22. Abnormal uterine bleeding

Abnormal menstrual bleeding (AUB) is a collective name for all vaginal bleeding problems such as heavy menstrual bleeding, intermenstrual bleeding, spotting and postmenopausal bleeding. To address AUB the classification of the International Federation of Gynaecology and Obstetrics (FIGO) is used worldwide. In 2011 the FIGO also developed a new classification system for the causes of AUB, the PALM-COEIN; polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified. The PALM part of this classification denotes the anatomical causes and the COEIN part stands for the essential causes of AUB. History and examination are the basis of investigation. Moreover the pictorial blood assessment chart gives an indication about the amount of blood lost each month. Several imaging tests (e.g. transvaginal ultrasound, hysteroscopy, MRI) are used to visualize the cause of AUB, followed by an individual tailored solution depending of the underlying cause.