DEFINITION

• Uterine bleeding associated with abnormal menstrual cycles can be anovulatory or ovulatory.
• In 2011, a new nomenclature system was introduced by the International Federation of Gynecology and Obstetrics (FIGO) and supported by The American College of Obstetricians and Gynecologists (ACOG) to describe uterine bleeding abnormalities in reproductive-aged women, known by the acronym PALM-COEIN[15][11].
  • PALM is an acronym referring to structural causes of abnormal uterine bleeding: Polyp, Adenomyosis, Leiomyoma (submucosal myoma or other myoma), Malignancy and hyperplasia
  • COEIN in an acronym referring to nonstructural causes of abnormal uterine bleeding: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not Yet classified
• Secondary amenorrhea: absence of menses for >3 months in women who previously had regular menstrual cycles or 6 months in women who had irregular menses.
• Oligomenorrhea: fewer than nine menstrual cycles in one year or menstrual cycles that occurs less frequently than every 35 days.
• Polymenorrhea: menstrual cycles that occurs more often than every 21 days.
• Heavy menstrual bleeding: replaces the term menorrhagia in the PALM-COEIN system and defined as heavy bleeding with menstrual blood loss >80mL; in practice, excessive blood loss based on patient’s perception.[11]
• Intermenstrual bleeding: replaces the term metrorrhagia in the PALM-COEIN system and is defined as uterine bleeding between menstrual cycles.