PALM-COEIN classification system of FIGO vs the classic terminology in patients with abnormal uterine bleeding

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This study compared the FIGO PALM-COEIN system to classic terminology for abnormal uterine bleeding, finding the PALM-COEIN system better describes etiological pathologies.

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This retrospective study compared the FIGO PALM-COEIN classification system with classic terminology for etiologies of abnormal uterine bleeding using pathology reports from 515 women evaluated at a single Turkish hospital (2015–2019). Classic terminology categorized hypermenorrhea, menorrhagia, metrorrhagia, and menometrorrhagia, while PALM-COEIN identified polyps (16.3%), adenomyosis (diffuse 38.1%, local 6.2%), leiomyoma (submucous 31.1% and other types 43.9%), and malignancy/hyperplasia (9.1%), highlighting that classic terms may be insufficient for underlying non-pregnant reproductive-age etiologies. The authors’ stated caveat is that their work is retrospective and based on pathology classification at one center rather than a prospective, standardized diagnostic workflow. Relevance to endometriosis: although the paper centers on PALM-COEIN for abnormal uterine bleeding, it specifically reports adenomyosis rates using the FIGO system, which is a related condition in the endometriosis spectrum and is explicitly quantified here.

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Abstract

OBJECTIVES: To evaluate the FIGO's novel classification system versus the classic terminology in patients with abnormal uterine bleeding. MATERIAL AND METHODS: A retrospective study was carried out between August 2015 and September 2019 in the Health Sciences University Gazi Yaşargil Training and Research Hospital. The pathology reports of the patients were classified according to the PALM-COEIN method and were compared with classical terminology. The operated patients with fibroids reported in the pathology results were classified as subgroups of fibroids. RESULTS: Evaluation was made of a total of 515 women with abnormal uterine bleeding. According to the classical terminology, 137 (26.6%) patients were defined with hypermenorrhea, 74 (14.4%) with menorrhagia, 57 (11.1%) with metrorrhagia, and 246 (47.8%) with menometrorrhagia. In the PALM-COEIN classification system, polyps were determined in 84 (16.3%) cases, adenomyosis in 228 [diffuse adenomyosis: 196 (38.1%), local adenomyosis: 32 (6.2%)], leiomyoma in 386 [submu-cous: 161 (31.1%), other types: 225 (43.9%)], and malignancy and hyperplasia in 47 (9.1%). CONCLUSIONS: The classical terminology for abnormal uterine bleeding is insufficient in terms of etiological pathologies in non-pregnant women of reproductive age. The widespread use of this novel system for the abnormal uterine bleeding classification will provide a more useful communication between physicians and researchers.
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Abstract

Objectives: To evaluate the FIGO’s novel classification system versus the classic terminology in patients with abnormal uterine bleeding. Material and methods: A retrospective study was carried out between August 2015 and September 2019 in the Health Sciences University Gazi Yaşargil Training and Research Hospital. The pathology reports of the patients were classified according to the PALM-COEIN method and were compared with classical terminology. The operated patients with fibroids reported in the pathology results were classified as subgroups of fibroids. Results: Evaluation was made of a total of 515 women with abnormal uterine bleeding. According to the classical terminology, 137 (26.6%) patients were defined with hypermenorrhea, 74 (14.4%) with menorrhagia, 57 (11.1%) with metrorrhagia, and 246 (47.8%) with menometrorrhagia. In the PALM-COEIN classification system, polyps were determined in 84 (16.3%) cases, adenomyosis in 228 [diffuse adenomyosis: 196 (38.1%), local adenomyosis: 32 (6.2%)], leiomyoma in 386 [submu-cous: 161 (31.1%), other types: 225 (43.9%)], and malignancy and hyperplasia in 47 (9.1%). Conclusions: The classical terminology for abnormal uterine bleeding is insufficient in terms of etiological pathologies in non-pregnant women of reproductive age. The widespread use of this novel system for the abnormal uterine bleeding classification will provide a more useful communication between physicians and researchers.

Keywords

abnormal uterine bleedingmenstrual disordersPALM-COEIN classificationclassic terminology

References

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Condition tags

adenomyosis

MeSH descriptors

Leiomyoma Leiomyoma Metrorrhagia Uterine Diseases Female Humans Retrospective Studies Uterine Hemorrhage Uterine Hemorrhage

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