Application of PALM-COEIN FIGO classification in diagnosis of abnormal uterine bleeding (AUB) patients

Sharda B Ahmed, Sushma Mogri
In: Indian Journal of Obstetrics and Gynecology Research · 2018 · vol. 5(2) , pp. 278–281 · doi:10.18231/2394-2754.2018.0061 · W3027222520
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

This study classified 350 women with abnormal uterine bleeding using the PALM-COEIN system, finding ovulatory dysfunction and leiomyoma to be the most prevalent causes.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

The paper studied 350 reproductive-age women with abnormal uterine bleeding (AUB) for at least 3 months, using structured history, physical and local pelvic examination, investigations including ultrasound, and endometrial histopathology to assign causes using the PALM-COEIN FIGO classification and then provide treatment aligned with the category. The most prevalent AUB cause was ovulatory dysfunction (28.2%), followed by leiomyoma (25.7%) and endometrial causes (14.5%), with adenomyosis identified in 8.5% of cases; malignancy/hyperplasia, polyps, iatrogenic causes, and coagulopathy were less frequent, and 9.7% were “not yet classified.” The authors’ main caveat is that classification relied on the available clinical, imaging, and histopathology assessments, leaving a subset not yet classified and providing only a single-center outpatient snapshot. Relevance to endometriosis and/or adenomyosis: adenomyosis is explicitly reported as an AUB category with 30/350 (8.5%) cases, though the study’s overall focus is applying PALM-COEIN classification to diagnose AUB causes.

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Abstract

Objective: The aim is to categorize women with AUB as per the PALM-COEIN classification system as this is a step towards cause based diagnosis and focused management of patients. The acronym PALM-COEIN comes from arranging 9 basic categories of the classification system. The PALM group comprises the structural entities, which can be measured visually or by using imaging techniques and histopathology. The COEIN group comprises the non-organic types which cannot be defined by imaging or histopathology. Materials and Methods: The study comprises 350 women of reproductive age with AUB for minimum 3 months time span. It describes and observes AUB in amount, interval and frequency for women attending outpatient Gynae department of AIIMS, Udaipur (Raj) from Nov 16 to Oct 17. They were assessed on the basis of structured history, physical examination, local pelvis examination, investigations, USG findings and endometrial histopathological report. Cause of AUB was determined and treatment was given to the patient as appropriated by categorization done in agreement with the PALM-COEIN classification. Results: The most prevalent cause of AUB was ovulatory dysfunction (n=99, 28.2%). Next common cause was leiomyoma (n=90, 25.7%), followed by endometrial causes (n=52, 14.5%), adenomyosis (n=30, 8.5%), not yet classified (n=32, 9.7%), Malignancy & Hyperplasia (n=28, 8.1%), Polyp (n=9, 2.5%), Iatrogenic (n=7, 2.2%) and Coagulopathy (n=1, 0.3%). Conclusion: The PALM-COEIN classification helps to practically ascertain the cause of AUB, and thereby effectively adopt the correct treatment for AUB patients. Keywords: Abnormal uterine bleeding, AUB, Classification system, Polyp leiomyoma, Adenomyosis, Ovulation, Malignancy
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Objective

The aim is to categorize women with AUB as per the PALM-COEIN classification system as this is a step towards cause based diagnosis and focused management of patients. The acronym PALM-COEIN comes from arranging 9 basic categories of the classification system. The PALM group comprises the structural entities, which can be measured visually or by using imaging techniques and histopathology. The COEIN group comprises the non-organic types which cannot be defined by imaging or histopathology.

Materials and methods

The study comprises 350 women of reproductive age with AUB for minimum 3 months time span. It describes and observes AUB in amount, interval and frequency for women attending outpatient Gynae department of AIIMS, Udaipur (Raj) from Nov 16 to Oct 17. They were assessed on the basis of structured history, physical examination, local pelvis examination, investigations, USG findings and endometrial histopathological report. Cause of AUB was determined and treatment was given to the patient as appropriated by categorization done in agreement with the PALM-COEIN classification.

Results

The most prevalent cause of AUB was ovulatory dysfunction (n=99, 28.2%). Next common cause was leiomyoma (n=90, 25.7%), followed by endometrial causes (n=52, 14.5%), adenomyosis (n=30, 8.5%), not yet classified (n=32, 9.7%), Malignancy & Hyperplasia (n=28, 8.1%), Polyp (n=9, 2.5%), Iatrogenic (n=7, 2.2%) and Coagulopathy (n=1, 0.3%).

Conclusion

The PALM-COEIN classification helps to practically ascertain the cause of AUB, and thereby effectively adopt the correct treatment for AUB patients.

Keywords

Abnormal uterine bleeding, AUB, Classification system, Polyp leiomyoma, Adenomyosis, Ovulation, Malignancy How to Cite This Article Vancouver Ahmed SB, Mogri S. Application of PALM-COEIN FIGO classification in diagnosis of abnormal uterine bleeding (AUB) patients [Internet]. Indian J Obstet Gynecol Res. 2018 [cited 2026 Jun 08];5(2):278-281. Available from: https://doi.org/10.18231/2394-2754.2018.0061 APA Ahmed, S. B., Mogri, S. (2018). Application of PALM-COEIN FIGO classification in diagnosis of abnormal uterine bleeding (AUB) patients. Indian Journal of Obstetrics and Gynecology Research, 5(2), 278-281. https://doi.org/10.18231/2394-2754.2018.0061 MLA Ahmed, Sharda B, Mogri, Sushma. "Application of PALM-COEIN FIGO classification in diagnosis of abnormal uterine bleeding (AUB) patients." Indian J Obstet Gynecol Res, vol. 5, no. 2, 2018, pp. 278-281. https://doi.org/10.18231/2394-2754.2018.0061 Chicago Ahmed, S. B., Mogri, S.. "Application of PALM-COEIN FIGO classification in diagnosis of abnormal uterine bleeding (AUB) patients." Indian J Obstet Gynecol Res 5, no. 2 (2018): 278-281. https://doi.org/10.18231/2394-2754.2018.0061

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