Heavy menstrual bleeding diagnosis and medical management

Intira Sriprasert, Tarita Pakrashi, Thomas Kimble, David F. Archer
In: Contraception and Reproductive Medicine · 2017 · vol. 2(1) , pp. 20 · doi:10.1186/s40834-017-0047-4 · PMID:29201425 · PMC5683444 · W2736339223
review OA: gold CC0 ⤵ 8 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review discusses the PALM-COEIN classification system for heavy menstrual bleeding and highlights current evidence on its etiologies and medical treatment modalities.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This open-access review examines heavy menstrual bleeding (HMB) by outlining how etiology can be classified using FIGO’s PALM-COEIN system (structural causes such as adenomyosis, polyps, and leiomyoma, and non-structural causes such as coagulopathy or endometrial disorders) and summarizes diagnostic approaches (e.g., history, physical exam, and imaging) and medical treatment options. It highlights that there is no single pathway causing HMB, so multiple therapies targeting different mechanisms are used, and it notes that hysterectomy is definitive but surgery carries small risks, making medical therapy a preferred primary intervention in most circumstances. A key limitation explicitly acknowledged throughout the paper is that measuring menstrual blood loss can be difficult and that practical estimates (e.g., PBAC or product-weighting) do not perfectly match women’s lived experience, even if they correlate with measured blood loss. Relevance to endometriosis: the review explicitly incorporates adenomyosis and endometriosis as gynecologic conditions that can co-occur with HMB (including adenomyosis/endometriosis mentioned in the context of hysterectomy and etiology via PALM-COEIN), though its main focus is general HMB diagnosis and medical management rather than endometriosis-specific mechanisms.

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Abstract

Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a woman's quality of life and the activities of daily living. Due to the difficulty in accurately describing menstrual bleeding abnormalities using older terminology, the PALM-COEIN classification system of the Federation Internationale de Gynecologie et d'Obstetrique was proposed to describe and identify the etiology of abnormal endometrial bleeding. As there is no single pathway that is associated with HMB, there are several therapeutic interventions involving different molecular pathways to reduce HMB. This article will highlight the current evidence as it relates to the etiology of HMB as well as medical modalities of treatment.

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europepmc
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License: CC0 · commercial use OK