as part of wellness visits and as needed for related problem visits. Use the International Federation of Gynecology and Obstetrics table to guide normal
and abnormal menstrual symptoms to guide clinical decision-making10 (figure 1).
Consider having patients complete a questionnaire regarding their menstrual health as it may assist provide privacy and avoid embarrassment around this sensitive topic. Family medicine clinicians should continue to emphasise the normalcy of these issues with patients, reassure them that these Lconversations are appropriate and necessary and that their clinician is a readily available resource for questions surrounding all these issues.
Many women have troublesome premenapausal or menopausal symptoms but may not mention them to their doctor as they may assume the symptoms are normal and/or there are no treatments to mitigate the symptoms.
See DAILY RECORD OF SEVERITY OF PROBLEMS [Link is to the PDF of menstrual problems]
