Abnormal uterine bleeding

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. A structured approach for establishing the cause using the Fédération International de Gynécologie et d'Obstétrique (FIGO) 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. Office hysteroscopy and increasing sophisticated imaging will assist provision of robust evidence for the underlying cause. Increased availability of medical options has expanded the choice for women and many will no longer need to recourse to potentially complicated surgery. Treatment must remain individualised and encompass the impact of pressure symptoms, desire for retention of fertility and contraceptive needs, as well as address the management of AUB in order to achieve improved quality of life.

Distribution of causes of abnormal uterine bleeding using new FIGO classification system-PALM COEIN: a rural tertiary hospital based study

“…12 In the present study,10.4% of cases of AUB was caused by polyps. Similarly, study done by Doraiswamy et al also showed that polyps accounted for 11.2% cases of AUB.…”

“…Intrauterine contraceptive device (IUD) may cause low grade endometritis and also cause unbalanced ratios of prostaglandins and thromboxanes which may contribute to AUB. 12 Iatrogenic causes contributed to 11.6% of cases of AUB. The category not yet classified is reserved for entities like chronic endometritis, myometrial hypertrophy which contributed to 1.6% of cases.…”

“…10 Many episodes of unscheduled bleeding are related to exogenous therapy. 12 Medications like anticonvulsants, hormonal steroids may have direct impact on ovulation. Intrauterine contraceptive device (IUD) may cause low grade endometritis and also cause unbalanced ratios of prostaglandins and thromboxanes which may contribute to AUB.…”

“…12,14 It is one of the common cause of AUB between 35-45 years. Multiparous women had high incidence of adenomyosis with diffuse subtype predominating.…”

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“…Leiomyoma is the most common benign smooth muscle tumor of the female genital tract. 1,2 It is composed of smooth muscle cells and varying amount of fibrous connective tissue, common in the reproductive age group. 3 Unopposed estrogenic stimulation causes secondary changes in leiomyomas along with associated endometrial proliferation or hyperplasia.…”