Categorization of patients with abnormal uterine bleeding according to PALM-COEIN FIGO classification


  • Arihant Tater Department of Obstetrics and Gynecology, Government Medical College, Dungarpur, Rajasthan, India
  • Prakash Jain Department of Obstetrics and Gynecology, RNT Medical College Udaipur, Rajasthan, India
  • Kamal Nayan Sharma Department of Obstetrics and Gynecology, RNT Medical College Udaipur, Rajasthan, India



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


Background: Abnormal uterine bleeding is a common problem of the women in the reproductive age group and leads to the frequent visits of women in hospitals to health care providers. In an effort to create a universally accepted system of nomenclature to describe uterine bleeding abnormalities in reproductive-aged women, an alternative classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN developed.

Methods: It is a retrospective study on 200 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patient 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=60, 30%). It was followed by leiomyoma (n=48, 24%) and endometrial causes (n=38, 19%) and were the top three etiologies for AUB respectively. Adenomyosis (n=26, 13%), not classified (n=12, 6%), iatrogenic (n=8, 4%), polyp (n=4, 2%) and malignancy and coagulopathy each (n=2, 1%) contributing least to the PALM-COEIN classification as an etiology for AUB.

Conclusions: PALM-COEIN classification is a universally accepted and consistent method of knowing exact etiology following investigations, so the proper treatment can be done for AUB.


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Original Research Articles