Main Article Content
Objective: To determine the causes of menstrual disorders according to PALM-COEIN classification system by international federation of gynecology and obstetrics (FIGO).
Methodology: This descriptive study was conducted in Department of Obstetrics & Gynaecology, Hayatabad Medical Complex, Peshawar, from 8th August 2019 to 9th August 2020. Patients admitted for hysterectomy/ endometrial sampling due to abnormal uterine bleeding (AUB) were included in the study through non-probability convenient sampling. Detailed history, clinical examination and relevant investigations were recorded on a predesigned proforma. Abnormal uterine bleeding was then classified according to FIGO new system (PALM-COEIN). Descriptive statistics were used in the form of frequencies and percentages.
Results: A total of 78 patients underwent surgical intervention for abnormal uterine bleeding. The mean age of the participants was 44.0±3.9 years. Most of the patients were either multi or grand multipara (n=75, 96.2%). Majority reported to have regular bleeding (n=55, 70.5%), frequent cycles (n=56,71.8%), prolonged flow (n=54, 69.2%) and heavy blood loss (n=61,78.2%). The PALM portion comprised of 33 (42.3%) causes of AUB, while COEIN portion comprises of 29 (37.2%) causes while sixteen (20.5%) cases were having more than one underlying pathologies. AUB-L (Leiomyoma) was most common cause in the PALM group (n=13, 16.7%), while AUB-E (Endometrial) in the COEIN group (n=13, 16.7%).
Conclusion: Multiple/mixed etiologies were the most common causes of AUB, followed by AUB-L and AUB-E.
Work published in JPMI is licensed under a
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Fraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A, Petraglia F. Prevalence of heavy menstrual bleed¬ing and experiences of affected wom¬en in a European patient survey. Int J Gynecol Obstet. 2015; 128:196–200.
Woolcock JG, Critchley HO, Munro MG, Broder MS, Fraser IS. Review of the confusion in current and historical terminology and definitions for distur¬bances of menstrual bleeding. Fertil Steril. 2008; 90:2269–80.
Critchley HO, Munro MG, Broder M, Fraser IS. A five-year international review process concerning terminol¬ogies, definitions, and related issues around abnormal uterine bleeding. Semin Reprod Med. 2011; 29:377– 82.
Munro MG, Critchley HO, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnor¬mal uterine bleeding in the reproduc¬tive years: 2018 revisions. Int J Gyne¬col Obstet. 2018; 143:393-408.
Fraser IS, Critchley HO, Munro MG, Broder M. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril. 2007; 87:466– 76.
Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the re¬productive years. Best Pract Res Clin Obstet Gynaecol. 2017; 40:3–22.
Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the re¬productive years. Fertil Steril. 2011; 95:2204–2208.
Bazot M, Darai E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril. 2018; 109:389–97.
Maheux-Lacroix S, Li F, Laberge PY, Abbott J. Imaging for polyps and leio¬myomas in women with abnormal uterine bleeding: A systematic review. Obstet Gynecol. 2016; 128:1425–36.
American College of Obstetricians and Gynecologists. ACOG committee opin¬ion no 557: Management of acute ab¬normal uterine bleeding in non-preg¬nant reproductive-aged women. Obstet Gynecol. 2013; 121:891–96.
Cote I, Jacobs P, Cumming DC. Use of health services associated with increased menstrual loss in the United States. Am J Obstet Gynecol. 2003;188: 343–8.
Mitra N, Patil P, Sethia A. Etiological factors of abnormal uterine bleeding according to PALMCOEIN classifi¬cation in perimenopausal women in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2020; 9(2):799-803.
Tater A, Jain P, Sharma KN. Categori¬zation of patients with abnormal uter¬ine bleeding according to PALM-COE¬IN FIGO classification. Int J Reprod Contracept Obstet Gynecol. 2019; 8(12):4783-85.
Ansari A, Urooj U. Study of causes behind abnormal uterine bleeding ac¬cording to PALM- COEIN classification at a tertiary care hospital. J Pak Med Assoc. 2020; 70:973-75.
Qureshi FU, Yusuf AW. Distribution of causes of abnormal uterine bleeding using the new FIGO classification system. J Pak Med Assoc. 2013; 63:154-56.
Sun Y, Wang Y, Mao L, Wen J, Bai W. Prevalence of abnormal uterine bleed¬ing according to new International Federation of Gynecology and Obstet¬rics classification in Chinese women of reproductive age. A cross-sectional study. Medicine. 2018; 97:31.
Betha K, Malavatu L, Talasani S. Dis¬tribution of causes of abnormal uter¬ine bleeding using new FIGO classi¬fication system-PALM COEIN: a rural tertiary hospital based study. Int J Reprod Contracept Obstet Gynecol. 2017; 6(8):3523-27.
Mishra D, Sultan S. FIGO’s PALM– COEIN Classification of Abnormal Uterine Bleeding: A Clinico-histo-pathological Correlation in Indian Set¬ting. J Obstet Gynecol India. 2017; 67(2):119-25.
Deneris A. PALM-COEIN Nomencla¬ture for Abnormal Uterine Bleeding. J Midwifery Womens Health. 2016; 61(3):376-9.