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Federación Mexicana de Ginecología y Obstetricia, A.C.

2024, Number 10

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Ginecol Obstet Mex 2024; 92 (10)

Abnormal uterine bleeding: PALM-COEIN classification. An update

Sepúlveda AJ, Torres LAS, Sepúlveda SAJ

Language: Spanish
References: 58
Page: 427-439
PDF size: 752.62 Kb.


ABSTRACT

Objective: To update the information related to abnormal uterine bleeding, its classification system, and to summarize the evidence published from 2018 to date.
Methodology: Retrospective study based on searching PubMed, LILACS, Scopus and Web of Science databases with the MeSH “PALM-COEIN”.
Results: 103 articles were found, of which 20 were selected for review after filtering with the Rayyan tool and applying the PRISMA method.
Conclusion: The classification system for abnormal uterine bleeding has received several modifications that it is necessary know and use in the current terminology proposed by FIGO. This will help in the understanding and better communication of this diagnosis. It has also demonstrated its effectiveness in guiding the cause according to the characteristics of the bleeding, which contributes to improving the epidemiologic study of patients suffering from any of the diseases considered in the PALM-COEIN system.


REFERENCES

  1. Munro MG, Critchley HOD, Fraser IS. The two FIGO systemsfor normal and abnormal uterine bleeding symptoms andclassification of causes of abnormal uterine bleeding in thereproductive years: 2018 revisions. Int J Gynecol Obstet 2018;143 (Suppl 2): 393-408. https://doi.org/10.1002/ijgo.12666.

  2. Sepúlveda J, Díaz G. Detención de la hemorragia uterinaanormal en pacientes a quienes se realizó histeroscopiaoperatoria. Ginecol Obstet Mex. 2018 ;86 (1): 13-25.https://doi.org/10.24245/gom.v86i1.1666.

  3. Ramalho I, Leite H, Águas F. Abnormal Uterine Bleeding inAdolescents: A Multidisciplinary Approach. Acta Med Port.2021; 34 (4): 291-97. https://doi.org/10.20344/amp.12829

  4. Donnez J, Carmona F, Maitrot-Mantelet L, Dolmans MM,et al. Uterine disorders and iron deficiency anemia. FertilSteril 2022; 118 (4): 615-24. https://doi.org/10.1016/j.fertnstert.2022.08.011

  5. Woolcock JG, Critchley HO, Munro MG, Broder MS, etal. Review of the confusion in current and historical terminologyand definitions for disturbances of menstrualbleeding. Fertil Steril 2008; 90 (6): 2269-80. https://doi.org/10.1016/j.fertnstert.2007.10.060

  6. Kahveci B, Budak MS, Ege S, Obut M, et al. PALM-COEINclassification system of FIGO vs the classic terminology inpatients with abnormal uterine bleeding. Ginekol Pol 2021;92 (4): 257-61. https://doi.org/10.5603/GP.a2021.0011

  7. Chodankar R, Critchley HOD. Abnormal uterine bleeding(including PALM COEIN classification). Obstet Gynecol ReprodMed 2019; 29 (3): 78-84. https://doi.org/10.1016/j.ogrm.2019.01.009

  8. Sepúlveda-Agudelo J, Sepúlveda-Sanguino AJ. Sangradouterino anormal y PALM COEIN. Ginecol Obstet Mex 2020;88 (1): 59-67. https://doi.org/10.24245/gom.v88i1.346

  9. Harlow SD, Lin X, Ho MJ. Analysis of menstrual diary dataacross the reproductive life span applicability of the bipartitemodel approach and the importance of within womanvariance. J Clin Epidemiol 2000; 53: 722-733. https://doi.org/10.1016/s0895-4356(99)00202-4

  10. National Collaborating Centre for Women's and Children'sHealth (UK). Heavy Menstrual Bleeding. London: RCOGPress, 2007.

  11. Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO WorkingGroup on Menstrual Disorders. FIGO classification system(PALM-COEIN) for causes of abnormal uterine bleedingin nongravid women of reproductive age. Int J GynaecolObstet 2011; 113 (1): 3-13. https://doi.org/10.1016/j.ijgo.2010.11.011

  12. Munro MG, Critchley HO, Fraser IS. The FIGO systems fornomenclature and classification of causes of abnormaluterine bleeding in the reproductive years: who needsthem? Am J Obstet Gynecol 2012; 207 (4): 259-65 https://doi.org/10.1016/j.ajog.2012.01.046

  13. Raz N, Feinmesser L, Moore O, Haimovich S. Endometrialpolyps: diagnosis and treatment options – a review ofliterature. Minim Invasive Ther Allied Technol 2021; 30 (5):278-87 https://doi.org/10.1080/13645706.2021.1948867

  14. American Association of Gynecologic Laparoscopists. AAGLpractice report: practice guidelines for the diagnosis andmanagement of endometrial polyps. J Minim InvasiveGynecol 2012; 19 (1): 3-10. https://doi.org/10.1016/j.jmig.2011.09.003

  15. Lieng M, Istre O, Sandvik L, Qvigstad E. Prevalence, 1-yearregression rate, and clinical significance of asymptomaticendometrial polyps: cross-sectional study. J Minim InvasiveGynecol 2009; 16 (4): 465-471. https://doi.org/10.1016/j.jmig.2009.04.005

  16. Ni P, Wu M, Guan H, Yuan Y, et al. Etiology distribution ofabnormal uterine bleeding according to FIGO classificationsystem: A combined study of ultrasound and histopathology.J Obstet Gynaecol Res 2022; 48 (7): 1913-20. https://doi.org/10.1111/jog.15226

  17. Sun Y, Wang Y, Mao L, Wen J, et al. Prevalence of abnormaluterine bleeding according to new International Federationof Gynecology and Obstetrics classification in Chinesewomen of reproductive age: A cross-sectional study.Medicine (Baltimore) 2018; 97 (31): e11457. https://doi.org/10.1097/MD.0000000000011457

  18. Lee SC, Kaunitz AM, Sanchez-Ramos L, Rhatigan RM.The oncogenic potential of endometrial polyps: asystematic review and meta-analysis. Obstet Gynecol2010; 116 (5): 1197-205. https://doi.org/10.1097/AOG.0b013e3181f74864.

  19. Bel S, Billard C, Godet J, Viviani V, Akladios C, Host A, FallerE, Boisrame T, Hummel M, Baldauf JJ, Lecointre L, Garbin O.Risk of malignancy on suspicion of polyps in menopausalwomen. Eur J Obstet Gynecol Reprod Biol. 2017;216:138-142. https://doi.org/10.1016/j.ejogrb.2017.07.013.

  20. Vitale SG, Haimovich S, Laganà AS, Alonso L, Di SpiezioSardo A, Carugno J; From the Global Community of HysteroscopyGuidelines Committee. Endometrial polyps. Anevidence-based diagnosis and management guide. Eur JObstet Gynecol Reprod Biol. 2021;260:70-77. https://doi.org/10.1016/j.ejogrb.2021.03.017.

  21. Nijkang NP, Anderson L, Markham R, Manconi F. Endometrialpolyps: Pathogenesis, sequelae and treatment.SAGE Open Med. 2019;7:1-12. https://doi.org/10.1177/2050312119848247.

  22. Marnach ML, Laughlin-Tommaso SK. Evaluation andManagement of Abnormal Uterine Bleeding. Mayo ClinProc. 2019;94(2):326-335. https://doi.org/10.1016/j.mayocp.2018.12.012.

  23. Vannuccini S, Petraglia F. Recent advances in understandingand managing adenomyosis. F1000Res. 2019;8:1-10.https://doi.org/10.12688/f1000research.17242.1.

  24. Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G,Taniguchi F. The Impact of Adenomyosis on Women's Fertility.Obstet Gynecol Surv. 2016;71(9):557-568. https://doi.org/10.1097/OGX.0000000000000346.

  25. Abbott JA. Adenomyosis and Abnormal Uterine Bleeding(AUB-A)-Pathogenesis, diagnosis, and management. BestPract Res Clin Obstet Gynaecol. 2017;40:68-81. https://doi.org/10.1016/j.bpobgyn.2016.09.006.

  26. Bazot M, Daraï E. Role of transvaginal sonography andmagnetic resonance imaging in the diagnosis of uterineadenomyosis. Fertil Steril. 2018;109(3):389-397. https://doi.org/10.1016/j.fertnstert.2018.01.024.

  27. Van den Bosch T, Dueholm M, Leone FP, Valentin L, RasmussenCK, Votino A, et al. Terms, definitions and measurementsto describe sonographic features of myometriumand uterine masses: A consensus opinion from the MorphologicalUterus Sonographic Assessment (MUSA) group.Ultrasound Obstet Gynecol. 2015;46(3):284-298. https://doi.org/10.1002/uog.14806.

  28. McWilliams MM, Chennathukuzhi VM. Recent Advances inUterine Fibroid Etiology. Semin Reprod Med. 2017;35(2):181-189. https://doi.org/10.1055/s-0037-1599090.

  29. Giuliani E, As-Sanie S, Marsh EE. Epidemiology andmanagement of uterine fibroids. Int J Gynaecol Obstet.2020;149(1):3-9. https://doi.org/10.1002/ijgo.13102.

  30. Sabre A, Serventi L, Nuritdinova D, Schiattarella A,Sisti G. Abnormal uterine bleeding types accordingto the PALM-COEIN FIGO classification in a medicallyunderserved American community. J Turk Ger GynecolAssoc. 2021;22(2):91-96. https://doi.org/10.4274/jtgga.galenos.2021.2020.0228.

  31. Vilos GA, Allaire C, Laberge PY, Leyland N; SPECIAL CONTRIBUTORS.The management of uterine leiomyomas. JObstet Gynaecol Can. 2015;37(2):157-178. https://doi.org/10.1016/S1701-2163(15)30338-8.

  32. Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F.Epidemiology and Risk Factors of Uterine Fibroids. BestPract Res Clin Obstet Gynaecol 2018; 46: 3-11. https://doi.org/10.1016/j.bpobgyn.2017.09.004

  33. Dueholm M, Hjorth IM. Structured imaging technique inthe gynecologic office for the diagnosis of abnormal uterinebleeding. Best Pract Res Clin Obstet Gynaecol 2017; 40:23-43. https://doi.org/10.1016/j.bpobgyn.2016.09.010

  34. Kalambe M, Jungari M, Chaudhary A, Kalambe A, ShrivastavaD. Palm Coein Figo Classification System for Causes ofAbnormal Uterine Bleeding (AUB) in Non Gravid Womenof Reproductive Age Group in a Peri Urban Tertiary CareHospital. Int J Cur Res Rev. 2020;12:128-33. https://doi.org/10.31782/ijcrr.2020.121523

  35. Singh K, Agarwal C, Pujani M, Raychaudhuri S, SharmaN, Chauhan V, Chawla R, Ahuja R, Singh M. A ClinicopathologicalCorrelation of International Federation ofGynecology and Obstetrics’s PALM-COEIN Classificationof Abnormal Uterine Bleeding: Indian Scenario. J MidlifeHealth. 2019;10(3):147-152. https://doi.org/10.4103/jmh.JMH_128_18.

  36. Ansari A, Urooj U. Study of causes behind abnormal uterinebleeding according to PALM- COEIN classification at a tertiarycare hospital. J Pak Med Assoc. 2020;70(1):154-157.https://doi.org/10.5455/JPMA.2749.

  37. Bacon JL. Abnormal Uterine Bleeding: Current Classificationand Clinical Management. Obstet Gynecol Clin NorthAm. 2017;44(2):179-193. https://doi.org/10.1016/j.ogc.2017.02.012.

  38. Kostov S, Watrowski R, Kornovski Y, Dzhenkov D, SlavchevS, Ivanova Y, Yordanov A. Hereditary Gynecologic CancerSyndromes - A Narrative Review. Onco Targets Ther.2022;15:381-405. https://doi.org/10.2147/OTT.S353054.

  39. Long B, Clarke MA, Morillo ADM, Wentzensen N, Bakkum-Gamez JN. Ultrasound detection of endometrial cancer inwomen with postmenopausal bleeding: Systematic reviewand meta-analysis. Gynecol Oncol 2020; 157 (3): 624-633.https://doi.org/10.1016/j.ygyno.2020.01.032

  40. Smith-Bindman R, Weiss E, Feldstein V. How thick is toothick? When endometrial thickness should prompt biopsyin postmenopausal women without vaginal bleeding UltrasoundObstet Gynecol 2004; 24: 558–565. https://doi.org/10.1002/uog.1704

  41. Vitale SG, Riemma G, Haimovich S, Carugno J, Alonso Pacheco L,Perez-Medina T, et al. Risk of endometrial cancer in asymptomaticpostmenopausal women in relation to ultrasonographicendometrial thickness: systematic review and diagnostic testaccuracy meta-analysis. Am J Obstet Gynecol. 2023;228(1):22-35. https://doi.org/10.1016/j.ajog.2022.07.043

  42. Zhang L, Guo Y, Qian G, Su T, Xu H. Value of endometrialthickness for the detection of endometrial cancer andatypical hyperplasia in asymptomatic postmenopausalwomen. BMC Women's Health. 2022;22:517. https://doi.org/10.1186/s12905-022-02089-y.

  43. Chodankar RR, Munro MG, Critchley HOD. Historical Perspectivesand Evolution of Menstrual Terminology. FrontReprod Health. 2022;4:820029. https://doi.org/10.3389/frph.2022.820029.

  44. Emons G, et al. New WHO Classification of EndometrialHyperplasias. Geburtshilfe Frauenheilkd. 2015;75(2):135-136. https://doi.org/10.1055/s-0034-1396256.

  45. Adams T, Denny L. Abnormal vaginal bleeding in womenwith gynaecological malignancies. Best Pract Res Clin ObstetGynaecol. 2017;40:134-147. https://doi.org/10.1016/j.bpobgyn.2016.09.014.

  46. Aalpona FZ, Mondal D, Pandit P, Kamrul-Hasan AB. Etiologyof Chronic Abnormal Uterine Bleeding According to theFIGO’s PALM-COEIN Classification in Bangladeshi Womenof Reproductive Age: A Cross-Sectional Study. MymensinghMed J. 2022;31(2):312-317.

  47. Oruç N, Celik H, Gündüz N, Yildirim G. Evaluation of thePatients with Abnormal Uterine Bleeding Based on PALMCOEINClassification. Istanbul Med J. 2019;20:477-481.https://doi.org/10.4274/imj.galenos.2019.03780

  48. Hapangama DK, Bulmer JN. Pathophysiology of heavy menstrualbleeding. Womens Health (Lond). 2016;12(1):3-13.https://doi.org/10.2217/whe.15.81.

  49. Hauk L; American College of Obstetricians and Gynecologists.ACOG releases guidelines on management ofabnormal uterine bleeding associated with ovulatorydysfunction. Am Fam Physician. 2014;89(12):987-988.

  50. Kitahara Y, Hiraike O, Ishikawa H, Kugu K, Takai Y, YoshinoO, et al. National survey of abnormal uterine bleedingaccording to the FIGO classification in Japan. J Obstet GynaecolRes. 2023;49(1):321-330. https://doi.org/10.1111/jog.15464.

  51. Munro MG, Balen AH, Cho S, Critchley HOD, Díaz I, FerrianiR, et al; FIGO Committee on Menstrual Disordersand Related Health Impacts, and FIGO Committee onReproductive Medicine, Endocrinology, and Infertility.The FIGO Ovulatory Disorders Classification System†. HumReprod. 2022;37(10):2446-2464. https://doi.org/10.1093/humrep/deac180.

  52. Khrouf M, Terras K. Diagnosis and Management of FormerlyCalled "Dysfunctional Uterine Bleeding" Accordingto PALM-COEIN FIGO Classification and the New Guidelines.J Obstet Gynaecol India. 2014;64(6):388-393. https://doi.org/10.1007/s13224-014-0641-1.

  53. Smith SK, Abel MH, Kelly RW, Baird DT. A role for prostacyclin(PGi2) in excessive menstrual bleeding. Lancet.1981;1(8219):522-524. https://doi.org/10.1016/s0140-6736(81)92862-2

  54. Gleeson NC. Cyclic changes in endometrial tissue plasminogenactivator and plasminogen activator inhibitortype 1 in women with normal menstruation and essentialmenorrhagia. Am J Obstet Gynecol 1994; 171 (1): 178-83.https://doi.org/10.1016/0002-9378(94)90466-9

  55. Toth M, Patton DL, Esquenazi B, Shevchuk M, Thaler H,Divon M. Association between Chlamydia trachomatisand abnormal uterine bleeding. Am J Reprod Immunol2007; 57 (5): 361-66. doi https://doi.org/10.1111/j.1600-0897.2007.00481.x

  56. Middelkoop MA, Don EE, Hehenkamp WJK, Polman NJ, etal. Angiogenesis in abnormal uterine bleeding: a narrativereview. Hum Reprod Update 2023; 29: 457-85. https://doi.org/10.1093/humupd/dmad004

  57. Bryk AH, Piróg M, Plens K, Undas A. Heavy menstrualbleeding in women treated with rivaroxaban and vitaminK antagonists and the risk of recurrent venous thromboembolism.Vascul Pharmacol 2016; 87: 242-47. https://doi.org/10.1016/j.vph.2016.11.003

  58. Murji A, Sanders AP, Monteiro I, Haiderbhai S, et al; InternationalFederation of Gynecology and Obstetrics (FIGO)Committee on Menstrual Disorders and Related HealthImpacts. Cesarean scar defects and abnormal uterinebleeding: a systematic review and meta-analysis. FertilSteril 2022; 118 (4): 758-66. https://doi.org/10.1016/j.fertnstert.2022.06.031




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