New worldwide classification system facilitates treatment and research for women with abnormal uterine bleeding

There is inconsistency in the terminology used to describe abnormal uterine bleeding (AUB) among nongravid women of reproductive age. In an effort to close that gap, a multinational group of clinicians and investigators from 6 continents and 17 countries have created a new classification system, with a particular emphasis on including participants from low- as well as higher-income countries.

The classification system, which was published recently in the International Journal of Gynaecology and Obstetrics, is to be used[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] worldwide by both clinicians and researchers who treat and investigate AUB in women of reproductive age.

Key Point: The absence of a universally accepted method for classifying abnormal uterine bleeding hampers both investigation and management of the condition. This proposed classification creates a practical system that could be used by clinicians in most countries worldwide to classify patients readily and consistently. It also has an easy to remember and pronounce name: PALM-COEIN (pronounced “pahm-koin”).

“Research into the causes and appropriate investigation and treatment has been hampered by confusing and inconsistently applied nomenclature and the absence of a standardized classification system to help guide both investigators and educators,” said Malcolm G. Munro, MD, FRCS(c), FACOG, lead author of the study.

“The new FIGO systems for nomenclature and classification of causes have been developed with input from Indian physicians, and others worldwide, in an attempt to develop unambiguous and easily translated terms and definitions,” Munro said. “Hopefully these efforts will result in improved design and interpretation of basic science and clinical research, and provide the opportunity for greater clarity in the realm of education of both providers and patients.”

PALM-COEIN

The paper presents the PALM-COEIN classification system, which has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO classification system. The easy to remember and pronounce acronym PALM-COEIN (pronounced “pahm-koin”) includes 9 main categories that are arranged according to the acronym: polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; not yet classified. In general, the PALM group has discrete entities that can be measured visually (structural); and the COEIN group has entities that are not defined by imaging (nonstructural).


“The new FIGO systems for nomenclature and classification of causes have been developed with input from Indian physicians, and others worldwide, in an attempt to develop unambiguous and easily translated terms and definitions.”
-Malcolm G. Munro, MD, FRCS(c), FACOG, lead author of the PALM-COEIN study for the International Federation of Gynecology and Obstetrics


The authors of the classification system, representing the FIGO Working Group on Menstrual Disorders, agreed upon specific terminology (eg, abnormal uterine bleeding) and some long-standing but outdated terms were discarded (eg, menorrhagia). The group also discussed the importance of ensuring that the system was applicable in the whole spectrum of healthcare environments worldwide—in both low- and high-income countries.

The concept behind the classification system was to have a “living” document, which will be analyzed and revised periodically. The group specifically recommends “periodic modification and occasional substantial revision depending on advances in knowledge and technology.”

Source: Munro MG, Critchley HO, Broder MS, et al, for the FIGO Working Group on Menstrual Disorders. 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.

Access the original journal information here:
http://www.ncbi.nlm.nih.gov/pubmed/21316671\
Journal publishers are independent from mdCurrent-India and may require a subscription or charge a fee to download the full article.

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