PALM-COEIN Criteria for Abnormal Uterine Bleeding

The PALM-COEIN classification system, developed by FIGO (International Federation of Gynecology and Obstetrics), provides a standardized framework for categorizing causes of abnormal uterine bleeding in non-pregnant reproductive-age women. It helps answer two different questions. FIGO System 1 describes the bleeding itself by its frequency, duration, regularity, and volume. FIGO System 2 classifies the underlying cause. Keeping these systems separate prevents a symptom such as heavy bleeding from being mistaken for a diagnosis. The 2018 FIGO revision retired menorrhagia, metrorrhagia, and dysfunctional uterine bleeding as current diagnostic terms. Use descriptive language instead, such as heavy menstrual bleeding, intermenstrual bleeding, or irregular bleeding. Heavy menstrual bleeding is excessive menstrual blood loss that interferes with a patient’s physical, social, emotional, or material quality of life. A measured loss greater than 80 mL per cycle is a research reference, not a required clinical threshold. A patient who changes protection frequently, misses work, avoids activities, or becomes iron deficient may have clinically significant heavy menstrual bleeding even when the exact volume is unknown. Chronic AUB is abnormal bleeding from the uterine corpus present during most...