Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2

Abstract

Abnormal uterine bleeding (AUB) is common, often debilitating, and may affect over 50% of reproductive‐aged women and girls. Whereas AUB is a collection of symptoms that include intermenstrual bleeding and abnormalities in period duration, cycle length, and regularity, it is heavy menstrual bleeding (HMB) that is most contributory to iron deficiency and related anemia. It is apparent that AUB, in general, and HMB, in particular, remain underrecognized and underreported. FIGO created two systems for assessing and classifying AUB. FIGO System 1 defines the bleeding pattern using four primary descriptors: frequency, duration, regularity, and flow volume. FIGO System 2 provides a structured classification system of possible causes of AUB, using the acronym PALM‐COEIN. “PALM” refers to structural causes of AUB (Polyp, Adenomyosis, Leiomyoma, Malignancy), and “COEI” refers to nonstructural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, and Iatrogenic). The “N” is reserved for those entities that are currently not otherwise classified. Using FIGO System 1 as a gateway to FIGO System 2 streamlines the investigation of reproductive‐aged women and girls with AUB. Understanding the pathogenesis of the FIGO System 2 “PALM‐COEIN” causes helps interpret investigations and the onward management of AUB. Numerous evidence gaps exist concerning AUB; however, if researchers and trialists universally adopt FIGO Systems 1 and 2 for the assessment and diagnosis of AUB, clear translatable research findings can be applied globally.

Abnormal uterine bleeding in adolescents: modern views of the problem

“…FIGO System 1 визначає схему кровотечі за допомогою чотирьох основних дескрипторів: частоти, тривалості, регулярності та об'єму кровотечі. FIGO System 2 надає структуровану систему класифікації можливих причин АМК, використовуючи акронім PALM-COEIN [32]. Ця система, яка також використовується для визначення причини кровотечі у пубертаті, представлена у табл.…”

Effect of norethisterone dose and duration in the management of abnormal uterine bleeding: a narrative review and case report

“… 27 However, an overlap between the features of the conditions described by the PALM-COEIN system may make diagnosis and management of AUB complex. 28 , 29 …”

Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia

“… 40 , 41 , 42 , 43 , 44 This risk is exemplified by evaluating iron‐dependent erythropoiesis in women with and without HMB, 2 and a Finnish study of women with HMB showed that 27% of its participants had IDA, 90% with a serum ferritin less than 30 µg/L, and 60% with serum ferritin levels below 15 µg/L. 45 Effective diagnostic and therapeutic strategies exist for the varying causes of the symptoms of HMB 46 , 47 ; failure to identify and address this issue will prolong or even prevent the sustained normalization of iron stores. Moreover, it is of importance to screen females experiencing HMB and recurrent or refractory IDA without uterine organic lesions for congenital bleeding disorders (CBDs) such as platelet function disorders and von Willebrand disease (VWD).…”