Abstract
Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. Abnormal uterine bleeding (AUB) is one of the common presenting complaints encountered by a Gynaecologist. The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has recently developed a classification system (PALM–COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study and analyse the structural (PALM) and the functional (COEIN) component of the PALM–COEIN system of AUB in perimenopausal age group. A total of 200 perimenopausal women (aged 40 years and above till 1 year beyond menopause) who were admitted with complaints of abnormal uterine bleeding comprised the study population. Clinical diagnosis and allocation to PALM–COEIN was done. Endometrial biopsy and hysterectomy specimens (wherever applicable) were obtained and sent for histopathology. As per the histopathological findings, possible underlying causes were categorized. Clinical diagnosis was then correlated with histopathology-based final diagnosis. PALM and COEIN components contributed almost equally for AUB when assessed clinically. The histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB. The PALM COEIN classification system helps us in understanding various etiological causes of AUB and can be used by clinicians and researchers for international comparisons.
 Keywords: Abnormal uterine bleeding (AUB) , PALM–COEIN . Perimenopause
Highlights
Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs.AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint
The PALM COEIN classification system helps us in understanding various etiological causes of AUB and can be used by clinicians and researchers for international comparisons
There are nine main categories, which are arranged according to the acronym PALM–COEIN: polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified
Summary
Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs.AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and not otherwise classified classification system will facilitate accurate diagnosis and inform treatment options.[1] Abnormal uterine bleeding (AUB) is one of the common presenting complaints encountered by a Gynaecologist. It is a significant cause of hysterectomy and is a major health problem. This was followed by the histopathological studies and correlation of cases wherever applicable for the structural (PALM) component and for categories of International Journal of Medical and Biomedical Studies (IJMBS)
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