Understanding Causes of Abnormal Uterine Bleeding in Perimenopausal Women: A Prospective Observational Study Using the FIGO PALM COEIN Classification System

Background: Abnormal uterine bleeding (AUB) is prevalent among perimenopausal women, necessitating accurate diagnosis for effective management. The FIGO PALM COEIN classification system aids in identifying underlying causes of AUB. Aim: This study aims to categorize AUB causes in perimenopausal women using the FIGO PALM COEIN classification system. Study Design: A hospital-based prospective observational study was conducted involving 200 perimenopausal women aged 40 and above, within one year of menopause, presenting with complaints of AUB to the gynecology department at AVMC. Methods: Clinical diagnosis using the FIGO PALM COEIN system, supplemented by investigations and endometrial sampling, was conducted. Data were analyzed using descriptive statistics. Results: Participants (mean age: 45-50 years) predominantly presented with leiomyoma (41.5%), followed by polyps (23%), endometrial abnormalities (17.5%), malignancies/hyperplasia (9%), and ovulatory dysfunction (6%). Adenomyosis, iatrogenic causes, and coagulopathy were less common. Normal ultrasonography results were observed in 40.5% of cases. Endometrial hyperplasia (24.5%) and adenocarcinoma (15.09%) were detected histologically. Polyps (18.5%) and fibroids (8.5%) were identified via ultrasonography. Conclusion: The study underscores diverse AUB causes in perimenopausal women and advocates for ultrasonography incorporation in initial assessments, followed by endometrial sampling when indicated. PALM components played a significant role in categorizing AUB clinically, with leiomyoma as the primary cause. However, histological testing revealed a higher prevalence of PALM-related causes.