Evaluation of Clinical, Radiological and Histopathological Spectrum of Abnormal Uterine Bleeding and Its Clinico-Pathological Correlation as Per International Federation of Gynaecology and Obstetrics (FIGO) PALM-COEIN Classification – A Descriptive Study in Tertiary Care Centre in Rural Area

Introduction: The most prevalent menstruation problem during the perimenopause isabnormal uterine bleeding (AUB). A method of categorization (PALM–COEIN) for theetiology of the AUB in non-gravid women has been created by the InternationalFederation of Gynecology and Obstetrics working group on menstrual disorders. Thecurrent study's objectives were to investigate the two parts of this system in clinicalpractice generally and, in particular, to demonstrate a clinico-pathological associationbetween the AUB and the PALM component. Materials and Method: This study wasconducted on 100 perimenopausal women with symptoms of abnormal uterinebleeding. The subjects were aged 40 years and above and till one year after menopause.A clinical diagnosis was established using the PALM–COEIN classification followinga comprehensive history and examination, followed by pelvic ultrasound.Analysis wasdone on the relative contributions of the different causes of the structural (PALM) andfunctional (COEIN) components. Histology evaluated the hysterectomy specimen andendometrial sample following all recommended investigations. A statistical analysiswas performed on a clinicopathological connection. Results: When evaluatedclinically, the contributions of the COEIN and PALM components to AUB were almostidentical. Conversely, the histological analysis demonstrated a notably higher numberof instances of the PALM (structural) component of AUB, namely 63%versus 48% (p< 0.05). AUB-L was the most prevalent (43%) aetiology overall. The discrepancy wasprimarily explained by the discovery of more instances of AUB-M (malignancy andhyperplasia) in highly significant proportions (p ≤.01) and coexisting cases of AUBA;L.Conclusion: Since the two diagnostic modalities are complementary, the PALM–COEIN classification system should consider both the clinical and histologicaldiagnoses in women with AUB around perimenopause. This will optimize the outcomeby placing the clinical impression in the appropriate context of the classification.