by Malcolm G. Munro MD, FACOG, FRCSC
Abnormal uterine bleeding (AUB) in the reproductive years affects millions of women worldwide. It is estimated that 30% of women experience the problem at some time in their lives and that 5% of those from the age of 30-50 will consult their physicians for symptoms of AUB each year.
Research, education, and clinical care for these women has been compromised by poorly defined and inconsistently-used nomenclature, and an absence of the structured approach to evaluation that could consistently provide those affected the full spectrum of treatment options.
In 2011 FIGO's Menstrual Disorders Working Group, now the Menstrual Disorders Committee (MDC), published the results of a 7-year process whereby experts in menstrual and related disorders, as well as representatives from a number of professional societies, medical journals, and regulatory experts from around the world, collaborated to provide both standardized nomenclature for symptoms, and a classification system for causes of AUB in the reproductive years. The two systems were widely accepted by national obstetrical and gynecological societies, but were revised and published in 2018. The nomenclature system, known as FIGO AUB System 1, describes both normal and abnormal uterine bleeding, while System 2, also known as the "PALM-COEIN" system, is a categorization of causes or contributors to AUB symptoms in non-pregnant girls and women in their reproductive years. These systems, appropriately and consistently applied, help clinicians, educators, and investigators provide more consistent care and education, and should facilitate both the design and interpretation of basic, translational, and clinical research. These two FIGO systems are subject to regular review with revision or modification as new information becomes available.
This site, content designed by Malcolm G. Munro MD, is designed to familiarize clinicians, educators, and investigators with an approach to the problem of AUB in the reproductive years using these FIGO systems as an infrastructure to facilitate understanding of pathogenesis, clinical relevance, laboratory and imaging investigation, and medical and surgical treatment options. Included are a number of downloadable tools to assist in the evaluation of such patients, including menstrual symptoms, clinical investigation, and treatment options. Also on the site is a link to the web book "Understanding and Solving My Abnormal Periods", a companion piece for patients who may be, or are known to be, experiencing AUB symptoms. Together these two webbooks should facilitate both better understanding and improved care for women with symptoms of abnormal uterine bleeding.
"An episode of heavy bleeding, that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss."
Munro et al IJGO 2011;113:3-13
"Bleeding, from the uterine corpus, that is abnormal in volume, regularity, and/or timing, and has been present for the majority of the past six months"
Munro et al IJGO 2011;113:3-13