Abnormal Uterine Bleeding (AUB)
AUB refers to bleeding from the uterine corpus that is abnormal in volume, regularity, and/or timing. The FIGO classification system uses the mnemonic PALM-COEIN to categorize etiologies.
PALM-COEIN Classification
| Category | Description |
|---|---|
| PALM (Structural) | Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia. |
| COEIN (Non-Structural) | Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified. |
Clinical Evaluation
- History: Determine duration, frequency, and severity (e.g., impact on daily life).
- Physical/Pelvic Exam: Assess for source of bleeding (cervical, vaginal, or uterine).
- Imaging/Biopsy: Transvaginal ultrasound (TVUS) for structural abnormalities. Endometrial biopsy is mandatory for women ≥ 45 or those with risk factors for endometrial cancer (e.g., obesity, PCOS).
High-Yield Exam Pearl:
- Acute Hemorrhage: If unstable, the first step is stabilization. If stable, high-dose estrogen or oral contraceptives are used to stop heavy acute bleeding.
- Ovulatory Dysfunction: The most common non-structural cause, often seen at the extremes of reproductive age (menarche or perimenopause) or in PCOS.