International Journal of Clinical Obstetrics and Gynaecology

Background: Abnormal Uterine Bleeding (AUB) is a common gynaecological complaint in reproductive-age women and requires systematic evaluation. The FIGO PALM-COEIN classification provides a standardized framework for diagnosing and managing AUB.
Objectives: To classify reproductive-age women with AUB according to the FIGO PALM-COEIN system and to establish individualized management protocols for each etiological group.
Methods: This observational study was conducted on 200 women attending the Gynaecology Outpatient Department at Modern Government Maternity Hospital, Petlaburz, Hyderabad. Detailed history, clinical examination, and laboratory investigations were performed for all participants. Endometrial samples were obtained through dilatation and curettage under aseptic precautions and evaluated histopathologically. Medical management included mefenamic acid, tranexamic acid (500 mg TID during menstruation), norethindrone acetate (5-10 mg, days 5-25), combined oral contraceptives, and levonorgestrel-releasing intrauterine system (LNG-IUS). Surgical management was provided where indicated.
Results: The majority of participants were aged 40-44 years (57%) and were predominantly multiparous. Heavy menstrual bleeding was the most common presenting pattern (69%). Proliferative endometrium was the most frequent histopathological finding. Hormonal therapy along with tranexamic acid and mefenamic acid demonstrated good efficacy in controlling AUB. Surgical interventions included hysterectomy in 78.5% of hyperplasia/malignancy cases, 45.7% of leiomyoma cases, and 20% of adenomyosis cases. Myomectomy was performed in 11.4% of leiomyoma cases. LNG-IUS was effective in 60% of adenomyosis patients.
Conclusion: The FIGO PALM-COEIN system proved effective in classifying AUB and guiding targeted management. Most women responded well to medical therapy, while surgical treatment was reserved for structural causes and refractory cases. Tailored management based on classification improves outcomes and reduces unnecessary interventions.