FIGO PALM-COEIN (Abnormal Uterine Bleeding Causes)
The FIGO PALM-COEIN classification of the causes of abnormal uterine bleeding in non-gravid women of reproductive age (Munro and colleagues 2011, revised 2018).
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- P - Polyp
- 0
- A - Adenomyosis
- 0
- L - Leiomyoma
- 1
- M - Malignancy and atypical hyperplasia
- 0
- C - Coagulopathy
- 0
- O - Ovulatory dysfunction
- 1
- E - Endometrial
- 0
- I - Iatrogenic
- 0
- N - Not otherwise classified
- 0
- Leiomyoma secondary classification
- SM — submucosal, involving the endometrial cavity. From the 2018…
- Leiomyoma tertiary type, optional
- 2
Result: AUB P0 A0 L1(SM type 2) M0 - C0 O1 E0 I0 N0.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- PALM
- Structural: polyp, adenomyosis, leiomyoma, malignancy and atypical hyperplasia.
- COEIN
- Non-structural: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic; plus not-otherwise-classified.
- Three values
- Each category is 0 absent, 1 present, or ? not yet assessed. Every category is reported for every patient.
- Leiomyoma
- Three tiers. The secondary tier, SM submucosal versus O other, carries the clinical weight. Tertiary types 0 to 8.
- 2018 revision
- Type 3 sits inside the submucous group, and anticoagulant-associated bleeding is AUB-I rather than AUB-C.
- Scope
- Organises a diagnosis rather than making one. It does not exclude malignancy and does not quantify bleeding.
What you enter
- P - Polyp
- A - Adenomyosis
- L - Leiomyoma
- M - Malignancy and atypical hyperplasia
- C - Coagulopathy
- O - Ovulatory dysfunction
- E - Endometrial
- I - Iatrogenic (includes anticoagulants from the 2018 revision)
- N - Not otherwise classified
- Leiomyoma secondary classification.
- Leiomyoma tertiary type, optional
Full field descriptions
- P - Polyp [0 = absent; 1 = present; ? = not yet assessed]
- A - Adenomyosis [0 = absent; 1 = present; ? = not yet assessed]
- L - Leiomyoma [0 = absent; 1 = present; ? = not yet assessed]
- M - Malignancy and atypical hyperplasia [0 = absent; 1 = present; ? = not yet assessed]
- C - Coagulopathy [0 = absent; 1 = present; ? = not yet assessed]
- O - Ovulatory dysfunction [0 = absent; 1 = present; ? = not yet assessed]
- E - Endometrial [0 = absent; 1 = present; ? = not yet assessed]
- I - Iatrogenic (includes anticoagulants from the 2018 revision) [0 = absent; 1 = present; ? = not yet assessed]
- N - Not otherwise classified [0 = absent; 1 = present; ? = not yet assessed]
- Leiomyoma secondary classification. REQUIRED when leiomyoma is 1; this tier carries the clinical weight [SM — submucosal, involving the endometrial cavity. From the 2018 revision this spans types 0 to 3.; O — other. From the 2018 revision this spans types 3 to 8, with type 3 straddling both groups.]
- Leiomyoma tertiary type, optional [0 — intracavitary, attached to the endometrium by a narrow stalk (pedunculated); 1 — submucosal, less than 50 percent intramural; 2 — submucosal, 50 percent or more intramural; 3 — totally extracavitary but abuts the endometrium; 4 — intramural, entirely within the myometrium, no extension to the endometrial surface or serosa; 5 — subserosal, 50 percent or more intramural; 6 — subserosal, less than 50 percent intramural; 7 — subserosal, attached to the serosa by a stalk (pedunculated); 8 — does not relate to the myometrium at all: cervical, round or broad ligament without direct uterine attachment, or parasitic]
How this is calculated
Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408. Revises Munro MG, et al. Int J Gynaecol Obstet. 2011;113(1):3-13. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.