FIGO PALM–COEIN Classification of Abnormal Uterine Bleeding in Saudi Women

Abstract

Abstract Background: Abnormal uterine bleeding (AUB) is a significant concern in women’s health. However, there is limited research on its prevalence and characteristics in Saudi Arabia. Objectives: To determine the prevalence of AUB in a gynecology outpatient setting in Saudi Arabia and to categorize the cases of AUB according to the FIGO classification. Methods: This retrospective study included all Saudi female patients who presented to the Obstetrics and Gynecology clinic at King Khalid University Hospital, Riyadh, Saudi Arabia, over a 2-year period, except those who were pregnant. Data regarding demographics, BMI, clinical symptoms, laboratory tests, ultrasound results, and histopathology findings was collected. Cases of AUB were classified using the FIGO PALM-COEIN system. Results: A total of 2724 patients were included, of which 44.6% had AUB. The most common presentations of AUB were irregular cycles (59.3%) and heavy bleeding (12.8%), and the most affected group was the reproductive age group (19-39 years). Obesity was identified as a significant risk factor. AUB-O (ovulatory disorder; functional cause) was the most prevalent (23%), followed by AUB-L (leiomyomas, 18%; structural cause) and AUB-P (polyps, 8.8%). Specific AUB patterns correlated with ultrasonographic findings, with heavy bleeding associated with polyps, adenomyosis, and leiomyomas. AUB patients had lower hemoglobin levels, indicating potential health impacts. Conclusions: The study found that nearly half of all women presenting with gynecological complaints in Riyadh, Saudi Arabia, have AUB. According to the FIGO classification, functional causes of AUB were more prevalent than structural causes. Further research is necessary to explore underlying causes of AUB and its long-term health implications.