Chapter 7 – Abnormal Uterine Bleeding and Other Disorders of the Menstrual Cycle

Abnormal uterine bleeding

Abnormal uterine bleeding includes:

heavy menstrual bleeding (HMB) (previously called menorrhagia) intermenstrual bleeding (IMB) post coital bleeding (PCB)(13-22) postmenopausal bleeding

Reference is made in this chapter to peri-menopausal bleeding and to pregnancy-related bleeding. Further information can be found in Chapter 11: Menopause and Chapter 9: Preconception Care and Pregnancy.

The investigation and management has been assisted by the development of The International Federation of Gynecology and Obstetrics (FIGO) classification system for abnormal uterine bleeding, which stratifies the causes of abnormal uterine bleeding into nine categories arranged according to the acronym PALM-COEIN encompassing both structural and non-structural causes.

FIGO classification system for AUB

The classification system is stratified into nine basic categories that are arranged according to the acronym PALM-COEIN:(14)

PALM-COEIN is usually applied after cervical causes have been excluded by history and vaginal and speculum examination.

Structural lesions

Polyp (AUB-P) Adenomyosis (AUB-A) Leiomyoma (fibroids) (AUB-L) Malignancy and hyperplasia (AUB-M)

Non-structural conditions

Coagulopathy (AUB-C) Ovulatory Disorders (AUB-O) Endometrium (AUB-E) Iatrogenic (AUB-I) Not Otherwise Classified (AUB-N)


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Heavy menstrual bleeding (HMB)

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Intermenstrual and post-coital bleeding

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Perimenopausal bleeding

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Postmenopausal bleeding (PMB)

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