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Rukhsana Karim
Saima Ayub



Objective: To determine the causes of menstrual disorders according to PALM-COEIN classification system by international federation of gynecology and obstetrics (FIGO).

Methodology: This descriptive study was conducted in Department of Obstetrics & Gynaecology, Hayatabad Medical Complex, Peshawar, from 8th August 2019 to 9th August 2020. Patients admitted for hysterectomy/ endometrial sampling due to abnormal uterine bleeding (AUB) were included in the study through non-probability convenient sampling. Detailed history, clinical examination and relevant investigations were recorded on a prede­signed proforma. Abnormal uterine bleeding was then classified according to FIGO new system (PALM-COEIN). Descriptive statistics were used in the form of frequencies and percentages.

Results: A total of 78 patients underwent surgical intervention for abnormal uterine bleeding. The mean age of the participants was 44.0±3.9 years. Most of the patients were either multi or grand multipara (n=75, 96.2%). Majority reported to have regular bleeding (n=55, 70.5%), frequent cycles (n=56,71.8%), prolonged flow (n=54, 69.2%) and heavy blood loss (n=61,78.2%). The PALM portion comprised of 33 (42.3%) causes of AUB, while COEIN portion comprises of 29 (37.2%) causes while sixteen (20.5%) cases were having more than one under­lying pathologies. AUB-L (Leiomyoma) was most common cause in the PALM group (n=13, 16.7%), while AUB-E (Endometrial) in the COEIN group (n=13, 16.7%).

Conclusion: Multiple/mixed etiologies were the most common causes of AUB, followed by AUB-L and AUB-E.

Article Details

How to Cite
Karim R, Saima Ayub. DETERMINATION OF CAUSES OF MENSTRUAL DISORDERS USING PALM COEIN CLASSIFICATION SYSTEM. J Postgrad Med Inst [Internet]. 2021 Jun. 30 [cited 2024 Jul. 24];35(2):110-3. Available from:
Original Article


Fraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A, Petraglia F. Prevalence of heavy menstrual bleed¬ing and experiences of affected wom¬en in a European patient survey. Int J Gynecol Obstet. 2015; 128:196–200.

Woolcock JG, Critchley HO, Munro MG, Broder MS, Fraser IS. Review of the confusion in current and historical terminology and definitions for distur¬bances of menstrual bleeding. Fertil Steril. 2008; 90:2269–80.

Critchley HO, Munro MG, Broder M, Fraser IS. A five-year international review process concerning terminol¬ogies, definitions, and related issues around abnormal uterine bleeding. Semin Reprod Med. 2011; 29:377– 82.

Munro MG, Critchley HO, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnor¬mal uterine bleeding in the reproduc¬tive years: 2018 revisions. Int J Gyne¬col Obstet. 2018; 143:393-408.

Fraser IS, Critchley HO, Munro MG, Broder M. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril. 2007; 87:466– 76.

Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the re¬productive years. Best Pract Res Clin Obstet Gynaecol. 2017; 40:3–22.

Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the re¬productive years. Fertil Steril. 2011; 95:2204–2208.

Bazot M, Darai E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril. 2018; 109:389–97.

Maheux-Lacroix S, Li F, Laberge PY, Abbott J. Imaging for polyps and leio¬myomas in women with abnormal uterine bleeding: A systematic review. Obstet Gynecol. 2016; 128:1425–36.

American College of Obstetricians and Gynecologists. ACOG committee opin¬ion no 557: Management of acute ab¬normal uterine bleeding in non-preg¬nant reproductive-aged women. Obstet Gynecol. 2013; 121:891–96.

Cote I, Jacobs P, Cumming DC. Use of health services associated with increased menstrual loss in the United States. Am J Obstet Gynecol. 2003;188: 343–8.

Mitra N, Patil P, Sethia A. Etiological factors of abnormal uterine bleeding according to PALMCOEIN classifi¬cation in perimenopausal women in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2020; 9(2):799-803.

Tater A, Jain P, Sharma KN. Categori¬zation of patients with abnormal uter¬ine bleeding according to PALM-COE¬IN FIGO classification. Int J Reprod Contracept Obstet Gynecol. 2019; 8(12):4783-85.

Ansari A, Urooj U. Study of causes behind abnormal uterine bleeding ac¬cording to PALM- COEIN classification at a tertiary care hospital. J Pak Med Assoc. 2020; 70:973-75.

Qureshi FU, Yusuf AW. Distribution of causes of abnormal uterine bleeding using the new FIGO classification system. J Pak Med Assoc. 2013; 63:154-56.

Sun Y, Wang Y, Mao L, Wen J, Bai W. Prevalence of abnormal uterine bleed¬ing according to new International Federation of Gynecology and Obstet¬rics classification in Chinese women of reproductive age. A cross-sectional study. Medicine. 2018; 97:31.

Betha K, Malavatu L, Talasani S. Dis¬tribution of causes of abnormal uter¬ine bleeding using new FIGO classi¬fication system-PALM COEIN: a rural tertiary hospital based study. Int J Reprod Contracept Obstet Gynecol. 2017; 6(8):3523-27.

Mishra D, Sultan S. FIGO’s PALM– COEIN Classification of Abnormal Uterine Bleeding: A Clinico-histo-pathological Correlation in Indian Set¬ting. J Obstet Gynecol India. 2017; 67(2):119-25.

Deneris A. PALM-COEIN Nomencla¬ture for Abnormal Uterine Bleeding. J Midwifery Womens Health. 2016; 61(3):376-9.