Complete guide
The Higham Score: definition, criteria and interpretation
Everything you need to know about this recognised clinical tool for assessing menstrual flow abundance: from its history to the precise interpretation of your results.
- Updated in 2025
- Reading time: 8 min
- Medically verified content
History and origins of the Higham score
The Higham score was developed in 1990 by Dr J.M. Higham and colleagues in the United Kingdom. At the time, the assessment of heavy periods relied almost entirely on the subjective experience of patients — an approach insufficient for clinical practice.
The stakes were high: menorrhagia (pathologically heavy periods) affects approximately 20% of women of childbearing age, yet without a standardised tool, diagnosis remained vague and treatment was often delayed. The Higham score provided a simple, practical and reproducible solution.
Published in the British Journal of Obstetrics and Gynaecology, this tool is now used in many countries and recommended by several gynaecological societies as an objective method for assessing menstrual flow.
How it works
The Higham score is based on a menstrual diary kept throughout the entire cycle. Each day, the patient records the number and level of saturation of their sanitary protection, as well as the presence of any clots or leaks.
Each observation corresponds to a predefined number of points. All points are added up at the end of the cycle to obtain the total score. This score is then compared against the clinical threshold of 100 points, above which menorrhagia is diagnosed.
The strength of the Higham score lies in its simplicity and accessibility: it requires no medical equipment, can be completed at home, and provides objective data that can be used immediately in a clinical consultation.
Detailed criteria and scoring
Below is the official Higham score chart. Each protection used is assessed according to its observed level of saturation:
| Type of protection | Level of saturation | Points |
|---|---|---|
| Sanitary pad | Lightly soiled (traces) | 1 pt |
| Sanitary pad | Moderately soiled (< half) | 5 pt |
| Sanitary pad | Completely saturated | 20 pt |
| Tampon | Lightly soiled | 1 pt |
| Tampon | Moderately soiled | 5 pt |
| Tampon | Completely saturated | 20 pt |
| Menstrual cup | Less than a quarter full | 1 pt |
| Menstrual cup | Half full | 5 pt |
| Menstrual cup | Full | 20 pt |
| Clots | Small | 1 pt / clot |
| Clots | Large | 5 pts / clot |
| Leaks | Stain on underwear or sheets | 5 pts / incident |
Interpreting the results
Normal
Normal to moderate flow
Menstrual loss is within physiological norms. No menorrhagia is detected. Monitoring remains advisable if symptoms are debilitating despite a low score.
Elevated
Mild to moderate menorrhagia
The clinical threshold for menorrhagia has been exceeded. A medical consultation is advised to assess the potential risk of iron-deficiency anaemia and to discuss treatment options.
Severe
Severe menorrhagia
Blood loss is very significant and has a major impact on quality of life. An urgent medical assessment is recommended, including a blood test (FBC, ferritin) and a gynaecological evaluation.
Limitations and precautions
Like any clinical tool, the Higham score has certain limitations worth knowing:
Partial subjectivity: Assessing the level of saturation of a protection remains subjective from one person to another. Two women may score the same amount of blood differently.
Types of protection: The score was initially validated using conventional pads and tampons. The inclusion of the menstrual cup is more recent and may require some adaptation in interpretation.
Not suitable for all situations: The Higham score is not designed to assess postpartum bleeding, metrorrhagia (bleeding between periods) or postmenopausal bleeding, all of which require a separate medical evaluation.
Higham score vs other methods
Several methods exist for assessing menstrual flow abundance. Here is how the Higham score compares to the main alternatives:
Higham score
Recommended
- Simple to carry out at home
- Compatible with cup, tampon, pad
- Validated clinical threshold
- Longitudinal tracking possible
- Recommended en consultation
Alkaline haematin measurement
- Laboratory reference method
- Highly precise (measures in ml)
- Cannot be done at home
- Reserved for clinical research
- Not available in routine practice
How to use the score in daily life
To get the most out of the Higham score, here are the recommended best practices:
1. Start from the first day of your period. The score is calculated over the entire cycle — do not start partway through, as you will lose important data.
2. Record in real time. Log each protection at the time of changing it. Memory is unreliable, especially over several days.
3. Repeat over several cycles. A single score may be atypical. Tracking 2 to 3 consecutive cycles gives a much more representative picture.
4. Bring your results to your appointment. A history of scores is a valuable tool for your doctor or gynaecologist, far more useful than a verbal description.
📱 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.