Abnormal uterine bleeding types according to the PALM-COEIN FIGO classification in a medically underserved American community

Abstract

Objective: To describe the distribution of abnormal uterine bleeding (AUB) type according to the polyp (AUB-P); adenomyosis (AUB-A); leiomyoma (AUB-L); malignancy and hyperplasia (AUB-M); coagulopathy (AUB-C); ovulatory dysfunction (AUB-O); endometrial (AUB-E); iatrogenic (AUB-I); and not yet classified International Federation of Gynecology and Obstetrics classification system in a medically underserved American inner-city population. Our secondary objective was to find an association between risk factors and type of AUB. Material and Methods: We conducted a descriptive cross-sectional analysis at our outpatient women’s health clinic located in the Bronx, New York City, from November 2016 to December 2019. Results: Among 390 patients, the most common AUB type was AUB-L (n=185, 47.4%), followed AUB-P (n=100, 25.6%), AUB-A (n=55, 14.1%), AUB-O (n=19, 4.9%), AUB-M (n=15, 3.8%), AUB-E (n=14, 3.6%) and AUB-I (n=2, 0.5%). Race was distributed as follows: Hispanic (68.2%), Black (25.9%), Caucasian (3.3%), and Asian (2.1%). Comorbidities included hypertension (36.4%), diabetes (15.6%), and thyroid disease (6.9%). The median age at diagnosis was significantly higher in AUB-M (59 years old, p<0.001), AUB-P (52.5 years old, p<0.001), AUB-E (51.5 years old, p=0.001) compared to AUB-L (46 years old). The median body mass index (BMI) was significantly higher in AUB-E (34.2 kg/m 2 , p=0.048) and AUB-O (32.6 kg/m 2 , p=0.038) compared to AUB-L (30 kg/m 2 ). Race was equally distributed among the AUB types. AUB-M (66.6%, p=0.002), AUB-E (57.1%, p=0.022), AUB-P (47%, p<0.001), and AUB-A (30.8%, p<0.001), had statistically significantly more cases of hypertension compared to AUB-L (28.1%). AUB-P (27%, p<0.001), AUB-M (26.6%, p=0.025), AUB-E (35.7%, p=0.001) and AUB-A (9%, p<0.001) had more patients with diabetes mellitus (DM) than AUB-L (3.3%). Conclusion: In an American population of medically underserved patients, the most common cause of AUB was leiomyoma and the most common race was Hispanic. Women with AUB-L were younger, with lower BMI, and with fewer cases of hypertension and DM when compared to other types of AUB.

Etiology distribution of abnormal uterine bleeding according to FIGO classification system: A combined study of ultrasound and histopathology

“…Several studies have reported a prevalence rate of AUB-P fluctuated from 6.7% to 26.5%. [6][7][8][9]16 Our results were somewhere in their middle range and were very close to what Yu Sun et al 17 reported. Polyps are epithelial proliferations arising from the endometrial stroma and glands.…”

“…The prevalence of AUB‐P, AUB‐A, and AUB‐M in our study was 16.53%, 9.58%, and 2.91%, respectively. Several studies have reported a prevalence rate of AUB‐P fluctuated from 6.7% to 26.5% 6–9,16 . Our results were somewhere in their middle range and were very close to what Yu Sun et al 17 reported.…”

“…In our study, the most common type in PALM group was AUB-L (487,45.73%), which was in accordance with some previous literatures on women from an Indian setting, 6 a tertiary care hospital from Pakistan 7 and a medically underserved American community. 9 Leiomyomas were the most common benign fibromuscular tumors in reproductive age women, 10 and have a lifetime incidence of approximately 70% in the general population. 11 They can be screened by ultrasonography including the location, number, and size and also can be sub-classified into submucosal (L SM ) and others (L O ).…”

“…5 In our study, we used ultrasonography technique and the prevalence was 9.58%, a little lower than Saber A 's study(14.1%). 9 We thought that the distribution of AUB may be diverse with different countries of origin.…”

Prediction of Factors Associated with Abnormal Uterine Bleeding by Transvaginal Ultrasound Combined with Bleeding Pattern

“…The nonstructural ones mainly include the anovulatory type which is associated with ovulation, or with ovulatory menstrual disorders, and the AUB caused by the contraceptive ring or subepithelial implants. Iatrogenic AUB is mostly caused by improper medication and some AUB of unknown cause [ 18 ]. Endometrial polyps, which causes uterine bleeding, is a common uterine cavity lesion with abnormal growth and excessive thickening of the endometrium due to some reasons.…”