Corrigendum to "Anovulatory bleeding and the spectrum of bleeding disorders: Understanding heavy menstrual bleeding in adolescents"

doi: 10.1002/ijgo.70579 Following publication of this article and in response to a Letter to the Editor, the authors wish to clarify and correct the following points. 1. CLARIFICATION OF FIGO AUB SYSTEMS AND PALM‐COEIN CLASSIFICATION The FIGO (the International Federation of Gynecology & Obstetrics) classification framework comprises two distinct systems. FIGO abnormal uterine bleeding (AUB) System 1 standardizes symptom terminology, describing bleeding patterns using five descriptors: frequency, duration, regularity, volume, and intermenstrual bleeding. Our manuscript incorrectly implied three categories. Heavy menstrual bleeding (HMB) is a symptom within this system, not a diagnosis or a manifestation separate from AUB; our original phrasing of HMB as a “manifestation” of AUB was imprecise and should be read as: HMB is a core symptom of AUB as defined by FIGO System 1. FIGO AUB System 2 is the PALM‐COEIN classification, which categorizes causes of AUB in nongravid reproductive‐age women. PALM covers structural causes: Polyp (AUB‐P), Adenomyosis (AUB‐A), Leiomyoma (AUB‐L), and Malignancy/hyperplasia (AUB‐M). COEIN covers nonstructural causes: Coagulopathy (AUB‐C), Ovulatory dysfunction (AUB‐O), Endometrial (AUB‐E), Iatrogenic (AUB‐I), and Not yet classified (AUB‐N). As structural causes are rare in adolescents, our study population was predominantly characterized by AUB‐O (ovulatory dysfunction) and AUB‐C (coagulopathy). Throughout the manuscript, the nonstandard terms “AUB‐An” and “HMB‐An” were used to describe adolescents with and without HMB attributed to anovulatory cycles. These terms should be replaced by the established FIGO category AUB‐O (ovulatory dysfunction) throughout the article. Similarly, the term “BD” (bleeding disorder) corresponds to AUB‐C in the PALM‐COEIN system. Wherever AUB‐An, HMB‐An, or BD appear in the text, tables, and figures, readers should understand these as referring to AUB‐O, HMB due to AUB‐O, and AUB‐C, respectively. The sentence in the Methods section stating that “patients meeting FIGO criteria for ovulatory dysfunction were excluded from the anovulatory group” was imprecise. The intended meaning was that patients with identified secondary endocrine causes of ovulatory dysfunction (e.g. congenital adrenal hyperplasia, hypothyroidism) were excluded from analysis, as these represented distinct pathological entities. None of the patients with bleeding disorders (AUB‐C) met criteria for these secondary causes. 2. TERMINOLOGY: REPLACEMENT OF THE OBSOLETE TERM “MENORRHAGIA” The term menorrhagia appears in the Discussion section and was retired. All instances of menorrhagia in the manuscript should be read as heavy menstrual bleeding (HMB). 3. CORRECTION OF CITATION ERRORS In the Discussion, a transfusion rate of 7.4% was inadvertently attributed to Munro et al. (reference 23). This figure derives from reference 23 (O’Brien et al.) and not from any publication by Munro et al. We apologize for this misattribution. In the Discussion, the description by Munro et al. (reference 40) was inaccurate in two respects. First, the study did not exclude patients with coagulopathies. Second, our description omitted the maintenance phase of treatment: following the initial 7‐day high‐dose regimen (medroxyprogesterone acetate 20 mg three times daily; or COC containing 35 μg ethinyl estradiol + 1 mg norethindrone three times daily), both treatments were continued at reduced doses for an additional 3 weeks. The complete and correct description is: in a randomized controlled trial, Munro et al. compared a monophasic COC with oral medroxyprogesterone acetate, each administered three times daily for 7 days followed by a reduced maintenance dose for 3 weeks, reporting bleeding cessation in 88% and 76% of participants, respectively, with a median time to cessation of 3 days in both groups. Citation 14 in the reference list was a duplicate of citation 39. The correct reference for citation 14 is: American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive‐aged women. Obstet Gynecol. 2013;121(4):891–896. 4. CORRECTION OF THE IATROGENIC CASE CLASSIFICATION (AUB‐I) In the Results section, two patients were classified as having “other causes” (one receiving therapeutic enoxaparin and one taking acetylsalicylic acid. Per the PALM‐COEIN system, these cases should have been explicitly classified as having AUB‐I (iatrogenic). 5. TYPOGRAPHICAL CORRECTION IN FIGURE 1 Figure 1 contains a spelling error: “anovulatory cyclus” should read “anovulatory cycles” in both instances where it appeared. We apologize for these errors.