Missing Cases of Heavy Menstrual Bleeding when Investigating the Etiology of Iron Deficiency

Due to incorrect answers to simple questions like ``Do you have heavy menstrual bleeding?'', heavy menstrual bleeding, the most prevalent cause of iron deficiency in women, is underdiagnosed. In this retrospective and cross-sectional study, menstruating female patients who applied to the iron deficiency outpatient clinic between April and September 2021 were analyzed. Scores on the picture bleeding assessment chart (PBAC) and complaints of heavy menstrual bleeding were recorded. The chi-square test and confusion matrix were conducted. There were 157 patients in the sample. There were 82 patients who said they did not have heavy menstrual bleeding, while 75 patients said they did ($$\chi^2(1)=19.7$$, $$p<0.001$$). Sixty percent of patients who did not report significant bleeding had a PBAC score greater than 100, with a median score of 184. The Chi-square test revealed a significant difference between complaints of heavy menstrual bleeding (yes/no) and PBAC (normal/high). The negative predictive value was calculated to be 40.2, while the false miss rate was 59.8%. Six out of ten patients who are investigated for iron deficiency and whose primary cause is heavy menstrual bleeding may be overlooked by this query. In such etiologic investigations, much more objective methodologies, such as PBAC, should be applied.