Published: 2021-03-24

Distribution of causes of abnormal uterine bleeding according to PALM COEIN classification in tertiary health centre and its histopathological correlation

Mamta Sharma, Alka Maurya, Rinku Kumari


Background: AUB is a common problem among women of all ages, accounting for 20-30% of outpatient visits in the reproductive age group and 69 percent in the peri or postmenopausal age group. It has a major effect on women's personal, social, physical, and psychological well-being.

Methods: This prospective observational research was performed at J K Lone Mother and Child Hospital and Government Medical College, Kota, Rajasthan, from date January 2018 to July 2019, in the department of obstetrics and gynecology. The researchers looked at all women in the 40-year-old age group who had AUB and were not responding to nonsurgical care. Several causes of PALM and COEIN were investigated, and a histo-pathological association was calculated.

Results: Total 60 women with AUB not responding to medical management were taken. Majority (53.3%) women were between 40-50 years of age. Majority (63%) were para 2.Most common associated structural cause was leiomyoma (31%) followed by adenomyosis (25%) followed by ovulatory dysfunction (18%) followed by malignancy and polyp (10%).Most common histopathological finding was secretory phase (31.7%) followed by proliferative phase (28.3%) and then by hyperplasia (21.7%).ROC curve analysis showed that AUB-PALMCOEIN can predict diagnosis up to 95.8%. P value analysis for polyp, fibroid, ovulatory, endometrial was not significant showing that AUB-PALMCOEIN can predict diagnosis as much as histopathological examination. P value analysis for adenomyosis and malignancy was significant showing histopathology to be more accurate in giving diagnosis.

Conclusions: The PALM-COEIN classification aids in determining the cause of AUB and, as a result, efficiently adopting and planning for patient care. The structural cause of AUB played a larger role in the development of AUB. The major causes of AUB were divided into structural and non-structural causes in this research. The COEIN part of the classification needs to be improved further through in-depth analysis.


Abnormal uterine bleeding, Histo-pathological, PALM-COEIN

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