Assessment and Categorisation of abnormal uterine bleeding according to palm-coein classification

Background: Abnormal uterine bleeding (AUB) is a common cause for concern among reproductive women, sometimes debilitating, for which patients seek advice in gynecology outpatient department. The aim of the study was: 1.To categorize women with AUB attending a rural teaching hospital according to new classification system PALM-COEIN by the International Federation of Gynecology and Obstetrics (FIGO). 2.To collect clinical and histopathologic data based on new terminology and definitions. 3.To correlate the clinical and pathologic features. Materials and Methods: This study was a cross sectional descriptive study to categorize women with AUB according to PALM COEIN classification system by International Federation of Obstetrics and Gynecology (FIGO), conducted in MALLAREDDY INSTITUTE OF MEDICAL SCIENCES, Suraram, Hyderabad, Telangana from October 2015 to March 2017. The study carried out on 250 non-gravid women presenting with AUB attending gynecology OPD after considering inclusion and exclusion criteria. The variables were analyzed using frequencies, percentages and chi-square test. The data and graphical techniques were presented by latest version of statistical software (SPSS-6). Results: In this study 250 nongravid women presented with AUB aged between 25-45years were included. Among women with 25-30 years Polyp was most common structural abnormality seen. Where as in women aged 31-45 years leiomyoma. Among women with 25-30 years iatrogenic cause was the most common and ovulatory dysfuntion in 36-45 years age group among non-structral causes. 68.8% of women presented with chronic AUB, while only 31.2% presented with acute AUB. Among all causes of AUB, leiomyoma was the most common cause and coagulopathy was the least common cause accounting for 0.8% of all cases. On sub classifying polyps, 69.3% were arising from endometrium and 30.7% were from cervix. Of 26 cases of polyps, 16 cases (61.5%) were associated with proliferative phase of endometrium and 8 cases (30.7%) with secretory phase of endometrium. Most of the women with adenomyosis had secretory phase of endometrium (53.3%), where as leiomyoma were associated with (55.2%) secretory phase of endometrium, followed by proliferative phase of endometrium (38.15%). Most of the leiomyoma cases were from sub mucosal (68.5%) origin. Most of the cases of endometrial hyperplasia are of simple endometrial hyperplasia without atypia contributing to 64.2% of cases. In the category of malignancy and hyperplasia, endometrial hyperplasia contributed to 73.7% and malignancy contributed to 36.7%. Most of the cases with ovulatory dysfunction had endometrium in proliferative phase (52.9%), while atrophic were only 10% of endometrial causes of AUB.62% of the cases were having a history of using hormonal medications in the preceding three months, while 38% of women were using intra uterine contraceptive devices. 58% of women with AUB had single pathology and 42% of women were having multiple pathologies. This classification helps in denoting a patient with single or multifactorial etiology. Conclusion: Confusion regarding the terminology, definitions and classification of AUB has been overcome by new standard terminology and universally accepted classification system, PALM-COEIN by the International Federation of Gynecology and Obstetrics (FIGO). Maximum number of patients with AUB were in 41-45 years age group and more common in multiparous women. Most common clinical presentation was HMB. In this study 42% of cases were identified to have multiple pathologies. This classification system helps in understanding various exact etiological causes of AUB and can be used by the clinicians to facilitate communication, clinical care and research. For this reason we strongly recommend adoption of this classification for AUB and HMB.