Palm-Coein Classification of Abnormal Uterine Bleeding and Clinicopathological Correlation

Authors

  • Rabia Nasir Kakar Department of Obstetrics and Gynaecology, Bolan Medical Complex (BMC) Hospital, Quetta, Balochistan, Pakistan.
  • Summaira Hamza Department of Obstetrics and Gynaecology, Bolan Medical Complex (BMC) Hospital, Quetta, Balochistan, Pakistan.
  • Hira Yousaf Department of Obstetrics and Gynaecology, Bolan Medical Complex (BMC) Hospital, Quetta, Balochistan, Pakistan.
  • Syeda Ume Farwa Department of Obstetrics and Gynaecology, Bolan Medical Complex (BMC) Hospital, Quetta, Balochistan, Pakistan.
  • Mahpara Department of Obstetrics and Gynaecology, Bolan Medical Complex (BMC) Hospital, Quetta, Balochistan, Pakistan.
  • Bibi Ruqia Department of Obstetrics and Gynaecology, Bolan Medical Complex (BMC) Hospital, Quetta, Balochistan, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i4.1041

Keywords:

Palm-Coein, Abnormal Uterine Bleeding, Classification, Clinicopathological Correlation

Abstract

Background: AUB is a prevalent gynaecological condition that has a substantial effect on women's social, emotional, and physical health. AUB causes are systematically divided into structural (PALM) and non-structural (COEIN) components using the PALM-COEIN categorisation system, which was introduced by the International Federation of Gynaecology and Obstetrics (FIGO). Although it has been widely used, there are still issues with its clinical application and diagnostics, especially in areas with low resources. Objective: The objective of this study was to establish a clinicopathological connection, classifying AUB patients using the PALM-COEIN system, and evaluating treatment outcomes and diagnostic difficulties in women of reproductive age. Methods: Purposive sampling was used in a qualitative study including 160 women with an AUB diagnosis. Comprehensive patient interviews, clinical assessments, and histological examination of endometrial samples were all part of the data collection process. Trends in clinical presentations, histology results, and therapy responses were found using thematic analysis. Findings: Non-structural reasons (COEIN) made up 37.4% of cases, with ovulatory dysfunction (18.8%) being the most common, while structural causes (PALM) accounted for 62.6% of cases, with leiomyomas (21.9%) being the most common. Women between the ages of 31 and 40 had the highest frequency of AUB (40.6%). The most common histological finding (34.4%) was proliferative endometrium, which suggests that ovulatory disruption had a significant role. In postmenopausal individuals, endometrial hyperplasia (15%) and carcinoma (5.6%) were more prevalent. Conclusion: The PALM-COEIN categorisation system offered a methodical way to diagnose AUB, allowing for focused therapeutic approaches. Diagnostic difficulties still exist, nevertheless, particularly when there are overlapping characteristics or insufficient histopathological resources. To improve patient care outcomes and improve classification accuracy, more research is required, especially in settings with limited resources.

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References

Bahamondes, L., & Ali, M. (2015). Recent advances in managing and understanding menstrual disorders. F1000Prime Reports, 7. https://doi.org/10.12703/p7-33

Bahamondes, L., Ali, M. (2015). Levonorgestrel intrauterine system for heavy menstrual bleeding. Human Reproduction Update, 21(1), 165-176.

Bakour, S. H., Khan, K. S., & Gupta, J. K. (2000). Controlled analysis of factors associated with insufficient sample on outpatient endometrial biopsy. BJOG: An International Journal of Obstetrics & Gynaecology, 107(10), 1312-1314. https://doi.org/10.1111/j.1471-0528.2000.tb11627.x

Côté, I., Jacobs, P., & Cumming, D. C. (2003). Use of health services associated with increased menstrual loss in the United States. American Journal of Obstetrics and Gynecology, 188(2), 343-348. https://doi.org/10.1067/mob.2003.92

Dueholm, M., Forman, A., Jensen, M. L., Laursen, H., & Kracht, P. (2001). Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding. Ultrasound in Obstetrics & Gynecology, 18(1), 54-61. https://doi.org/10.1046/j.1469-0705.2001.00430.x

Guido, R. S., Kanbour-Shakir, A. M. A. L., Rulin, M. C., & Christopherson, W. A. (1995). Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. The Journal of reproductive medicine, 40(8), 553-555. https://europepmc.org/article/med/7473450

Ozturk Inal, Z., Inal, H. A., Kucukosmanoglu, I., & Kucukkendirci, H. (2017). Assessment of endometrial sampling and histopathological results: Analysis of 4,247 cases. The Eurasian Journal of Medicine, 49(1), 44-47. https://doi.org/10.5152/eurasianjmed.2017.16269

Jahan, I., Rumana, R., Munni, N., Akter, T., & ZU, H. (2020). Spectrum of clinico-pathological correlation of abnormal uterine bleeding cases in a tertiary care hospital. Surgical Research, 2(2). https://doi.org/10.33425/2689-1093.1030

Jairajpuri, Z. S., Rana, S., & Jetley, S. (2013). Atypical uterine bleeding-Histopathological audit of endometrium A study of 638 cases. Al Ameen J Med Sci, 6(1), 21-8. http://ajms.alameenmedical.org/ArticlePDFs/AJMS%20V6.N1.2013%20p%2021-28.pdf

Kelekci, S., Kaya, E., Alan, M., Alan, Y., Bilge, U., & Mollamahmutoglu, L. (2005). Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertility and Sterility, 84(3), 682-686. https://doi.org/10.1016/j.fertnstert.2005.03.036

Kotagasti, S., Jaiswal, S. (2020). Barriers to the application of PALM-COEIN classification in low-resource settings. Indian Journal of Gynecologic Oncology, 18(3), 45-52.

Lethaby, A., Farquhar, C., & Cooke, I. (2000). Antifibrinolytics for heavy menstrual bleeding. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd000249

Munro, M. G., Critchley, H. O., Broder, M. S., & Fraser, I. S. (2011). FIGO classification system (PALM‐COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynecology & Obstetrics, 113(1), 3-13. https://doi.org/10.1016/j.ijgo.2010.11.011

Munro, M. G., Critchley, H. O., & Fraser, I. S. (2012). The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: Who needs them? American Journal of Obstetrics and Gynecology, 207(4), 259-265. https://doi.org/10.1016/j.ajog.2012.01.046

Perino, M., et al. (2017). Overlapping features of leiomyoma and adenomyosis. Journal of Obstetrics and Gynaecology Research, 43(6), 862-868.

Pujani, M., Singh, K., Agarwal, C., Raychaudhuri, S., Sharma, N., Chauhan, V., Chawla, R., Ahuja, R., & Singh, M. (2019). A clinicopathological correlation of international Federation of gynecology and obstetrics's PALM–COEIN classification of abnormal uterine bleeding: Indian scenario. Journal of Mid-life Health, 10(3), 147. https://doi.org/10.4103/jmh.jmh_128_18

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Published

2025-04-16

How to Cite

Palm-Coein Classification of Abnormal Uterine Bleeding and Clinicopathological Correlation. (2025). Indus Journal of Bioscience Research, 3(4), 227-232. https://doi.org/10.70749/ijbr.v3i4.1041