FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in non-gravid women


  • Forum J. Trivedi Department of Obstetrics and Gynaecology, Smt. NHL MMC, Ellisbridge, Ahmedabad, Gujarat, India
  • Kruti J. Deliwala Department of Obstetrics and Gynaecology, Smt. NHL MMC, Ellisbridge, Ahmedabad, Gujarat, India
  • Dhanvi J. Deliwala B. J. Medical College, Ahmedabad, Gujarat, India
  • Shlok V. Patel B. J. Medical College, Ahmedabad, Gujarat, India



PALM-COEIN, Abnormal uterine bleeding, Ovulatory dysfunction, Leiomyoma


Background: Abnormal uterine bleeding is one of the most common problems of the women of reproductive age group leading to increased number of hospital visits. International federation of gynecology and obstetrics (FIGO) has suggested a new etiological classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN to standardize the terminology, investigations, diagnosis and management of abnormal uterine bleeding (AUB) in non-pregnant women of reproductive age group.

Methods: This is a retrospective study on 150 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patients were grouped under these categories after detailed history, examination, investigations and histopathological reports.

Results: Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=42, 28%). It was followed by leiomyoma (n=37, 24.67%) and endometrial causes (n=23, 15.33%). They constitute the top 3 causes of AUB. Adenomyosis (n=22, 14.67%), not known (n=10, 6.67%), iatrogenic (n=5, 3.33%), polyp (n=6, 4%), coagulopathy (n=1, 0.67%) and malignancy (n=4, 2.66%) contributing least to the PALM-COEIN classification as an etiology for AUB.

Conclusions: The PALM COEIN classification system is useful in understanding various etiological causes of AUB, facilitates accurate diagnosis and hence helps in optimizing the treatment.


Committee on Practice Bulletins-Gynecology. Practice bulletin no. 128: Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197-206.

Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO working group on menstrual disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13.

Barclay L, Murata P. New classification system categorizes causes of abnormal uterine bleeding. Int J Gynecol Obstet. 2011;113:3-13.

Jonathan AA, Saravanan S. A two year clinicopathological study of non-gravid women with abnormal uterine bleeding in a rural tertiary care centre in Tamil Nadu: in concurrence with the Figo recommendations. J Evol Med Dental Sci. 2015;4(63):10990-1001.

Mishra D, Sultan S. FIGO’s PALM–COEIN Classification of Abnormal Uterine Bleeding: A Clinico-histopathological Correlation in Indian Setting. J Obstet Gynecol India. 2017;67(2):119-25.

Tater A, Jain P, Sharma KN. Categorization of patients with abnormal uterine bleeding according to PALM-COEIN FIGO classification. Int J Reprod Contracept Obstet Gynecol. 2019;8:4783-5.

Qureshi FU, Yusuf AW. Distribution of causes of abnormal uterine bleeding using the new FIGO classification system. JPMA. 2013;63(973).

Munro MG. Classification of menstrual bleeding disorders. Rev Endocr Metab Disord. 2012;13:225-34.

Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.

Doraiswami S, Johnson T, Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK. Study of endometrial pathology in abnormal uterine bleeding. J Obstet Gynaecol India. 2011;61(4):426-30.

Templeman C, Marshall SF, Ursin G, Horn-Ross PL, Clarke CA, Allen M et al. Adenomyosis and endometriosis in the California Teachers Study. Fertil Steril. 2008;90(2):415-24.

Weiss G, Maseelall P, Schott LL, Brockwell SE, Schocken M, Johnston JM. Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN). Fertil Steril. 2009;91(1):201-6.

Taran FA, Weaver AL, Coddington CC, Stewart EA. Characteristics indicating adenomyosis coexisting with leiomyomas: a case control study. Hum Reprod. 2010;1177-82.

National Institute for Health and Clinical Excellence (NICE). Clinical Guideline 44; Heavy menstrual bleeding 2007. Available at: nicemedia/pdf/CG44FullGuideline.pdf. Accessed on 10 January 2024.






Original Research Articles