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PALM COEIN CLASSIFICATION
AUB-P: Polyp (Uterine or Cervical Polyps)
AUB-A: Adenomyosis
AUB-L: Leiomyoma
AUB-M:
Malignancy/hyperplasia
• Cervical Intraepithelial Neoplasia, Cervical Cancer
• Endometrial Hyperplasia and Uterine Cancers
• Oestrogen-secreting (granulosa cell) ovarian tumours
AUB-C:
Coagulopathy
• Von Willebrand Disease
• Coagulation Factor Deficiencies, e.g., Hypofibrinogenemia,
Haemophilia A and B carriers, Thrombocytopenia
AUB-O:
Ovulation dysfunction
• Hepatic Failure (AUB is present in 60% of these patients):
• AUB is caused by ovulation dysfunction (abnormal oestrogen
metabolism), coagulation factor deficiency (secondary to diminished
synthesis), and thrombocytopenia (secondary to portal
hypertension)
• Chronic Renal Failure (80% of patients requiring dialysis): ovulatory
dysfunction is due to disturbance of pulsatile GnRH secretion
Endocrinopathies, e.g., hypothyroidism, adrenal disorders, polycystic
ovary syndrome, hyperprolactinemia, obesity,
AUB-E:
Endometrial
dysfunction
• Atrophic endometritis, e.g., postmenopausal
AUB-I:
Iatrogenic
• Exogenous hormones, e.g., hormonal contraceptives, steroids
• Intrauterine devices
AUB-N:
Not otherwise specified
• Müllerian anomalies, e.g., didelphys, septate and bicornuate uterus
• Arteriovenous malformation (congenital or acquired)
• Cesarean scar defect