How to proceed?

• Miss U, 19 yrs
• Studying in B. Tech
• Menarche at 12 yrs
• Irregular cycles
• Once in 2 to 3 months
• Feeling tired, weak and
unable to concentrate on
her studies
• Heavy menstrual bleeding
for 15 days
• Preceded by 3 months of
amenorrhoea
Abnormal Uterine Bleeding (AUB):
Nomenclature & Classification

Dr Saubhagya Kumar Jena

Department of Obstetrics and Gynaecology
 Specific learning objectives (SLO)

After end of this session the students should be able

to:
• 1. Define abnormal uterine bleeding.
• 2. Describe the different nomenclatures of abnormal
uterine bleeding.
• 3. Describe the FIGO classification system of
abnormal uterine bleeding.
What is not normal?

ABNORMAL
 Normal uterine bleeding
(Menstruation)
Amount
(Patient determined) A
Light, Normal & Heavy
FIGO 2018
B
Frequency (Cycle) C
≥24 to ≤38 days
D
R
Duration
≤8 days

Regularity
Normal or Regular:≤7-9 days
Irregular:≥8-10 days
P
h
y
s
I
o
l
o
g
y
Abnormal uterine bleeding

Uterine bleeding which is abnormal

either in amount, cycle, duration or
regularity.

DUB
 Classification
(According to Age group)
• Adolescent
• Adults
• Premenopausal
• Postmenopausal

- Acute
- Chronic
- Intermenstrual
 Pattern of bleeding
Menometrorrhagia

Menorrhagia Metrorrhagia

Regular cycles, Prolonged Irregular and acyclic

and/or Heavy bleeding

PolymenorrhagiaFIGO 2007
Abolition of this Latin & Greek origin terminology

Polymenorrhoea Oligomenorrhoea

Frequent cycles, Infrequent cycles,

Normal bleeding Normal bleeding

Hypomenorrhoea
Regular cycles
Light bleeding
 Change in nomenclature
(PALM-COEIN)
• FIGO introduced in 2011.
• Standard nomenclature for bleeding based on etiology
and bleeding pattern.
• ACOG accepted in 2012.
• No more DUB/ menorrhagia/ metrorrhagia etc.
• AUB:
- Heavy menstrual bleeding AUB/HMB.
- Intermenstrual bleeding AUB/IMB.
Etiology
 PALM-COEIN: 2018

Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine
bleeding symptoms and classification of causes of abnormal uterine bleeding in the
reproductive years: 2018 revisions. Int J Gynecol Obstet 2018;143:393-409.
 Summary
• Remember what is “normal”
• Not normal is abnormal
• Change from “D” to “A”: AUB → no more DUB
• Classification: Acute, chronic & intermenstrual
• Nomenclature: PALM-COEIN

In child bearing age group

try to exclude pregnancy
related complications
Thank you

drsaubhagya@gmail.com