Background: AUB is the commonest menstrual problem of women of reproductive age group specially during perimenopause. It significantly impacts women’s personal, social, physical and quality of life. International Federation of Gynecology and Obstetrics (FIGO) developed a new classification system PALM-COEIN in order to standardise the terminology, diagnosis and investigations of the causes of AUB.

Aims and Objectives: 1. To categorise the causes of AUB in perimenopausal women in context to PALM-COEIN classification system.

2. To establish a clinico-pathological correlation of various causes of AUB.

Materials and Method: All women of perimenopausal age group (40 and above till 1 year beyond menopause) with complaints of AUB, admitted in Gynec ward were studied. After detail history and clinical examination, clinical diagnosis was made based on PALM-COEIN classification. Relavant investigations were carried out. Various causes of PALM and COEIN were studied and a clinico-pathological correlation was analysed statistically.

Results: Total 253 women of perimenopausal  age group were registered. Majority (43.47%) women were between 45-50 years of age. 56% were parity 3 and above. Most common complaint was heavy menstrual bleeding (67.8%).  PALM and COEIN groups accounted for (60%) and (39.9%) respectively. Leiomyoma was the commonest cause of AUB (36.75%) followed by Ovulatory disorder (26%). Obesity (9.8%) found to be the commonest associated risk factor. Histopathological examination detected more cases of PALM (69.96%) as compared to COEIN component (30.03%). Coexisting AUB-A, L (6.1% , p=<0.0001) and AUB-E (2.82%, p=<0.001) were statistically significant. AUB-M (18.77%) and AUB-O (28.16) were in more as compared to clinical diagnosis.

Conclusion: PALM component contributes more to the causes of AUB. This classification system helps to understand the various causes of AUB, gives simpler terminology, diagnosis and investigations of the casuses of AUB and offers specific management. PALM-COEIN system and HPE are correlative. Regular review of both can provide effective means of quality assurance and appropriateness of treatment.

Keywords: Abnormal uterine bleeding, clinic-pathological, PALM-COEIN.

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Dr Abha Choudhary

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