A retrospective perspective on abnormal uterine bleeding and the PALM-COEIN classification: Experiences of a tertiary center

Background: The Menstrual Disorders Working Group of the International Federation of Gynecology and Obstetrics (FIGO) created a new classification system called “PALM-COEIN” for abnormal uterine bleeding in 2011. The aim of our study is to investigate the new classification system and compare it with the classical terminology for abnormal uterine bleeding. Materials and Methods: Our study was conducted retrospectively between February 2022 and July 2022 in the gynecology clinic of Keciören Training and Research Hospital. Premenopausal women without known chronic disease were enrolled in the study. Each patient enrolled in the study was examined based on anatomical structure, physical examination, and pelvic ultrasonography. If necessary, endometrial specimens and hysterectomy material were obtained for histopathologic examination. Possible causes were classified according to the new classification system. Results: The study included 135 premenopausal women with abnormal uterine bleeding. In general, the patients with bleeding complaints had leiomyoma uteri and polyps according to the classical terminology. They were grouped under the labels of hypermenorrhea, menorrhagia, metrorrhagia, and menometrorrhagia, which were due to various causes, including polyps, adenomyosis, hyperplasia, and iatrogenic causes. According to the classification PALM-COEIN, 35 (25.9%) polyps, 16 (11.8%) adenomyosis, 38 (28.1%) leiomyomas, 4 (2.9%) malignancies and hyperplasia were detected. Conclusion: The classification of abnormal uterine bleeding is generally inconsistent. The new classification system, created for many reasons, is an important step towards understanding complex situations. Another need is that a widely accepted and known classification system should facilitate communication among clinicians and clarify the review of the target population. It is also clear that the new classification system will improve communication between patients. Widespread use of the system will also reveal new treatment options for abnormal uterine bleeding.