Etiological factors of abnormal uterine bleeding according to PALM- COEIN classification in perimenopausal women in a tertiary care centre

Authors

  • Nishi Mitra Department of Obstetrics and Gynecology, L. N. Medical College and J. K. Hospital, Bhopal, Madhya Pradesh, India
  • Pooja Patil Department of Obstetrics and Gynecology, L. N. Medical College and J. K. Hospital, Bhopal, Madhya Pradesh, India
  • Ayushi Sethia Department of Obstetrics and Gynecology, L. N. Medical College and J. K. Hospital, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20200380

Keywords:

Abnormal uterine bleeding, Adenomyosis, Leiomyoma, Menorrhagia, PALM COEIN, Perimenopause

Abstract

Background: Perimenopause is described as years prior to menopause that encompasses the change from normal ovulatory cycle to cessation of menses, ending 12 months after the last menses. International federation of gynaecology and obstetrics (FIGO) developed a new classification PALM-COEIN in order to standardize the factors associated with AUB. It classifies AUB as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia (PALM) - structural abnormalities Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (COEIN) - unrelated to structural abnormalities. Objectives of this study were to categorise the causes of AUB in perimenopausal women in context to PALM COEIN classification system. Correlation of co-morbities (diabetes, hypertension and thyroid disorders) with AUB in perimenopausal age group.

Methods: This is a retrospective study from the month of May 2019 to October 2019, considering 100 patients of perimenopausal age group (40 to 55 years of age group) in J. K. Hospital Bhopal, Madhya Pradesh with complaints of abnormal uterine bleeding, admitted in gynae ward.

Results: Most of the patients in the current study were between 45-50 years of age i.e. 44%. Menorrhagia was the commonest menstrual disorder encountered in 52% of patients. As per FIGO; AUB-L constituted 42% AUB-O constituted 12%, AUB-P constituted 11%, AUB-A 10%, AUB-M constituted 8% AUB-E constituted 8%, not yet classified constituted 4% of total cases.

Conclusions: AUB (PALM-COEIN) for causes of abnormal uterine bleeding classification was very useful in categorizing cases of AUB. It suggests that etiology of AUB and also gives place for presence of multiple factors as a cause of AUB in a particular case.

References

Singh K, Agarwal C, Pujani M, Raychaudhuri S, Sharma N, Chauhan V, et al. A clinicopathological correlation of international federation of gynecology and obstetrics’s PALM-COEIN classification of abnormal uterine bleeding: Indian scenario. J -Life Health. 2019;10(3):147.

Munro MG, Critchley HO, Fraser IS, FIGO Menstrual Disorders Committee, Haththotuwa R, Kriplani A, Bahamondes L, Füchtner C, Tonye R, Archer D, Abbott J. 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. Int J Gynecol Obstet. 2018;143(3):393-408.

Palwade JM, Borole CS. A study of causes of abnormal uterine bleeding with respect to FIGO classification in the patients at perimenopausal age. Int Med J. 2016;3(11):5.

Sun Y, Wang Y, Mao L, Wen J, Bai W. Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age: a cross-sectional study. Medicine (Baltimore). 2018;97(31):e11457.

Prentice A. When does heavy flow merit treatment? Practitioner. 2000;244:174-9.

Jones HW, Rock JA, Te Linde's Operative gynecology, 11th ed. 2015:555.

Singh S, Yadav P, Rani R, Verma U. Diagnostic approach in perimenopausal women with abnormal uterine bleeding. J SAFOMS. 2014;2(1):12-4.

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.

Sethi B, Dhaded AV, Mathur PR. Dysfunctional uterine bleeding. J Obstet Gynecol India. 2002;52(3):87-9.

Munro MG, Critchley HOD, Broder. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet. 2011;113:3-13.

Verma U, Garg R, Singh S, Yadav P, Rani R. Diagnostic Approach in Perimenopausal Women with Abnormal Uterine Bleeding. J South Asian Fed Menopause Soc. 2014 Jan 1;2:12-4.

Kumar S. Clinicopathological study of abnormal uterine bleeding in North Indian patients. Asian J Biomed Pharma Sci. 2016;6(53):50-1.

Subedi S, Banerjee B, Manisha C. Thyroid disorders in women with dysfunctional uterine bleeding. J Pathol Nepal. 2016 Sep 24;6(12):1018-20.

Singh A, Choudhary A. A study of PALM-COEIN Classification of Abnormal Uterine Bleeding (AUB) in Perimenopausal Women at a Tertiary Care Teaching Hospital. J Med Sci Clinical Res. 2018;6(6):287-92.

Sabbioni L, Zanetti I, Orlandini C, Petraglia F, Luisi S. Abnormal uterine bleeding unrelated to structural uterine abnormalities: management in the perimenopausal period. Minerva Ginecol. 2017;69(1):75-83.

Downloads

Published

2020-01-28

Issue

Section

Original Research Articles