Duration: 2015 - 2021
Chair: Professor Malcolm Munro, USA
What is Abnormal Uterine Bleeding (AUB)?
AUB in the reproductive years, unrelated to pregnancy, is a set of symptoms, not a disorder.
While these symptoms are rarely life-threatening, they are frequently life altering, particularly the symptom of heavy menstrual bleeding (HMB) that is likely responsible for the high prevalence of iron deficiency anemia that affects 30% of women worldwide – an incidence that is much higher in developing nations. Iron deficiency and iron deficiency anemia can have profound effects on cognition, work productivity, and family and social life, and may be a contributor to increased maternal mortality and impaired neonatal development. Collectively, these circumstances that make AUB in the reproductive years an important and often overlooked and underappreciated health issue with insidious impact on world economies.
There exists a spectrum of potential causes of AUB in the reproductive years that include abnormalities in endocrine, endometrial and hemostatic function and a number of structural anomalies that include polyps, adenomyosis and leiomyomas or fibroids. It is important to understand that many of the structural abnormalities may not contribute to the patient’s symptoms – they may lie asymptomatic while the cause or causes of the AUB may be related to invisible but important causes such as coagulopathies, ovulatory dysfunction or disorders of endometrial hemostasis.
What are the challenges?
Determination of the causes of AUB in the reproductive years remains a major challenge for investigators, clinicians and educators. As a result, in order to obtain clearly informative basic science as well as translational and clinical investigation, a comprehensive approach to both investigation and categorisation was needed.
What has the FIGO Menstrual Disorder Committee (MDC) done to date?
In response to the challenges described above, the FIGO MDC has developed two systems, with the assistance of clinicians, educators, journal editors, and investigators worldwide.
- FIGO AUB System 1, by defining the parameters of normal menstrual bleeding, establishes a mechanism for defining the various symptoms that comprise AUB. Eliminated are terms such as menorrhagia, oligomenorrhea, metrorrhagia and dysfunctional uterine bleeding.
- FIGO AUB System 2, is also known as the PALM-COEIN system, provides a structured infrastructure for research, education and clinical care by categorizing the various possible causes or contributors to the symptoms of AUB in the reproductive years.
The MDC is also developing “sub-classification” systems for the various components of System 2 (PALM-COEIN), that should aid both investigators and clinicians navigate the often-complex circumstances and presentations that characterize these conditions:
- The first such system is the Leiomyoma Sub-classification System that is relevant not only to the symptom of AUB, but to other symptoms such as infertility and recurrent pregnancy loss.
- The next subclassification system currently in an advanced stage of development for adenomyosis, with endometrial polyps the next target.
- The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions, IJGO, 2018
- Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years,
- Best Practice & Research: Clinical Obstetrics & Gynaecology, 2017
- System 2 (PALM-COEIN) Endometrial Polyps and Abnormal Uterine Bleeding (AUB-P), Best Practice & Research: Clinical Obstetrics & Gynaecology, 2016
- System 2 (PALM-COEIN) Adenomyosis and Abnormal Uterine Bleeding (AUB-A) -Pathogenesis, diagnosis, and management, Best Practice & Research: Clinical Obstetrics & Gynaecology, 2016
- Abnormal uterine bleeding: advantages of formal classification to patients, clinicians and researchers, Acta Obstetricia et Gynecologica Scandinavica, 2014
- The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? American Journal of Obstetrics and Gynecology, 2012
- Management of abnormal uterine bleeding in low- and high-resource settings: consideration of cultural issues, Seminars in Reproductive Medicine, 2011
- The structured menstrual history: developing a tool to facilitate diagnosis and aid in symptom management, Seminars in Reproductive Medicine, 2011
- FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age, IJGO 2011
An additional publications list can be accessed here.
Committee Members 2015-2018
- Professor Rohana Hathtootuwa - Sri Lanka
- Professor Alka Kriplani - Co-Chair, India
- Dr Carlos Fuchtner - Ex officio, Bolivia
- Professor Ian Fraser, Australia
- Professor Hilary Critchley, UK
- Dr Rebecca Tonye, Cameroon
- Dr Mario Hidalgo, Spain
- Dr Luis Bahamondes, Brazil