Abnormal uterine bleeding in reproductive-age women: Terminology and PALM-COEIN etiology classification
- Ian S Fraser, AO, DSc, MD
Ian S Fraser, AO, DSc, MD
- Conjoint professor in Reproductive Medicine
- School of Women's and Children's Health
- University of New South Wales
- Malcolm G Munro, MD, FRCS(c), FACOG
Malcolm G Munro, MD, FRCS(c), FACOG
- Department of Obstetrics & Gynecology
- David Geffen School of Medicine at UCLA
- Hilary OD Critchley, MD, FRCOG
Hilary OD Critchley, MD, FRCOG
- Professor of Reproductive Medicine
- MRC Centre for Reproductive Health
- The University of Edinburgh
- The Queen's Medical Research Institute
Abnormal uterine bleeding (AUB) in nonpregnant reproductive-age women is a common gynecologic symptom. Over the history of medicine, there has been a wide range of poorly defined terminology used to describe AUB symptoms and etiologies.
The beginning of conflicting terminology for AUB dates back to the late 1700s when William Cullen, Professor of Physic at the University of Edinburgh, Scotland, began to write his medical research texts in English rather than in Latin . However, he was fond of demonstrating his classical language skills to his students and coined the Latin term menorrhagia, meaning "to burst forth monthly," to describe the excessive bleeding that many of his patients experienced. The term dysfunctional uterine bleeding was coined, but never clearly defined, by Graves in 1935 [2,3].
The varied use of terminology to describe AUB symptoms has led to difficulties in many areas, including documenting symptoms; reaching consensus on the use of various diagnostic techniques and medical and surgical therapies; design and interpretation of basic, translational, and clinical research; and attempts to conduct multicenter or multinational clinical trials [1,4-6].
These concerns led to the formation of the Menstrual Disorders Working Group within the International Federation of Gynecology and Obstetrics (FIGO), which has subsequently become a standing committee, the Menstrual Disorders Committee. This group has developed internationally supported recommendations on definitions and terminology for AUB symptoms [1,4,6-8] as well as a new classification of underlying causes of AUB in the reproductive years . Together, these terminology and classification systems provide the tools to improve precision in communicating about etiologies, symptoms, diagnosis, and treatment of AUB in the reproductive years.
The terminology for AUB symptoms as well as the FIGO system for classification of AUB etiologies are reviewed here. The differential diagnosis and approach to the evaluation of AUB are discussed in detail separately. (See "Approach to abnormal uterine bleeding in nonpregnant reproductive-age women" and "Differential diagnosis of genital tract bleeding in women".)
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- DEVELOPMENT OF THE FIGO SYSTEMS
- DEFINITIONS OF UTERINE BLEEDING
- Normal menstruation
- Abnormal uterine bleeding
- - Acute abnormal uterine bleeding
- - Chronic abnormal uterine bleeding
- DISTINGUISHING NORMAL MENSTRUATION FROM AUB
- Intermenstrual bleeding
- - Cyclic midcycle intermenstrual bleeding
- - Cyclic premenstrual or postmenstrual intermenstrual bleeding
- - Acyclic intermenstrual bleeding
- Women on hormonal medications
- PALM-COEIN CLASSIFICATION OF AUB ETIOLOGIES
- Polyps (AUB-P)
- Adenomyosis (AUB-A)
- Leiomyomas (AUB-L)
- Malignancy and hyperplasia (AUB-M)
- Coagulopathy (AUB-C)
- Ovulatory dysfunction (AUB-O)
- Endometrial causes (AUB-E)
- Iatrogenic causes (AUB-I)
- Not otherwise classified (AUB-N)