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Abnormal Uterine Bleeding (PALM-COEIN)


Maj Patel
Menstruation, or a period, is normal bleeding from the uterus through the vagina that occurs as part of a woman’s monthly cycle. Most periods last three to five days. Bleeding cycles normally occur every 21 to 35 days depending on the woman’s ovarian function. Abnormal uterine bleeding, or AUB, is any bleeding from the uterus other than a regular period. AUB can also describe unusually heavy bleeding during a period, or bleeding that lasts more than seven days. Major Spencer, can you tell us more about abnormal uterine bleeding?

Maj Spencer
Certainly, Dr. Patel. There are several different conditions that can cause abnormal uterine bleeding, and a provider may choose to conduct pelvic exams, blood tests, imaging tests, and other procedures to diagnose the underlying problem. Treatment, of course, will depend on the cause.

PALM-COEIN [pronounced pahm-koin] is a standardized classification system that providers use to diagnose the cause of AUB. PALM describes structural problems that can be measured with imaging tests. It stands for:

  • Polyp
  • Adenomyosis
  • Leiomyoma, and
  • Malignancy and hyperplasia

It’s important to note that providers may use the terms "myoma" or "fibroid" instead of "leiomyoma."

COEIN includes conditions that are not structural problems. It stands for:

  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic, and
  • Not yet classified

Coagulopathy refers to a condition in which a person’s blood doesn’t coagulate, or clot, properly. The term "iatrogenic" means that the problem is caused by a medical examination, medication, or other treatment.