The PALM-COEIN classification system (FIGO 2018) categorises causes of abnormal uterine bleeding (AUB). A 40-year-old woman with diffusely enlarged, globular uterus and heavy menstrual bleeding would be classified under which PALM-COEIN category?
- A AUB-L (Leiomyoma)
- B AUB-A (Adenomyosis) ✓
- C AUB-P (Polyp)
- D AUB-N (Not classified)
Correct answer: B. AUB-A (Adenomyosis)
Explanation
The PALM-COEIN acronym stands for: Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia (structural), Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified (functional). A diffusely enlarged globular uterus with heavy menstrual bleeding and dysmenorrhea is the classic clinical presentation of adenomyosis, classified as AUB-A. Leiomyomas cause asymmetric enlargement; fibroids are AUB-L (sub-classified by FIGO myoma classification into submucosal 0/1/2 which cause bleeding, vs intramural/subserosal).
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.