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FIGO’s New Classification Of Causes Of Abnormal Uterine Benefits Patients

May 19, 2011

Published in the International Journal of Gynecology & Obstetrics

Abnormal uterine bleeding (AUB) in women of reproductive age may be due to a wide range of disorders or pathologies. Until now, there has been no universally accepted method for classifying such patients, which has impeded basic science and clinical investigation, as well as the practical, rational, and consistent application of medical and surgical therapy. As the result of a stringent 5-year review process, a multinational group of clinician”“investigators with broad experience in the investigation of AUB has now agreed on a classification system to facilitate multi-institutional investigation into the epidemiology, etiology, and treatment of women with acute and chronic AUB. This classification has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO classification system and has been published in the International Journal of Gynecology & Obstetrics.

“There has been general inconsistency in the nomenclature used to describe abnormal uterine bleeding in reproductive aged women, and there is a plethora of potential causes””several of which may coexist in a given individual,” commented Malcolm G. Munro, MD, FRCS(c), FACOG, Professor of Obstetrics and Gynecology at the David Geffen School of Medicine, UCLA and Director of Gynecologic Services, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California. “It seems clear that the development of consistent and universally accepted nomenclature is a step toward rectifying this unsatisfactory circumstance. Another requirement is the development of a classification system for the causes of AUB, which can be used by clinicians, investigators, and even patients themselves to facilitate communication, clinical care, and research.”

Beginning with workshops in 2005, contributors from more than 17 countries on 6 continents developed the PALM-COEIN (pronounced “pahm-koin”) classification system for causes of AUB in the reproductive years. The basic system comprises 9 categories: The first 4 are defined by visually objective structural criteria (PALM: polyp; adenomyosis; leiomyoma; and malignancy and hyperplasia); a second 4 that are unrelated to structural anomalies (COEI: coagulopathy; ovulatory dysfunction; endometrial; and iatrogenic), and a final category reserved for entities that are not yet classified (N). A draft system was developed and revised, distributed for comments, and then discussed at a face-to-face meeting held in association with the 2009 FIGO World Congress in Cape Town, South Africa.

The process was systematically designed to create a practical system that could be used by clinicians in most countries worldwide to classify patients with AUB readily and consistently. Drs. Munro, Critchley and Fraser note that it is “recognized that the system will require periodic modification and occasional substantial revision depending on advances in knowledge and technology, and increasing availability of investigative options across geographic regions. Consequently, we recommend a scheduled systematic review of the system on a regular basis by a permanent committee of an international organization such as FIGO, which has already endorsed the establishment of a suitable ongoing Working Group on Menstrual Disorders.”

FIGO Chief Executive Hamid Rushwan said: “There is no existing classification of the causes of these common gynecologic symptoms that allows good communication between practicing clinicians and researchers, and which encourages focus on the optimal approaches to modern management. Therefore, FIGO is pleased to have a role in facilitating the use of this ground-breaking new classification worldwide.”

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