FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age

Malcolm G Munro; Hilary O D Critchley; Michael S Broder; Ian S Fraser; FIGO Working Group on Menstrual Disorders

doi:10.1016/j.ijgo.2010.11.011

Clinical Guidelines and Standards Diagnostic Criteria and Classification

FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age

Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders

Published April 2011 International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 113(1), 3-13

DOI 10.1016/j.ijgo.2010.11.011 PMID 21345435

RRM Academy Synopsis

FIGO adopts PALM-COEIN for abnormal uterine bleeding (nonpregnant)

A 2011 manuscript from the Menstrual Disorders Working Group reports that the Executive Board of FIGO approved PALM-COEIN as a FIGO classification system. FIGO is the International Federation of Gynecology and Obstetrics. The system applies to causes of abnormal uterine bleeding in nonpregnant women of reproductive age. The authors intend clinicians, researchers and patients to use it.

Key Findings

The authors describe inconsistent terminology for abnormal uterine bleeding and many possible causes, which may occur together in the same woman.
The authors call for consistent, universally accepted terminology as a step toward fixing this problem, and for a classification of causes developed on several levels.
The first group of letters includes polyp, adenomyosis and leiomyoma, plus malignancy and hyperplasia. The second includes coagulopathy, ovulatory dysfunction, endometrial and iatrogenic causes, plus a group for causes not yet classified.
The FIGO Executive Board approved the system as a FIGO classification system, and the authors describe the work as an ongoing process.

Interpretation

The record rests on the published abstract of a consensus paper from an international working group. The abstract states the aims and the approved framework and reports no patient data or outcomes. Because only the abstract is available, this synopsis describes the framework at a high level and leaves the definition of each category to the full paper.

RRM Context

Restorative reproductive medicine looks for the cause of a symptom, and a shared vocabulary for the causes of abnormal bleeding supports that work. The ovulatory dysfunction category links bleeding patterns to how the cycle is working.

Our editorial summary of this paper, not the article's abstract.

Abstract

There is general inconsistency in the nomenclature used to describe abnormal uterine bleeding (AUB), in addition to a plethora of potential causes-several of which may coexist in a given individual. It seems clear that the development of consistent and universally accepted nomenclature is a step toward rectifying this unsatisfactory circumstance. Another requirement is the development of a classification system, on several levels, for the causes of AUB, which can be used by clinicians, investigators, and even patients to facilitate communication, clinical care, and research. This manuscript describes an ongoing process designed to achieve these goals, and presents for consideration the PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified) classification system for AUB, which has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO classification system.

Topics

Clinical Guidelines and Standards › Diagnostic Criteria and Classification › Staging and Classification Systems · Menstrual Cycle › Cycle Disorders › Abnormal Uterine Bleeding

Malcolm G Munro, Hilary O D Critchley, Michael S Broder, Ian S Fraser

M Munro, H Critchley, Mike Broder, M Broder, I Fraser

PMID 21345435 21345435 DOI 10.1016/j.ijgo.2010.11.011 10.1016/j.ijgo.2010.11.011 Munro et al. 2011, Munro 2011

FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age

FIGO adopts PALM-COEIN for abnormal uterine bleeding (nonpregnant)

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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