The Role of FIGO PALM-COEIN classification of the underlying causes of abnormal uterine bleeding and clinicopathological correlation of patients undergoing hysterectomy in a Tertiary care Referral center of western Rajasthan

Abstract

Background: The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has developed a classification system (PALM–COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study the two components of this system in clinical practice in general and establish a clinicopathological correlation of AUB with the context of the PALM component in particular.

Methodology: The data of 158 patients who underwent hysterectomy for abnormal uterine bleeding in 1 year at the tertiary care Centre of western Rajasthan was collected from old case records and analysed. The patients were initially worked up in the outpatient department with the history and clinical examination, followed by transabdominal or transvaginal ultrasonography depending on the uterine size and the pathology. The patients requiring more detailed pictures were advised computed tomography (CT) scan. All the patients were screened for common medical disorders like thyroid disorders, prolactin levels, and blood sugar levels. Thereafter an endometrial biopsy and liquid-based cytology were done for all the patients to rule out malignancy. The relative contribution of various causes of PALM (structural) and COEIN (functional) components and clinicopathological correlation was analysed.

Results: PALM and COEIN components contributed almost equally for AUB when assessed clinically. On the other hand, the histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB, i.e., 17.2% versus 82.8 %. AUB-L was the commonest (41.1 %) aetiology overall.

Conclusion: The PALM–COEIN classification system should consider both the clinical and histopathological diagnoses in women having AUB. It is concluded that the most common cause of AUB is leiomyoma and the most common age group undergoing hysterectomy is the 4th decade. Although the medical treatment options are there, patients of premenopausal age require hysterectomy who do not benefit from medical regimens.