Semin Reprod Med 2011; 29(5): 391-399
DOI: 10.1055/s-0031-1287663
© Thieme Medical Publishers

The Flexible FIGO Classification Concept for Underlying Causes of Abnormal Uterine Bleeding

Malcolm G. Munro1 , Hilary O.D Critchley2 , Ian S. Fraser3
  • 1Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
  • 2MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
  • 3Department of Obstetrics and Gynaecology, University of Sydney, Camperdown, Australia
Further Information

Publication History

Publication Date:
08 November 2011 (online)

ABSTRACT

To this juncture, clinical management, teaching of medical providers, and the design and interpretation of clinical trials has been hampered by the absence of a consensus system for the classification of causes or potential causes of abnormal uterine bleeding (AUB). Indeed, more than one possible mechanism may be involved in the development of the bleeding symptoms experienced by a given individual. A consistent and universally accepted classification system could be used by clinicians, investigators, and even patients to facilitate communication, clinical care, and research. The “PALM-COEIN” AUB classification system is the result of several years of collaboration among a spectrum of individuals involved in clinical medicine, teaching, and the basic and clinical sciences and is proposed as a tool that meets the requirements just described but one that is capable of adaptation to our evolving insight into the mechanisms involved in the genesis of AUB. This system has been accepted by the International Federation of Gynecology and Obstetrics (FIGO) as a suitable system for widespread international use.

REFERENCES

  • 1 Woolcock JG, Critchley HO, Munro MG, Broder MS, Fraser IS. Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding.  Fertil Steril. 2008;  90 2269-2280
  • 2 Fraser IS, Critchley HO, Munro MG. Abnormal uterine bleeding: getting our terminology straight.  Curr Opin Obstet Gynecol. 2007;  19 591-595
  • 3 Fraser IS, Critchley HO, Munro MG, Broder M. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding.  Fertil Steril. 2007;  87 466-476
  • 4 Fraser IS, Critchley HO, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding?.  Hum Reprod. 2007;  22 635-643
  • 5 Benedet JL, Odicino F, Maisonneuve P et al.. Carcinoma of the cervix uteri.  Int J Gynaecol Obstet. 2003;  83 (Suppl 1) 41-78
  • 6 Revised American Society for Reproductive Medicine classification of endometriosis: 1996.  Fertil Steril. 1997;  67 817-821
  • 7 Bump RC, Mattiasson A, Bo K et al.. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.  Am J Obstet Gynecol. 1996;  175 10-17
  • 8 Munro MG. Abnormal Uterine Bleeding. Cambridge: Cambridge University Press; 2010
  • 9 Munro MG, Critchley H OD, Broder MS, Fraser IS. The FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in non-gravid women of reproductive age.  Int J Gynecol Obstet. 2011;  113 3-13
  • 10 Critchley H OD, Munro MG, Broder MS, Fraser IS. A five-year international review process concerning terminologies, definitions and related issues around abnormal uterine bleeding.  Semin Reprod Med. 2011;  29 (5) 377-382
  • 11 Munro MG, Broder MS, Critchley H OD, Matteson K, Hathtootuwa R, Fraser IS. An international response to questions about terminologies, investigation and management of abnormal uterine bleeding: use of an electronic audience respondse system.  Semin Reprod Med. 2011;  29 (5) 436-445
  • 12 Lieng M, Istre O, Sandvik L, Qvigstad E. Prevalence, 1-year regression rate, and clinical significance of asymptomatic endometrial polyps: cross-sectional study.  J Minim Invasive Gynecol. 2009;  16 465-471
  • 13 Weiss G, Maseelall P, Schott LL, Brockwell SE, Schocken M, Johnston JM. Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN).  Fertil Steril. 2009;  91 201-206
  • 14 Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I. Uterine adenomyosis: a need for uniform terminology and consensus classification.  Reprod Biomed Online. 2008;  17 244-248
  • 15 Dueholm M. Transvaginal ultrasound for diagnosis of adenomyosis: a review.  Best Pract Res Clin Obstet Gynaecol. 2006;  20 569-582
  • 16 Togashi K, Nishimura K, Itoh K et al.. Adenomyosis: diagnosis with MR imaging.  Radiology. 1988;  166 111-114
  • 17 Mark AS, Hricak H, Heinrichs LW et al.. Adenomyosis and leiomyoma: differential diagnosis with MR imaging.  Radiology. 1987;  163 527-529
  • 18 Dueholm M, Lundorf E, Hansen ES, Sorensen JS, Ledertoug S, Olesen F. Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis.  Fertil Steril. 2001;  76 588-594
  • 19 Lasmar RB, Barrozo PM, Dias R, Oliveira MA. Submucous myomas: A new presurgical classification to evaluate the viability of hysteroscopic surgical treatment-preliminary report.  J Min Invas Gynecol. 2005;  12 308-311
  • 20 Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension.  Obstet Gynecol. 1993;  82 736-740
  • 21 Tavassoli FA, Devilee P. World Health Organization Classification of Tumors: Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Lyon: IARC Press; 2003
  • 22 Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL et al.. Carcinoma of the corpus uteri. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer.  Int J Gynaecol Obstet. 2006;  95 Suppl 1 S105-143
  • 23 Shankar M, Lee CA, Sabin CA, Economides DL, Kadir RA. von Willebrand disease in women with menorrhagia: a systematic review.  BJOG. 2004;  111 734-740
  • 24 Dilley A, Drews C, Lally C, Austin H, Barnhart E, Evatt B. A survey of gynecologists concerning menorrhagia: perceptions of bleeding disorders as a possible cause.  J Womens Health Gend Based Med. 2002;  11 39-44
  • 25 Hale GE, Hughes CL, Burger HG, Robertson DM, Fraser IS. Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition.  Menopause. 2009;  16 50-59
  • 26 Hale GE, Manconi F, Luscombe G, Fraser IS. Quantitative measurements of menstrual blood loss in ovulatory and anovulatory cycles in middle- and late-reproductive age and the menopausal transition.  Obstet Gynecol. 115 249-256
  • 27 Livingstone M, Fraser IS. Mechanisms of abnormal uterine bleeding.  Hum Reprod Update. 2002;  8 60-67
  • 28 Critchley H OD, Maybin JA. Molecular and cellular causes of abnormal uterine bleeding of endometrial origin.  Semin Reprod Med. 2011;  29 (5) 400-409
  • 29 Gleeson NC. Cyclic changes in endometrial tissue plasminogen activator and plasminogen activator inhibitor type 1 in women with normal menstruation and essential menorrhagia.  Am J Obstet Gynecol. 1994;  171 178-183
  • 30 Smith SK, Abel MH, Kelly RW, Baird DT. A role for prostacyclin (PGi2) in excessive menstrual bleeding.  Lancet. 1981;  1 522-524
  • 31 Smith SK, Abel MH, Kelly RW, Baird DT. Prostaglandin synthesis in the endometrium of women with ovular dysfunctional uterine bleeding.  Br J Obstet Gynaecol. 1981;  88 434-442
  • 32 Pitsos M, Skurnick J, Heller D. Association of pathologic diagnoses with clinical findings in chronic endometritis.  J Reprod Med. 2009;  54 373-377
  • 33 Heatley MK. The association between clinical and pathological features in histologically identified chronic endometritis.  J Obstet Gynaecol. 2004;  24 801-803
  • 34 Toth M, Patton DL, Esquenazi B, Shevchuk M, Thaler H, Divon M. Association between Chlamydia trachomatis and abnormal uterine bleeding.  Am J Reprod Immunol. 2007;  57 361-366
  • 35 Endrikat J, Gerlinger C, Plettig K, Wessel J, Schmidt W, Grubb G et al.. A meta-analysis on the correlation between ovarian activity and the incidence of intermenstrual bleeding during low-dose oral contraceptive use.  Gynecol Endocrinol. 2003;  17 107-114
  • 36 Murphy PA, Kern SE, Stanczyk FZ, Westhoff CL. Interaction of St. John's Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding.  Contraception. 2005;  71 402-408
  • 37 Rosenberg MJ, Waugh MS, Stevens CM. Smoking and cycle control among oral contraceptive users.  Am J Obstet Gynecol. 1996;  174 628-632
  • 38 Fraser IS, Hickey MH. Endometrial vascular changes and bleeding patterns with long-acting progestogen-only contraceptives.  In: Spitz I (ed), Proceedings of an International Symposium, Jerusalem, August 1999, Progesterone, progestins and the antiprogestins in the next Millenium.  Steroids. 2000;  65 665-670
  • 39 Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkila A, Walker JJ, Cameron IT. Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia.  Br J Obstet Gynaecol. 1998;  105 592-598
  • 40 Munro MG, Heikinheimo O, Hathtootuwa R, Tank J, Fraser IS. The need for investigations to elucidate causes and effects of abnormal uterine bleeding.  Semin Reprod Med. 2011;  29 (5) 410-422

Malcolm G MunroM.D. 

Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Kaiser Permanente, Southern California

4900 Sunset Boulevard, Station 3-B, Los Angeles, CA 90027

Email: mgmunro@ucla.edu; mgmunro@aol.com

    >