FIGO Committee for Menstrual Disorders

Duration: 2015 - 2021

Chaired by Professor Malcolm Munro, USA

What is Abnormal Uterine Bleeding (AUB)

AUB in the reproductive years, unrelated to pregnancy, is rarely life-threatening, but is frequently life altering due to a complex set of disorders 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 elsewhere.

What are the challenges?

Determination of the causes of AUB in the reproductive years remains a major challenge for investigators, clinicians and educators.

Investigators have to conceive and then execute relevant bench and clinical investigation; clinicians must deal with the patient in their office or hospital and educators of medical students and postgraduate trainees such as residents and fellows are encumbered with the task of providing a mechanism for understanding AUB that facilitates proper investigation and therapy.

For a number of investigators and educators, it became apparent that there were at least two major impediments to dealing with these challenges. 

1) a disjointed collection of poorly defined and inconsistently used terms and definitions that undermined effective communication among investigators, clinicians and trainees alike.

2) the absence of a system for classifying the potential causes, or contributors to AUB symptoms in a specific patient.

These circumstances lead to difficulties with the interpretation of both basic science research and clinical trials as since specimens and patients could be "contaminated" with potential confounders. 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.

 Committee Publications

IJGO: The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in reproductive years - 2018 revisions

System 2 (PALM-COEIN) Endometrial Polyps and Abnormal Uterine Bleeding (AUB-P) - 2016

System 2 (PALM-COEIN) Adenomyosis and Abnormal Uterine Bleeding (AUB-A) -Pathogenesis, diagnosis, and management - 2016

Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years - 2016

Abnormal uterine bleeding: advantages of formal classification to patients, clinicians and researchers - 2014

The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? - 2012

Management of abnormal uterine bleeding in low - and high-resource settings: consideration of cultural issues - 2011

The structured menstrual history: developing a tool to facilitate diagnosis and aid in symptom management - 2011

FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age - 2011


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