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A retrospective perspective on abnormal uterine bleeding and the PALM-COEIN classification: Experiences of a tertiary center

Year 2022, , 171 - 175, 06.12.2022
https://doi.org/10.46969/EZH.1167744

Abstract

Background: The Menstrual Disorders Working Group of the International Federation of Gynecology and Obstetrics (FIGO) created a new classification system called “PALM-COEIN” for abnormal uterine bleeding in 2011. The aim of our study is to investigate the new classification system and compare it with the classical terminology for abnormal uterine bleeding.
Materials and Methods: Our study was conducted retrospectively between February 2022 and July 2022 in the gynecology clinic of Keciören Training and Research Hospital. Premenopausal women without known chronic disease were enrolled in the study. Each patient enrolled in the study was examined based on anatomical structure, physical examination, and pelvic ultrasonography. If necessary, endometrial specimens and hysterectomy material were obtained for histopathologic examination. Possible causes were classified according to the new classification system.
Results: The study included 135 premenopausal women with abnormal uterine bleeding. In general, the patients with bleeding complaints had leiomyoma uteri and polyps according to the classical terminology. They were grouped under the labels of hypermenorrhea, menorrhagia, metrorrhagia, and menometrorrhagia, which were due to various causes, including polyps, adenomyosis, hyperplasia, and iatrogenic causes. According to the classification PALM-COEIN, 35 (25.9%) polyps, 16 (11.8%) adenomyosis, 38 (28.1%) leiomyomas, 4 (2.9%) malignancies and hyperplasia were detected.
Conclusion: The classification of abnormal uterine bleeding is generally inconsistent. The new classification system, created for many reasons, is an important step towards understanding complex situations. Another need is that a widely accepted and known classification system should facilitate communication among clinicians and clarify the review of the target population. It is also clear that the new classification system will improve communication between patients. Widespread use of the system will also reveal new treatment options for abnormal uterine bleeding.

References

  • American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet and Gynecol 2013;121(4):891-896.
  • Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM‐COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011;113(1):3-13.
  • Agarwal SK, Singh SS, Archer DF et al. Endometriosis-related pain reduction during bleeding and nonbleeding days in women treated with elagolix. J Pain Res 2021; 14: 263-271.
  • Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician 2012;85(1):35-43.
  • Wouk N, Helton M. Abnormal uterine bleeding in premenopausal women. Am Fam Physician 2019;99(7):435-443.
  • Huang EC, Crum CP, Hornstein MD. Evaluation of the cyclic endometrium and benign endometrial disorders. Diagnostic Gynecologic and Obstetric Pathology Elsevier, Philadelphia, PA 2018; 471-523.
  • Prentice A. Health care implications of dysfunctional uterine bleeding. Baillieres Best Pract Res Clin Obstet Gynaecol 1999;13(2):181-188.
  • Qureshi FU, Yusuf AW. Distribution of causes of abnormal uterine bleeding using the new FIGO classification system. JPMA 2013;63:973.
  • Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril 2011;95(7):2204-2208.
  • Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol 2016;34:54-65.
  • Dueholm M. Transvaginal ultrasound for diagnosis of adenomyosis: a review. Best Pract Res Clin Obstet Gynaecol 2006;20(4):569-582.
  • Brosens J, Souza NM, Barker FG, Paraschos T, Winston RM. Endovaginal ultrasonography in the diagnosis of adenomyosis uteri: identifying the predictive characteristics. Br J Obstet Gynaecol 1995;102(6):471-474.
  • Mishra D, Sultan S. FIGO’s PALM–COEIN Classification of Abnormal Uterine Bleeding: A Clinico-histopathological Correlation in Indian Setting. J Obstet Gynaecol India 2017;67(2):119-125.
  • Perveen S. Endometrium Histology In Abnormal Uterine Bleeding. Medical Channel 2011;17(4):68-70.
  • Jonathan AA, Saravanan S. A two year clinicopathological study of non-gravid women with abnormal uterine bleeding in a rural tertiary care centre in Tamilnadu: in concurrence with the Figo recommendations. J of Evolution of Med and Dent Sci 2015;4(63):10990-11001.
  • Espindola D, Kennedy KA, Fischer EG. Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia. Obstet Gynecol Clin North Am 2007;34(4):717-737.
  • ESHRE Capri Workshop Group. Intrauterine devices and intrauterine systems. Hum Reprod Update 2008;14(3):197-208.

Anormal uterin kanama ve PALM-COEIN sınıflandırmasına retrospektif bakış açısı: Tersiyer merkezin deneyimleri

Year 2022, , 171 - 175, 06.12.2022
https://doi.org/10.46969/EZH.1167744

Abstract

Amaç: 2011 yılında Uluslararası Jinekoloji ve Obstetrik Federasyonu’nun (FIGO) Menstrüel Bozukluklar Çalışma Grubu, anormal uterin kanama için “PALM-COEIN” adlı yeni bir sınıflandırma sistemi oluşturdu. Çalışmamızın amacı, anormal uterin kanama için yeni sınıflandırma sistemini araştırmak ve klasik terminoloji ile karşılaştırmaktır.
Gereç ve Yöntem: Çalışmamız Şubat 2022 ile Temmuz 2022 tarihleri arasında Keçiören Eğitim ve Araştırma Hastanesi kadın hastalıkları kliniğinde retrospektif olarak yapılmıştır. Bilinen kronik hastalığı olmayan premenopozal kadınlar çalışmaya dahil edilmiştir. Çalışmaya alınan her hasta fizik muayene ve pelvik ultrasonografi ile değerlendirilmiştir. Gerekirse histerektomi materyali ve endometriyal spesmen histopatolojik inceleme için alındı. Olası nedenler yeni sınıflandırma sistemine göre sınıflandırıldı.
Bulgular: Çalışmaya anormal uterin kanaması olan 135 premenopozal kadın dahil edildi. Kanama şikayeti ile başvuran hastalar; polipler, adenomiyozis, hiperplazi ve iyatrojenik nedenler gibi çeşitli nedenlere bağlı hipermenore, menoraji, metroraji ve menometroraji etiketleri altında gruplandırılmıştır. PALM-COEIN sınıflamasına göre 35 (%25,9) polip, 16 (%11,8) adenomyozis, 38 (%28,1) leiomyom, 4 (%2,9) malignite ve hiperplazi tespit edildi.
Sonuç: Anormal uterin kanamanın sınıflandırılması genellikle tutarsızdır. Birçok nedenden dolayı oluşturulan yeni sınıflandırma sistemi, karmaşık durumları anlamak için önemli bir adımdır. Diğer bir ihtiyaç ise, yaygın olarak kabul edilen ve bilinen bir sınıflandırma sisteminin klinisyenler arasındaki iletişimi kolaylaştırması ve hedef popülasyonun gözden geçirilmesini netleştirmesidir. Yeni sınıflandırma sisteminin hastalar arasındaki iletişimi iyileştireceği de açıktır. Sistemin yaygın kullanımı anormal uterin kanamalar için de yeni tedavi seçeneklerini ortaya çıkaracaktır.

References

  • American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet and Gynecol 2013;121(4):891-896.
  • Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM‐COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011;113(1):3-13.
  • Agarwal SK, Singh SS, Archer DF et al. Endometriosis-related pain reduction during bleeding and nonbleeding days in women treated with elagolix. J Pain Res 2021; 14: 263-271.
  • Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician 2012;85(1):35-43.
  • Wouk N, Helton M. Abnormal uterine bleeding in premenopausal women. Am Fam Physician 2019;99(7):435-443.
  • Huang EC, Crum CP, Hornstein MD. Evaluation of the cyclic endometrium and benign endometrial disorders. Diagnostic Gynecologic and Obstetric Pathology Elsevier, Philadelphia, PA 2018; 471-523.
  • Prentice A. Health care implications of dysfunctional uterine bleeding. Baillieres Best Pract Res Clin Obstet Gynaecol 1999;13(2):181-188.
  • Qureshi FU, Yusuf AW. Distribution of causes of abnormal uterine bleeding using the new FIGO classification system. JPMA 2013;63:973.
  • Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril 2011;95(7):2204-2208.
  • Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol 2016;34:54-65.
  • Dueholm M. Transvaginal ultrasound for diagnosis of adenomyosis: a review. Best Pract Res Clin Obstet Gynaecol 2006;20(4):569-582.
  • Brosens J, Souza NM, Barker FG, Paraschos T, Winston RM. Endovaginal ultrasonography in the diagnosis of adenomyosis uteri: identifying the predictive characteristics. Br J Obstet Gynaecol 1995;102(6):471-474.
  • Mishra D, Sultan S. FIGO’s PALM–COEIN Classification of Abnormal Uterine Bleeding: A Clinico-histopathological Correlation in Indian Setting. J Obstet Gynaecol India 2017;67(2):119-125.
  • Perveen S. Endometrium Histology In Abnormal Uterine Bleeding. Medical Channel 2011;17(4):68-70.
  • Jonathan AA, Saravanan S. A two year clinicopathological study of non-gravid women with abnormal uterine bleeding in a rural tertiary care centre in Tamilnadu: in concurrence with the Figo recommendations. J of Evolution of Med and Dent Sci 2015;4(63):10990-11001.
  • Espindola D, Kennedy KA, Fischer EG. Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia. Obstet Gynecol Clin North Am 2007;34(4):717-737.
  • ESHRE Capri Workshop Group. Intrauterine devices and intrauterine systems. Hum Reprod Update 2008;14(3):197-208.
There are 17 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Article
Authors

Canan Tapkan 0000-0002-0849-0281

Bengü Mutlu Sütcüoğlu 0000-0002-5594-1719

Hande Nur Oncu 0000-0002-9407-2704

Müjde Can İbanoğlu 0000-0002-8413-2064

Publication Date December 6, 2022
Acceptance Date September 26, 2022
Published in Issue Year 2022

Cite

APA Tapkan, C., Mutlu Sütcüoğlu, B., Oncu, H. N., İbanoğlu, M. C. (2022). A retrospective perspective on abnormal uterine bleeding and the PALM-COEIN classification: Experiences of a tertiary center. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, 4(4), 171-175. https://doi.org/10.46969/EZH.1167744
AMA Tapkan C, Mutlu Sütcüoğlu B, Oncu HN, İbanoğlu MC. A retrospective perspective on abnormal uterine bleeding and the PALM-COEIN classification: Experiences of a tertiary center. Türk Kadın Sağlığı ve Neonatoloji Dergisi. December 2022;4(4):171-175. doi:10.46969/EZH.1167744
Chicago Tapkan, Canan, Bengü Mutlu Sütcüoğlu, Hande Nur Oncu, and Müjde Can İbanoğlu. “A Retrospective Perspective on Abnormal Uterine Bleeding and the PALM-COEIN Classification: Experiences of a Tertiary Center”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi 4, no. 4 (December 2022): 171-75. https://doi.org/10.46969/EZH.1167744.
EndNote Tapkan C, Mutlu Sütcüoğlu B, Oncu HN, İbanoğlu MC (December 1, 2022) A retrospective perspective on abnormal uterine bleeding and the PALM-COEIN classification: Experiences of a tertiary center. Türk Kadın Sağlığı ve Neonatoloji Dergisi 4 4 171–175.
IEEE C. Tapkan, B. Mutlu Sütcüoğlu, H. N. Oncu, and M. C. İbanoğlu, “A retrospective perspective on abnormal uterine bleeding and the PALM-COEIN classification: Experiences of a tertiary center”, Türk Kadın Sağlığı ve Neonatoloji Dergisi, vol. 4, no. 4, pp. 171–175, 2022, doi: 10.46969/EZH.1167744.
ISNAD Tapkan, Canan et al. “A Retrospective Perspective on Abnormal Uterine Bleeding and the PALM-COEIN Classification: Experiences of a Tertiary Center”. Türk Kadın Sağlığı ve Neonatoloji Dergisi 4/4 (December 2022), 171-175. https://doi.org/10.46969/EZH.1167744.
JAMA Tapkan C, Mutlu Sütcüoğlu B, Oncu HN, İbanoğlu MC. A retrospective perspective on abnormal uterine bleeding and the PALM-COEIN classification: Experiences of a tertiary center. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2022;4:171–175.
MLA Tapkan, Canan et al. “A Retrospective Perspective on Abnormal Uterine Bleeding and the PALM-COEIN Classification: Experiences of a Tertiary Center”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, vol. 4, no. 4, 2022, pp. 171-5, doi:10.46969/EZH.1167744.
Vancouver Tapkan C, Mutlu Sütcüoğlu B, Oncu HN, İbanoğlu MC. A retrospective perspective on abnormal uterine bleeding and the PALM-COEIN classification: Experiences of a tertiary center. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2022;4(4):171-5.