Evaluation of PALM - COEIN classification and management of abnormal uterine bleeding in peri-menopausal age group
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20251229Keywords:
Abnormal uterine bleeding, Endometrial hyperplasia, Evaluation of PALM-COEIN classification, Intermenstrual bleeding, Leiomyoma, AdenomyosisAbstract
Background: Abnormal uterine bleeding (AUB) is a prevalent condition affecting a significant portion of women, particularly in the perimenopausal age group. The FIGO PALM-COEIN classification system, introduced in 2011, categorizes AUB based on its etiology and is a useful tool in diagnosing and managing AUB. The aim of the study was to evaluate the clinical and histopathological outcomes of AUB diagnoses in women based on this classification.
Methods: A 6-month retrospective study was conducted in a tertiary care teaching hospital in western India, including 80 perimenopausal women, presenting with AUB between July and December 2024. Patients were assessed using clinical history, physical examination, and imaging. Additional diagnostic modalities like hysteroscopy and MRI were employed when necessary. Treatment outcomes were analyzed, focusing on medical and surgical interventions.
Results: The majority of patients were in the 40-45 years age group (60%), with heavy menstrual bleeding (77.50%) being the most common bleeding pattern. Ultrasonography identified leiomyoma (38.75%) and adenomyosis (28.75%) as the most frequent causes. Histopathological examination of hysterectomy specimens revealed leiomyoma (45.58%), adenomyosis (30.90%), and endometrial hyperplasia (14.70%). Hysterectomy was the most common final treatment modality (85%).
Conclusions: The PALM-COEIN classification system is a valuable, efficient tool for diagnosing AUB, facilitating targeted treatment strategies. Transvaginal ultrasonography remains the first-line imaging modality, but histopathological examination of all surgical specimens is essential to ensure comprehensive diagnosis and optimal management. Medical hormonal therapy is effective in most cases, but surgical options, including hysterectomy, remain crucial for definitive treatment.
Metrics
References
Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.
Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding: Malcolm G. Munro, Hilary O.D. Crithcley, Ian S. Fraser, for the FIGO Working Group on Menstrual Disorders. Int J Gynaecol Obstet. 2011;113(1):1-2. DOI: https://doi.org/10.1016/j.ijgo.2011.01.001
Munro MG, Critchley HO, Fraser IS. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them?. Am J Obstet Gynecol. 2012;207(4):259-65. DOI: https://doi.org/10.1016/j.ajog.2012.01.046
Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions [published correction appears in Int J Gynaecol Obstet. 2019;144(2):237. DOI: https://doi.org/10.1002/ijgo.12709
National Collaborating Centre for Women’s and Children’s Health; National Institute for Health and Care Excellence. NICE guideline CG44: heavy menstrual bleeding. London: Royal College of Obstetricians and Gynaecologists, 2007. Available at: http://www.nice.org.uk/CG44. Accessed on 25 February 2025.
Avis NE, Brambilla D, McKinlay SM, Vass K. Psychologic distress during the menopausal transition: Associations across the reproductive life cycle. American J Public Health. 2001;91(9):1435-42.
Ryu JA, Kim B, Lee J, Kim S, Lee SH. Comparison of transvaginal ultrasonography with hysterosonography as a screening method in patients with abnormal uterine bleeding. Korean J Radiol. 2004;5(1):39-46. DOI: https://doi.org/10.3348/kjr.2004.5.1.39
Nicula R, Costin N. Management of endometrial modifications in perimenopausal women. Clujul Med. 2015;88(2):101-10. DOI: https://doi.org/10.15386/cjmed-421
Suresh AY, Suresh YV, Jain P. Abnormal uterine bleeding: a clinico- histopathological analysis. Int J Reprod Contracept Obstet Gynecol 2014;3:656- 61.
Sreelakshmi U, Bindu VT, Subhashini T. Abnormal uterine bleeding in perimenopausal age group women: a study on clinicopathological evaluation and management. Int J Reprod Contracept Obstet Gynecol 2018;7:192-7. DOI: https://doi.org/10.18203/2320-1770.ijrcog20175844
Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65. DOI: https://doi.org/10.1016/j.bpobgyn.2015.11.012
Deligdisch L. Hormonal pathology of the endometrium. Mod Pathol.2000;13:285-94. DOI: https://doi.org/10.1038/modpathol.3880050
Kelly P, Dobbs SP, McCluggage WG. Endometrial hyperplasia involving endometrial polyps: report of a series and discussion of the significance in an endometrial biopsy specimen. BJOG. 2007;114(8):944-50. DOI: https://doi.org/10.1111/j.1471-0528.2007.01391.x
Orvieto R, Bar-Hava I, Dicker D, Bar J, Ben-Rafael Z, Neri A. Endometrial polyps during menopause: characterization and significance. Acta Obstet Gynecol Scand. 1999;78(10):883-6. DOI: https://doi.org/10.1034/j.1600-0412.1999.781009.x
Anupamasuresh Y, Suresh YV, Jain P. Abnormal uterine bleeding: a clinico-histopathological analysis. Int J Reprod Contracept Obstet Gynecol 2014;3:656-61. DOI: https://doi.org/10.5455/2320-1770.ijrcog20140954
Downloads
Published
How to Cite
Issue
Section
