Categorization of patients with abnormal uterine bleeding according to PALM-COEIN FIGO classification

Arihant Tater, Prakash C. Jain, Kamal Nayan Sharma
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2019 · vol. 8(12) , pp. 4783 · doi:10.18203/2320-1770.ijrcog20195320 · W2990879651
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⚙ AI-generated summary by claude@2026-06, 2026-06-11 ⓘ

This retrospective study on 200 abnormal uterine bleeding patients found ovulatory dysfunction, leiomyoma, and endometrial causes to be the most frequent etiologies according to the PALM-COEIN classification.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This retrospective study categorized 200 reproductive-age patients with abnormal uterine bleeding using the FIGO PALM-COEIN classification based on history, examination, investigations, and histopathology reports. Ovulatory dysfunction was the most common etiology (30%), followed by leiomyoma (24%) and endometrial causes (19%), with adenomyosis accounting for 13%; the remaining categories were less frequent, including malignancy and coagulopathy (1% each). The paper’s main limitation is that it is a single-center retrospective categorization without a stated comparison or validation of diagnostic accuracy beyond the work-up and histopathological findings. Relevance to endometriosis: adenomyosis is included as a PALM-COEIN category and is quantified as an etiology (n=26, 13%), linking this AUB classification work to uterine pathology closely related to the endometriosis/adenomyosis research space.

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Abstract

Background: Abnormal uterine bleeding is a common problem of the women in the reproductive age group and leads to the frequent visits of women in hospitals to health care providers. In an effort to create a universally accepted system of nomenclature to describe uterine bleeding abnormalities in reproductive-aged women, an alternative classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN developed.Methods: It is a retrospective study on 200 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patient grouped under these categories after detailed history, examination, investigations and histopathological reports.Results: Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=60, 30%). It was followed by leiomyoma (n=48, 24%) and endometrial causes (n=38, 19%) and were the top three etiologies for AUB respectively. Adenomyosis (n=26, 13%), not classified (n=12, 6%), iatrogenic (n=8, 4%), polyp (n=4, 2%) and malignancy and coagulopathy each (n=2, 1%) contributing least to the PALM-COEIN classification as an etiology for AUB.Conclusions: PALM-COEIN classification is a universally accepted and consistent method of knowing exact etiology following investigations, so the proper treatment can be done for AUB.
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Background

Abnormal uterine bleeding is a common problem of the women in the reproductive age group and leads to the frequent visits of women in hospitals to health care providers. In an effort to create a universally accepted system of nomenclature to describe uterine bleeding abnormalities in reproductive-aged women, an alternative classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN developed.

Methods

It is a retrospective study on 200 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patient grouped under these categories after detailed history, examination, investigations and histopathological reports.

Results

Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=60, 30%). It was followed by leiomyoma (n=48, 24%) and endometrial causes (n=38, 19%) and were the top three etiologies for AUB respectively. Adenomyosis (n=26, 13%), not classified (n=12, 6%), iatrogenic (n=8, 4%), polyp (n=4, 2%) and malignancy and coagulopathy each (n=2, 1%) contributing least to the PALM-COEIN classification as an etiology for AUB.

Conclusions

PALM-COEIN classification is a universally accepted and consistent method of knowing exact etiology following investigations, so the proper treatment can be done for AUB. Metrics

References

ACOG Committee on Practice Bulletins - Gynecology. ACOG Practice Bulletin No 108: Polycystic ovary syndrome. Obstet Gynecol. 2009;114:936-49. Committee on Practice Bulletins-Gynecology. Practice bulletin no. 128: Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197-206. Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO working group on menstrual disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13. Barclay L, Murata P. New classification system categorizes causes of abnormal uterine bleeding. Int J Gynecol Obstet. 2011;113:3-13. Abnormal uterine bleeding (AUB) new standardized terminology, definitions, and classification. Available at: http://www.acog.org/-/media/ District VIII/ AbnormalUterineBleeding.pdf. Accessed on 21st December 2015. Abnormal uterine bleeding. The American College of Obstetricians and Gynecologists. FAQ095, December 2012. Available at: http://www.acog.org/ Patients/FAQs/AbnormalUterine-Bleeding. Accessed on 21st December 2015. Qureshi FU, Yususf AW. Distribution of causes of abnormal uterine bleeding using the new FIGO classification system. J Pak Med Assoc 2013: 63:974. Khrouf M, Terras K. Diagnosis and management of formerly called - dysfunctional uterine bleeding‖ according to PALM-COEIN FIGO classification and the newguidelines. J Obstet Gynaecol India. 2014;64:388-93. Madhra M, Fraser IS, Munro MG, Critchley HO. Abnormal uterine bleeding: Advantages of formal classification to patients, clinicians and researchers. Acta Obstet Gynecol Scand. 2014;93:619-25. Bahamondes L, Ali M. Recent advances in managing and understanding menstrual disorders. F1000 Prime Rep. 2015;7:33.

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