RSS-Feed abonnieren
DOI: 10.1055/s-0031-1287663
The Flexible FIGO Classification Concept for Underlying Causes of Abnormal Uterine Bleeding
Publikationsverlauf
Publikationsdatum:
08. November 2011 (online)

ABSTRACT
To this juncture, clinical management, teaching of medical providers, and the design and interpretation of clinical trials has been hampered by the absence of a consensus system for the classification of causes or potential causes of abnormal uterine bleeding (AUB). Indeed, more than one possible mechanism may be involved in the development of the bleeding symptoms experienced by a given individual. A consistent and universally accepted classification system could be used by clinicians, investigators, and even patients to facilitate communication, clinical care, and research. The “PALM-COEIN” AUB classification system is the result of several years of collaboration among a spectrum of individuals involved in clinical medicine, teaching, and the basic and clinical sciences and is proposed as a tool that meets the requirements just described but one that is capable of adaptation to our evolving insight into the mechanisms involved in the genesis of AUB. This system has been accepted by the International Federation of Gynecology and Obstetrics (FIGO) as a suitable system for widespread international use.
KEYWORDS
Menstrual disorders - classification
REFERENCES
- 1
Woolcock JG, Critchley HO, Munro MG, Broder MS, Fraser IS.
Review of the confusion in current and historical terminology and definitions for
disturbances of menstrual bleeding.
Fertil Steril.
2008;
90
2269-2280
MissingFormLabel
- 2
Fraser IS, Critchley HO, Munro MG.
Abnormal uterine bleeding: getting our terminology straight.
Curr Opin Obstet Gynecol.
2007;
19
591-595
MissingFormLabel
- 3
Fraser IS, Critchley HO, Munro MG, Broder M.
A process designed to lead to international agreement on terminologies and definitions
used to describe abnormalities of menstrual bleeding.
Fertil Steril.
2007;
87
466-476
MissingFormLabel
- 4
Fraser IS, Critchley HO, Munro MG, Broder M.
Can we achieve international agreement on terminologies and definitions used to describe
abnormalities of menstrual bleeding?.
Hum Reprod.
2007;
22
635-643
MissingFormLabel
- 5
Benedet JL, Odicino F, Maisonneuve P et al..
Carcinoma of the cervix uteri.
Int J Gynaecol Obstet.
2003;
83
(Suppl 1)
41-78
MissingFormLabel
- 6
Revised American Society for Reproductive Medicine classification of endometriosis:
1996.
Fertil Steril.
1997;
67
817-821
MissingFormLabel
- 7
Bump RC, Mattiasson A, Bo K et al..
The standardization of terminology of female pelvic organ prolapse and pelvic floor
dysfunction.
Am J Obstet Gynecol.
1996;
175
10-17
MissingFormLabel
- 8 Munro MG. Abnormal Uterine Bleeding. Cambridge: Cambridge University Press; 2010
MissingFormLabel
- 9
Munro MG, Critchley H OD, Broder MS, Fraser IS.
The FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding
in non-gravid women of reproductive age.
Int J Gynecol Obstet.
2011;
113
3-13
MissingFormLabel
- 10
Critchley H OD, Munro MG, Broder MS, Fraser IS.
A five-year international review process concerning terminologies, definitions and
related issues around abnormal uterine bleeding.
Semin Reprod Med.
2011;
29
(5)
377-382
MissingFormLabel
- 11
Munro MG, Broder MS, Critchley H OD, Matteson K, Hathtootuwa R, Fraser IS.
An international response to questions about terminologies, investigation and management
of abnormal uterine bleeding: use of an electronic audience respondse system.
Semin Reprod Med.
2011;
29
(5)
436-445
MissingFormLabel
- 12
Lieng M, Istre O, Sandvik L, Qvigstad E.
Prevalence, 1-year regression rate, and clinical significance of asymptomatic endometrial
polyps: cross-sectional study.
J Minim Invasive Gynecol.
2009;
16
465-471
MissingFormLabel
- 13
Weiss G, Maseelall P, Schott LL, Brockwell SE, Schocken M, Johnston JM.
Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women
in the Study of Women's Health Across the Nation (SWAN).
Fertil Steril.
2009;
91
201-206
MissingFormLabel
- 14
Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I.
Uterine adenomyosis: a need for uniform terminology and consensus classification.
Reprod Biomed Online.
2008;
17
244-248
MissingFormLabel
- 15
Dueholm M.
Transvaginal ultrasound for diagnosis of adenomyosis: a review.
Best Pract Res Clin Obstet Gynaecol.
2006;
20
569-582
MissingFormLabel
- 16
Togashi K, Nishimura K, Itoh K et al..
Adenomyosis: diagnosis with MR imaging.
Radiology.
1988;
166
111-114
MissingFormLabel
- 17
Mark AS, Hricak H, Heinrichs LW et al..
Adenomyosis and leiomyoma: differential diagnosis with MR imaging.
Radiology.
1987;
163
527-529
MissingFormLabel
- 18
Dueholm M, Lundorf E, Hansen ES, Sorensen JS, Ledertoug S, Olesen F.
Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis.
Fertil Steril.
2001;
76
588-594
MissingFormLabel
- 19
Lasmar RB, Barrozo PM, Dias R, Oliveira MA.
Submucous myomas: A new presurgical classification to evaluate the viability of hysteroscopic
surgical treatment-preliminary report.
J Min Invas Gynecol.
2005;
12
308-311
MissingFormLabel
- 20
Wamsteker K, Emanuel MH, de Kruif JH.
Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding:
results regarding the degree of intramural extension.
Obstet Gynecol.
1993;
82
736-740
MissingFormLabel
- 21 Tavassoli FA, Devilee P. World Health Organization Classification of Tumors: Pathology and Genetics of Tumours
of the Breast and Female Genital Organs. Lyon: IARC Press; 2003
MissingFormLabel
- 22
Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL et al..
Carcinoma of the corpus uteri. FIGO 6th Annual Report on the Results of Treatment
in Gynecological Cancer.
Int J Gynaecol Obstet.
2006;
95 Suppl 1
S105-143
MissingFormLabel
- 23
Shankar M, Lee CA, Sabin CA, Economides DL, Kadir RA.
von Willebrand disease in women with menorrhagia: a systematic review.
BJOG.
2004;
111
734-740
MissingFormLabel
- 24
Dilley A, Drews C, Lally C, Austin H, Barnhart E, Evatt B.
A survey of gynecologists concerning menorrhagia: perceptions of bleeding disorders
as a possible cause.
J Womens Health Gend Based Med.
2002;
11
39-44
MissingFormLabel
- 25
Hale GE, Hughes CL, Burger HG, Robertson DM, Fraser IS.
Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase
(LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition.
Menopause.
2009;
16
50-59
MissingFormLabel
- 26
Hale GE, Manconi F, Luscombe G, Fraser IS.
Quantitative measurements of menstrual blood loss in ovulatory and anovulatory cycles
in middle- and late-reproductive age and the menopausal transition.
Obstet Gynecol.
115
249-256
MissingFormLabel
- 27
Livingstone M, Fraser IS.
Mechanisms of abnormal uterine bleeding.
Hum Reprod Update.
2002;
8
60-67
MissingFormLabel
- 28
Critchley H OD, Maybin JA.
Molecular and cellular causes of abnormal uterine bleeding of endometrial origin.
Semin Reprod Med.
2011;
29
(5)
400-409
MissingFormLabel
- 29
Gleeson NC.
Cyclic changes in endometrial tissue plasminogen activator and plasminogen activator
inhibitor type 1 in women with normal menstruation and essential menorrhagia.
Am J Obstet Gynecol.
1994;
171
178-183
MissingFormLabel
- 30
Smith SK, Abel MH, Kelly RW, Baird DT.
A role for prostacyclin (PGi2) in excessive menstrual bleeding.
Lancet.
1981;
1
522-524
MissingFormLabel
- 31
Smith SK, Abel MH, Kelly RW, Baird DT.
Prostaglandin synthesis in the endometrium of women with ovular dysfunctional uterine
bleeding.
Br J Obstet Gynaecol.
1981;
88
434-442
MissingFormLabel
- 32
Pitsos M, Skurnick J, Heller D.
Association of pathologic diagnoses with clinical findings in chronic endometritis.
J Reprod Med.
2009;
54
373-377
MissingFormLabel
- 33
Heatley MK.
The association between clinical and pathological features in histologically identified
chronic endometritis.
J Obstet Gynaecol.
2004;
24
801-803
MissingFormLabel
- 34
Toth M, Patton DL, Esquenazi B, Shevchuk M, Thaler H, Divon M.
Association between Chlamydia trachomatis and abnormal uterine bleeding.
Am J Reprod Immunol.
2007;
57
361-366
MissingFormLabel
- 35
Endrikat J, Gerlinger C, Plettig K, Wessel J, Schmidt W, Grubb G et al..
A meta-analysis on the correlation between ovarian activity and the incidence of intermenstrual
bleeding during low-dose oral contraceptive use.
Gynecol Endocrinol.
2003;
17
107-114
MissingFormLabel
- 36
Murphy PA, Kern SE, Stanczyk FZ, Westhoff CL.
Interaction of St. John's Wort with oral contraceptives: effects on the pharmacokinetics
of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding.
Contraception.
2005;
71
402-408
MissingFormLabel
- 37
Rosenberg MJ, Waugh MS, Stevens CM.
Smoking and cycle control among oral contraceptive users.
Am J Obstet Gynecol.
1996;
174
628-632
MissingFormLabel
- 38
Fraser IS, Hickey MH.
Endometrial vascular changes and bleeding patterns with long-acting progestogen-only
contraceptives.
In:
Spitz I (ed), Proceedings of an International Symposium, Jerusalem, August 1999,
Progesterone, progestins and the antiprogestins in the next Millenium.
Steroids.
2000;
65
665-670
MissingFormLabel
- 39
Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkila A, Walker JJ, Cameron IT.
Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone
for treatment of idiopathic menorrhagia.
Br J Obstet Gynaecol.
1998;
105
592-598
MissingFormLabel
- 40
Munro MG, Heikinheimo O, Hathtootuwa R, Tank J, Fraser IS.
The need for investigations to elucidate causes and effects of abnormal uterine bleeding.
Semin Reprod Med.
2011;
29
(5)
410-422
MissingFormLabel
Malcolm G MunroM.D.
Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA,
Kaiser Permanente, Southern California
4900 Sunset Boulevard, Station 3-B, Los Angeles, CA 90027
eMail: mgmunro@ucla.edu; mgmunro@aol.com