PALM-COEIN Classification of Abnormal Uterine Bleeding among Women of Reproductive Age in a Tertiary Care Centre of Eastern Nepal

Abstract

Aims: Abnormal Uterine Bleeding (AUB) is a highly prevalent condition with complex underlying condition. The absence of standardized definitions and uniform criteria for describing menstrual symptoms has posed challenges in investigation and management of the case. This study was conducted to categorize the causes of AUB among Nepalese women of reproductive age using the PALM-COIEN classification system (provided by FIGO) and to describe the bleeding patterns exhibited by them.

Methods: A descriptive cross-sectional study was conducted among 139 women of reproductive age group visiting out-patient care in a tertiary care hospital with complaints of abnormal uterine bleeding. The causes of AUB were classified before treatment using the PALM-COEIN system.

Results: The mean age of patients was 37.9 ± 10.1 years, with 57.6% of them aged 38 years or more. Structural causes accounted for 31% of the AUB cases, while non-structural causes were present in 69% of them. AUB-O was the most frequent finding 91(65.5%) among the patients, followed by AUB-L in 19 (13.7%) women and AUB-A in 11 (7.9%) women. More than half of the patients (54.7%) were anemic, and hypothyroidism was seen in 14.2% of them.

Conclusion: Non-structural causes of AUB particularly ovulatory dysfunction contributed to major cause of AUB. Evidence of various etiological causes of AUB among Nepalese women based on this PALM-COEIN system can provide uniformity in investigation and management of such cases.