Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, Kaiser Permanente, Southern California, Los Angeles, CA 90027, USA.
Rev Endocr Metab Disord. 2012 Dec;13(4):225-34. doi: 10.1007/s11154-012-9220-x.
There exists a spectrum of potential causes of abnormal uterine bleeding (AUB) in nonpregnant reproductive-aged women. In some instances the abnormal bleeding may emanate from definable pathologic entities in the endometrial cavity such as polyps or submucous leiomyomas (fibroids), while in others, it may occur secondary to coagulopathies or disorders of local or systemic hemostasis. If the patient is subjected to a rigorous evaluation more than one potential contributor may be identified, a circumstance that challenges the clinician since entities such as polyps, leiomyomas, and adenomyosis may frequently be asymptomatic, even in women with AUB. The bench or clinical investigator may also be influenced by the existence of the multiplicity of potential causes that could confound the results of research. This paper describes FIGO's (Fédération Internationale de Gynécologie et d'Obstétrique) new PALM-COEIN classification of causes of AUB in the reproductive years (Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia-Coagulopathy, Ovulatory disorder, Endometrial, Iatrogenic, Not yet classified). This system is designed to assist clinicians in the evaluation of patients, investigators in the design and interpretation of research and faculty in the education of medical students and residents/trainees. Additionally, given the longstanding existence of a confusing array of conflicting definitions, the manuscript describes the FIGO standardized terminology for both normal menstruation and AUB symptoms.
在非妊娠育龄期妇女中，异常子宫出血（AUB）存在一系列潜在原因。在某些情况下，异常出血可能源自子宫内膜腔中可定义的病理实体，如息肉或黏膜下平滑肌瘤（肌瘤），而在其他情况下，它可能继发于凝血功能障碍或局部或全身止血功能障碍。如果对患者进行严格评估，可能会发现不止一个潜在的病因，这种情况对临床医生构成了挑战，因为息肉、肌瘤和子宫腺肌病等实体可能经常无症状，即使在有 AUB 的女性中也是如此。临床研究人员也可能受到多种潜在病因的影响，这些病因可能会使研究结果复杂化。本文描述了 FIGO（国际妇产科联合会）对育龄期 AUB 病因的新 PALM-COEIN 分类（息肉、子宫腺肌病、平滑肌瘤、恶性肿瘤和增生-凝血功能障碍、排卵障碍、子宫内膜、医源性、未分类）。该系统旨在帮助临床医生评估患者、研究人员设计和解释研究以及教师教育医学生和住院医师/学员。此外，鉴于长期存在一系列令人困惑的相互矛盾的定义，本文档还描述了 FIGO 对正常月经和 AUB 症状的标准化术语。
