Categorization of the Causes of Abnormal Uterine Bleeding According to PALM-COEIN Classification

Introduction: Polyp; adenomyosis; leiomyoma; malignancy and hyperplasia - coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (PALM-COEIN) is the new classification system to categorize the causes of abnormal uterine bleeding (AUB) according to the International Federation of Gynecology and Obstetrics. Purpose: To categorize 300 women with AUB presenting to the Gynaecology outpatient department (OPD) of Sri Padmavathi Medical College for Women-SVIMS according to PALM-COEIN classification system by the International Federation of Gynecology and Obstetrics. Materials and Methods: It is a descriptive observational study comprising 300 women of reproductive age with AUB either in duration, volume, or in frequency for at least 3 months presenting to the OPD of Sri Padmavathi Medical College for women-SVIMS hospital, Tirupati, India, from April 2014 to March 2015. These women underwent structured history, physical and local examination, pelvic ultrasonography, and necessary investigations. Endometrial biopsy specimens were obtained for histopathology where applicable. Possible causes of the problem were categorized according to the PALM-COEIN classification system. Results: Among the 4170 women attending the Gynaecology outpatient clinic, 845 (20.2%) had AUB. PALM-COEIN categorization was performed in 300 (37%) cases that showed 6 (2%) polyp, 38 (12.66%) adenomyosis, 74 (24.67%) leiomyoma, 15 (5%) malignancy and hyperplasia, 9 (3%) coagulopathy, 81 (27%) ovulatory dysfunction, 27 (9%) endometrial causes, 24 (8%) iatrogenic, and 19 (6.33%) cases were under non-specific category. Around 7 (2.34%) cases were under mixed category. Conclusion: A universally accepted system of nomenclature and classification helps in the evolution of collaborative research and evidence-based application of results to clinical practice.