Classification of Abnormal Uterine Bleeding

Classification of Abnormal Uterine Bleeding

• PALM refers to structural etiologies: polyp, adenomyosis, leiomyoma, malignancy, and hyperplasia
• COEIN refers to nonstructural etiologies: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified

Evaluation and Diagnosis

• Detailed history and pelvic examination are necessary for evaluation
• Laboratory testing includes a pregnancy test and complete blood count
• Endometrial sampling is recommended for patients 45 years and older, and younger patients with significant history of unopposed estrogen exposure
• Transvaginal ultrasonography is the preferred imaging modality for suspected structural etiologies or persistent symptoms

Treatment Options

• Medical treatment options: oral estrogen, high-dose estrogen-progestin oral contraceptives, oral progestins, intravenous tranexamic acid
• Long-term medical treatment options: levonorgestrel-releasing intrauterine system, estrogen-progestin oral contraceptives, oral progestins, oral tranexamic acid, nonsteroidal anti-inflammatory drugs, depot medroxyprogesterone
• Surgical treatment options: hysterectomy, endometrial ablation, myomectomy, polypectomy, uterine artery embolization

Epidemiology and Impact

• Abnormal uterine bleeding affects 10% to 30% of women of reproductive age
• It negatively affects quality of life, is associated with financial loss, decreased productivity, poor health, and increased use of health care resources

Definitions and Classification

• Abnormal uterine bleeding is a symptom, not a diagnosis
• It is defined as bleeding that falls outside population-based 5th to 95th percentiles for menstrual regularity, frequency, duration, and volume
• Chronic bleeding occurs for most of the previous six months, while acute bleeding warrants immediate intervention
• Intermenstrual bleeding occurs between otherwise normal menstrual periods

Classification of Abnormal Uterine Bleeding

• PALM refers to structural etiologies: polyp, adenomyosis, leiomyoma, malignancy, and hyperplasia
• COEIN refers to nonstructural etiologies: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified

Evaluation and Diagnosis

• Detailed history and pelvic examination are necessary for evaluation
• Laboratory testing includes a pregnancy test and complete blood count
• Endometrial sampling is recommended for patients 45 years and older, and younger patients with significant history of unopposed estrogen exposure
• Transvaginal ultrasonography is the preferred imaging modality for suspected structural etiologies or persistent symptoms

Treatment Options

• Medical treatment options: oral estrogen, high-dose estrogen-progestin oral contraceptives, oral progestins, intravenous tranexamic acid
• Long-term medical treatment options: levonorgestrel-releasing intrauterine system, estrogen-progestin oral contraceptives, oral progestins, oral tranexamic acid, nonsteroidal anti-inflammatory drugs, depot medroxyprogesterone
• Surgical treatment options: hysterectomy, endometrial ablation, myomectomy, polypectomy, uterine artery embolization

Epidemiology and Impact

• Abnormal uterine bleeding affects 10% to 30% of women of reproductive age
• It negatively affects quality of life, is associated with financial loss, decreased productivity, poor health, and increased use of health care resources

Definitions and Classification

• Abnormal uterine bleeding is a symptom, not a diagnosis
• It is defined as bleeding that falls outside population-based 5th to 95th percentiles for menstrual regularity, frequency, duration, and volume
• Chronic bleeding occurs for most of the previous six months, while acute bleeding warrants immediate intervention
• Intermenstrual bleeding occurs between otherwise normal menstrual periods