Frequently asked questions
All your questions about the Higham score
Calculation, interpretation, menorrhagia, app, anaemia: find answers here to the most frequently asked questions about the Higham score.
Understanding the score
What is the Higham score exactly?
The Higham score is a semi-quantitative medical tool created in 1990 to assess menstrual flow abundance. It assigns a number of points to each protection used according to its type and level of saturation, with additional points for clots and leaks.
The total score is calculated over the entire cycle. A score above 100 points corresponds to the clinical threshold for menorrhagia.
What is the menorrhagia threshold according to the Higham score?
The clinical threshold is set at 100 points per cycle. Above this score, the condition is referred to as menorrhagia (abnormally heavy periods). A score above 150 indicates severe menorrhagia requiring urgent medical assessment.
This threshold was validated by comparing the score with direct measurements of blood volume lost (alkaline haematin method).
How is the Higham score calculated in practice?
For each protection used during the cycle, you assign points according to the official chart:
Pads: lightly soiled = 1 pt · moderately = 5 pts · saturated = 20 pts
Tampons: lightly soiled = 1 pt · moderately = 5 pts · saturated = 20 pts
Cup: less than a quarter = 1 pt · half = 5 pts · full = 20 pts
Clots: small = 1 pt · large = 5 pts per clot
Leaks: 5 pts per incident
All these points are added together over the entire cycle to give the final score.
Is the Higham score reliable?
Yes, the Higham score is a scientifically validated clinical tool, published in the British Journal of Obstetrics and Gynaecology. It is used in many countries and recommended by gynaecological societies as an objective method for assessing menstrual flow.
Its reliability depends, however, on the rigour with which the diary is kept. Recording in real time (at the moment of changing protection) gives significantly more reliable results than reconstructing entries at the end of the day.
Is the Higham score reliable?
The Higham score measures only the volume of flow, not pain. It is entirely possible to have a low score with significant dysmenorrhoea (painful periods), particularly in cases of endometriosis.
If your periods are very painful even with a normal score, consult a doctor to investigate possible endometriosis or another condition.
Menorrhagia & health
Menorrhagia or heavy periods: what's the difference?
Both terms refer to the same reality. “Menorrhagia” is the medical term for abnormally heavy periods, defined as a volume exceeding 80 ml per cycle, a duration of more than 7 days, or both.
The medical term is useful in consultations as it helps to quickly guide further investigations.
My Higham score is high. Should I see a doctor?
If your score exceeds 100 over one or more cycles, a medical consultation is advised. Bring your diary with detailed scores (ideally over 2 to 3 cycles).
Your doctor may request a blood test (FBC, ferritin, coagulation screen) and a pelvic ultrasound to identify a cause.
Can heavy periods cause anaemia?
Yes. Menorrhagia is one of the leading causes of iron-deficiency anaemia in women. Repeated heavy blood loss depletes iron stores, leading to chronic fatigue, breathlessness, pallor and difficulty concentrating.
If your score is regularly above 100, ask for a ferritin test as part of your blood work. Ferritin levels can drop well before anaemia becomes visible on the FBC.
What is the difference between menorrhagia and metrorrhagia?
Menorrhagia: excessive bleeding occurring only at the time of periods (during the menstrual phase).
Metrorrhagia: bleeding occurring outside of periods, at any point in the cycle. This is a different symptom requiring prompt medical consultation, as the causes are distinct.
The Higham score assesses menorrhagia only, not metrorrhagia.
Can heavy periods improve without treatment?
In some cases yes, particularly with functional menorrhagia linked to a temporary hormonal imbalance (perimenopause, postpartum, significant stress). Flow may regulate itself spontaneously.
However, if heavy periods persist over several cycles, a consultation is necessary to rule out an organic cause (fibroid, adenomyosis, coagulation disorder).
The app
How do I download the Score de Higham app?
The app is available free of charge on the Apple App Store, for iPhone only. Search for “Score de Higham” in the App Store or click the download link on this site.
Does the app work offline?
Yes. All your data is stored locally on your iPhone. You do not need an internet connection to log your protection use, view your score, or generate a PDF report.
Can I use the app with a cup and pads at the same time?
Yes. The app handles all types of protection (cup, tampon, pad) with their specific scoring. You can use several types of protection on the same day or within the same cycle, and the calculation adjusts automatically.
Is the PDF report generated by the app usable in a medical consultation?
Yes. The PDF report contains your score history by cycle, a breakdown of the protection logged, and an interpretation against clinical thresholds. It is a structured document you can send by email to your doctor or bring printed to your appointment.
It does not replace a medical diagnosis but provides a valuable starting point for the consultation.
Is my health data kept confidential?
Yes, absolutely. The app collects no personal data and uses no external servers. All your entries are stored securely and locally on your iPhone. Neither the app developer nor any third party has access to your cycle information.
General questions
Can the Higham score be used after childbirth?
No. The Higham score is designed to assess normal menstrual periods within a gynaecological cycle. Lochia (postpartum bleeding) has a different nature and physiology and should not be assessed with this tool.
If you experience heavy bleeding after childbirth, contact your midwife or maternity unit directly.
From what age can the Higham score be used?
The Higham score can be used from the very first period. It is particularly useful for adolescents who experience heavy flow from puberty.
Is the Higham score recognised by doctors in France?
Yes. The Higham score is a recognised medical tool used in gynaecological consultations. It is recommended in professional guidelines for the assessment of menorrhagia.
Presenting your score diary to your doctor is a relevant and well-received approach in clinical consultations.
Does the Higham score replace a medical consultation?
No. The Higham score is a guidance and monitoring tool, not a diagnostic instrument. It allows flow to be objectively quantified and facilitates communication with a doctor, but does not replace clinical examination, laboratory tests and medical imaging.
If your score is high over several cycles, or if you have other symptoms (pain, intense fatigue, pallor), consult a healthcare professional.
📱 Calculate your score
Record your protection use day by day. The app calculates your score in real time and generates a PDF report for your doctor.