Evaluation and Management of Abnormal Uterine Bleeding (AUB)

Aim: This study aims to evaluate the clinical patterns, diagnostic approaches, and management outcomes of abnormal uterine bleeding (AUB) in 200 reproductive-age women attending a tertiary care center in Bhopal, India, from January 2025 to December 2025. The primary objective was to classify AUB using the PALM-COEIN system, assess treatment efficacy, and identify predictors of recurrence. Materials and Methods: A prospective observational study was conducted on 200 non-pregnant women aged 18-50 years with AUB. Inclusion criteria included menstrual frequency 38 days, duration >7 days, or blood loss >80 mL/cycle. Exclusion criteria comprised pregnancy, coagulopathy, and malignancy. Evaluation involved detailed history, pelvic examination, transvaginal ultrasound (TVUS), endometrial biopsy, and hematological tests. Management followed FIGO guidelines: medical (tranexamic acid, NSAIDs, hormonal therapies) for initial control, with surgical options (endometrial ablation, hysterectomy) for refractory cases. Results: PALM-COEIN classification showed structural causes (PALM) in 42% (polyps 18%, adenomyosis 12%, leiomyoma 10%, malignancy 2%) and non-structural (COEIN) in 58% (ovulatory dysfunction 32%, endometrial 15%, coagulopathy 6%, iatrogenic 3%, neoplasia 2%). Medical management succeeded in 78% at 6 months, with combined oral contraceptives (COCs) most effective (85% response). Recurrence occurred in 22%, higher in adenomyosis (35%). Hemoglobin improved from 9.2±1.8 g/dL to 11.4±1.5 g/dL (p<0.001). Conclusion: Tailored evaluation using PALM-COEIN and stepwise management significantly improves outcomes in AUB, with medical therapy as first-line. Early TVUS and biopsy enhance diagnostic yield, reducing surgical interventions by 40%. Future studies should explore long-term LNG-IUS efficacy in Indian cohorts.