ABNORMAL UTERINE BLEEDING

ABNORMAL UTERINE BLEEDINGTHE NEW FIGO CLASSIFICATION SYSTEMHaura Deast Ningtiarani10610501621IntroductionAbnormal uterine bleeding (AUB) is defined as bleeding from the uteruine corpus that is abnormal in volume, regularity, and/or timing.AUB afffect about 5-10% woman of reproductive age and probably higher percentage of women in older age groups.There has not been clarity with the diagnosis for women who present with deviation in uterine bleeding. Cumbersome terminology and confusing research outcome measures have bought forth recommendation from the FIGO for a universal classificaation system to describe AUB abnormalities in reproductive women.The PALM-COEIN classification identifies uterine bleeding abnormalities. 2Menstrual cycle

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4The PALM-COEIN Classification system for causes of AUB PALM Visually objective structural criteriaCOEI unrelated to structural anomaliesN Entities not yet classified5

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7POLYPS (AUB-P)

Abnormal vaginal bleeding is the most common presenting symptom in polyps.Polyps are categorized as either present or absent. Diagnosed by TVUS, saline infusion sonography, and hysteroscopy. 8ADENOMYOSIS (AUB-A)

The criteria for diagnosing adenomyosis determined by the depth of endometrial tissue beneath the endometrial-myometrial interface from hysterectomy specimens.70% of women with adenomyosis have symptoms of AUB. 30% have dysmenorrhea. 19% have both. Diagnosed by ultrasound or MRI. 9LEIOMYOMAS (AUB-Lsm or AUB-Lo)

10MALIGNANCY (AUB-M)AUB is primary symptom of endometrial neoplasiaAUB-M include both premalignant and malignant lesion.

11COAGULOPATHY (SYSTEMIC DISORDER OF HEMOSTASIS) (AUB-C)The term coagulopathy is used to encompass the spectrum of systemic disorder of hemostasis that may caused AUB. About 13% women with HMBhave biochemically detectable systemic disorders of hemostasis, most often von willebrand diseases.

12OVULATORY DISORDER (AUB-O)Ovulatory disorder is one of the leading cause of AUB, manifesting in some combination of unpredictable timing of bleeding and variable amount of flow.

13ENDOMETRIAL CAUSES (AUB-E)Most patients in this category will have regular cycles, normal ovulation and no definable cause of AUB. Usually present with HMB, Which may indicate a disorder of endometrial hemostasis. Others may present with IMB, which may be secondary to inflammation, infection, or abnormal inflammatory responses.

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IATROGENIC (AUB-I)Can be caused by medical interventions or device.Unscheduled endometrial bleeding that occurs during the use of exogenous gonadal steroid therapy is termed breakthrough bleeding (BTB) happend because low consentration estrogent in circulation can be caused by Patient forgot or late in consuming contraseption pillDaily usage of medication such as rifampisinCauses include IUD, exogenous gonald steroid and other systemic agents that affect blood coagulation or ovulation. Bleeding from anticoagulation therapy is listed under AUB-C rather than AUB-I15NOT YET CLASSIFIED (AUB-N)Reserved for entities that are poorly defined and/or not well examined.16NOTATION17References Hoffman B,Schorge j, et all. Menstrual Cycle: William Gynecology second edition. Dallas Parkland Hospital: Mc Graw Hill Professional; 2012.Munro MG, Critchley HOD, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years: Fertility and sterility. American Society for Reproductive Medicine 2011;95(7): 2204-2208.Qureshi FU, Yusuf AW. Disstribution of causes of abnormal uterine bleeding using the new FIGO classification system: Departement of Obstetrics and Gynaecology 2013;63(8): 973-975.Twiss JJ. A new look at abnormal uterine bleeding: the nurse practitioner. Lippincott William & Wilkins 2013;38(12): 22-30.18