PALM – COEIN
“There are 9 main categories, which are arranged according to the acronym PALM-COEIN. In general, the components of the PALM group are discrete (structural) entities that can be measured visually with imaging techniques and/or histopathology, whereas the COEIN group is related to entities that are not defined by imaging or histopathology (non-structural).” FIGO 2011.
| Classification | Disease type |
| Polyp | Endometrial and endocervical polyps |
| Adenomyosis | Adenomyosis |
| Leiomyoma (fibroids) | Leiomyomas are also fibroids, uterine myomas, or fibromas. They are “firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus.” obgyn.ucla.com |
| Malignancy, premalignancy/hyperplasia; | Endometrial cancer, Endometrial hyperplasia |
| Coagulopathy | von Willebrand disease; Bleeding in patients on anticoagulants. |
| Ovulatory dysfunction | Anovulatory bleeding, Endocrinopathies: -Polycystic ovary syndrome, -Hypothyroidism/thyroid disease -Hyperprolactinemia, Mental stress, Obesity, Anorexia, Weight loss, or Extreme exercise such as that associated with elite athletic training) |
| Endometrial. | Endometritis / Endometrial infection, e.g. chlamydia Normal variation. Endometrial bleed normal variations (postmenarchal, premenstrual spotting, postmenstrual spotting, midcycle ovulatory bleeding, perimenopausal) Menorrhagia (idiopathic) |
| Iatrogenic | Contraceptive related abnormal bleeding (OCPs, depo-medroxyprogesterone, IUDs, progestin implants) Drugs (anticoagulants, psychotropics, antibiotics like rifampin and Griseofulvin) Cigarette smoking |
| Not yet classified | Organ failure (late manifestation: kidney failure, liver failure) Ectopic pregnancy Intrauterine pregnancy complication |
Reference / Further Reading
Int J Gynaecol Obstet. 2011 Apr;113(1):3-13. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. https://www.ncbi.nlm.nih.gov/pubmed/21345435.
FIGO 2011 article: http://sogc.com.ar/PALN-COEIN.pdf
http://obgyn.ucla.edu/fibroids, Last Accessed 3/27/2018