PALM-COEIN Classification for Abnormal Uterine Bleeding: A Study of its Practical Applicability and Distribution of Causes

Abstract

Aim: The aim was to study the distribution of causes in nongravid women of reproductive age-group having abnormal uterine bleeding (AUB) as per the new International Federation of Gynecology and Obstetrics (FIGO) polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified—(PALM-COEIN) classification system and to evaluate the practical applicability of this classification system in the clinical scenario. Materials and methods: A prospective cross-sectional study was conducted among 300 women with AUB attending the outpatient department of gynecology, selected by the kth random sampling technique. The etiological diagnosis was made in the PALM-COEIN spectrum. The practical applicability of the AUB-FIGO classification system was assessed by the survey of clinicians with help of a scoring system. Results: The majority of the study subjects were from 40 to 55 years age group with the median age of the study subjects being 42 years. Fifty-two subjects had two attributable causes from PALM-COEIN for AUB. In our study, 45% of subjects had leiomyoma, which turned out to be the most common etiology for AUB, and hypothyroidism was the most common endocrinopathy associated with 10% of AUB cases. Hysteroscopy was required to diagnose one case of amenorrhea. The clinician survey emphasized the high practical applicability of PALM-COEIN classification. Conclusion: The data generated from the clinical settings with this classification could be more comparable due to homogeneity and consistency in nomenclature. Clinical significance: The International Federation of Gynecology and Obstetrics classification for AUB is a clinician-friendly modality providing an easy algorithm for accurate diagnosis and definitive treatment of AUB.