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
Correction(s) for this article
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Corrigendum to “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 143(2018) 393–408.]
- Volume 144Issue 2International Journal of Gynecology & Obstetrics
- pages: 237-237
- First Published online: November 27, 2018
Corresponding Author
Malcolm G. Munro
Departments of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA, USA
Correspondence
Malcolm G. Munro, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA, USA.
Email: [email protected]
Search for more papers by this authorHilary O.D. Critchley
MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
Search for more papers by this authorIan S. Fraser
School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
Search for more papers by this authorthe FIGO Menstrual Disorders Committee
Search for more papers by this authorCorresponding Author
Malcolm G. Munro
Departments of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA, USA
Correspondence
Malcolm G. Munro, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA, USA.
Email: [email protected]
Search for more papers by this authorHilary O.D. Critchley
MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
Search for more papers by this authorIan S. Fraser
School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
Search for more papers by this authorthe FIGO Menstrual Disorders Committee
Search for more papers by this authorAbstract
Background
The International Federation of Gynecology and Obstetrics (FIGO) systems for nomenclature of symptoms of normal and abnormal uterine bleeding (AUB) in the reproductive years (FIGO AUB System 1) and for classification of causes of AUB (FIGO AUB System 2; PALM-COEIN) were first published together in 2011. The purpose was to harmonize the definitions of normal and abnormal bleeding symptoms and to classify and subclassify underlying potential causes of AUB in the reproductive years to facilitate research, education, and clinical care. The systems were designed to be flexible and to be periodically reviewed and modified as appropriate.
Objectives
To review, clarify, and, where appropriate, revise the previously published systems.
Methodology and outcome
To a large extent, the process has been an iterative one involving the FIGO Menstrual Disorders Committee, as well as a number of invited contributions from epidemiologists, gynecologists, and other experts in the field from around the world between 2012 and 2017. Face-to-face meetings have been held in Rome, Vancouver, and Singapore, and have been augmented by a number of teleconferences and other communications designed to evaluate various aspects of the systems. Where substantial change was considered, anonymous voting, in some instances using a modified RAND Delphi technique, was utilized.
CONFLICTS OF INTEREST
Each author has received royalties from Up-to-Date. MGM and ISF have acted as consultants for, and/or given lectures for, and received honoraria from Bayer AG (Berlin), Bayer Women's Health, and Vifor Pharma, which has partly funded this initiative (as outlined in the relevant publications). ISF has acted as a consultant for Merk. MGM has functioned as a consultant to Abbvie, Datichi Sankyo, Myovant Sciences, and Hologic, the latter a contributor to funding to the FIGO Menstrual Disorders Committee. HODC has acted as a consultant (no personal honoraria received) for Bayer AG, PregLem SA, Gedeon Richter, Vifor Pharma UK, AbbVie, and Myovant Sciences. Many other organizations and companies have contributed in direct or indirect ways to the development of this process. The process has been approved by FIGO and the FIGO Menstrual Disorders Committee.
REFERENCES
- 1Khatri R, Gupta AN. Effect of childbirth on menstrual pattern. Indian J Med Res. 1978; 67: 66–72.
- 2Gao J, Zeng S, Sun BL, Fan HM, Han LH. Menstrual blood loss and hematologic indices in healthy Chinese women. J Reprod Med. 1987; 32: 822–826.
- 3Oehler MK, Rees MC. Menorrhagia: An update. Acta Obstet Gynecol Scand. 2003; 82: 405–422.
- 4Harlow SD, Campbell OM. Epidemiology of menstrual disorders in developing countries: A systematic review. BJOG. 2004; 111: 6–16.
- 5 Heavy Menstrual Bleeding. Excellence NIfHaC, editor. United Kingdom: National Institute for Health and Clinical Excellence; 2007.
- 6Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007; 10: 183–194.
- 7Matteson KA, Raker CA, Clark MA, Frick KD. Abnormal uterine bleeding, health status, and usual source of medical care: Analyses using the Medical Expenditures Panel Survey. J Womens Health (Larchmt). 2013; 22: 959–965.
- 8Fraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A, Petraglia F. Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynecol Obstet. 2015; 128: 196–200.
- 9Kazemijaliseh H, Ramezani Tehrani F, Behboudi-Gandevani S, Khalili D, Hosseinpanah F, Azizi F. A population-based study of the prevalence of abnormal uterine bleeding and its related factors among Iranian reproductive-age women: An updated data. Arch Iran Med. 2017; 20: 558–563.
- 10Cote I, Jacobs P, Cumming DC. Use of health services associated with increased menstrual loss in the United States. Am J Obstet Gynecol. 2003; 188: 343–348.
- 11Frick KD, Clark MA, Steinwachs DM, et al. Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment. Women's Health Issues. 2009; 19: 70–78.
- 12Khaskheli MN, Baloch S, Sheeba A, Baloch S, Khaskheli FK. Iron deficiency anaemia is still a major killer of pregnant women. Pak J Med Sci. 2016; 32: 630–634.
- 13Maswime S, Buchmann E. Causes and avoidable factors in maternal death due to cesarean-related hemorrhage in South Africa. Int J Gynecol Obstet. 2016; 134: 320–323.
- 14Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet. 2011; 113: 3–13.
- 15Fraser IS, Critchley HO, Munro MG, Broder M. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril. 2007; 87: 466–476.
- 16Fraser IS, Critchley HO, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum Reprod. 2007; 22: 635–643.
- 17Woolcock JG, Critchley HO, Munro MG, Broder MS, Fraser IS. Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding. Fertil Steril. 2008; 90: 2269–2280.
- 18Fraser IS, Munro MG, Critchley HOD. Abnormal uterine bleeding in reproductive-age women: Terminology and PALM-COEIN etiology classification. Published 2017. https://www.uptodate.com/contents/abnormal-uterine-bleeding-in-reproductive-age-women-terminology-and-palm-coein-etiology-classification. Accessed March 20, 2018.
- 19Munro MG, Critchley H, Fraser IS. Research and clinical management for women with abnormal uterine bleeding in the reproductive years: More than PALM-COEIN. BJOG. 2017; 124: 185–189.
- 20Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol. 2017; 40: 3–22.
- 21Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril. 2011; 95: 2204–2208, 8.e1-3.
- 22Critchley HO, Munro MG, Broder M, Fraser IS. A five-year international review process concerning terminologies, definitions, and related issues around abnormal uterine bleeding. Semin Reprod Med. 2011; 29: 377–382.
- 23Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011; 29: 383–390.
- 24Munro MG, Critchley HO, Fraser IS. The flexible FIGO classification concept for underlying causes of abnormal uterine bleeding. Semin Reprod Med. 2011; 29: 391–399.
- 25 American College of Obstetricians and Gynecologists. ACOG committee opinion no 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013; 121: 891–896.
- 26Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: Addressing the unfinished agenda of staging reproductive aging. Fertil Steril. 2012; 97: 843–851.
- 27Harlow SD, Lin X, Ho MJ. Analysis of menstrual diary data across the reproductive life span applicability of the bipartite model approach and the importance of within-woman variance. J Clin Epidemiol. 2000; 53: 722–733.
- 28 Heavy menstrual bleeding: Assessment and management (NG88). London; 2018.
- 29Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS. Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: Systematic review comparing test accuracy. Acta Obstet Gynecol Scand. 2010; 89: 1374–1384.
- 30Bazot M, Darai E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril. 2018; 109: 389–397.
- 31Van den Bosch T, Dueholm M, Leone FP, et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: A consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015; 46: 284–298.
- 32Andres MP, Borrelli GM, Ribeiro J, Baracat EC, Abrao MS, Kho RM. Transvaginal ultrasound for the diagnosis of adenomyosis: Systematic review and meta-analysis. J Minim Invasive Gynecol. 2018; 25: 257–264.
- 33Laughlin-Tommaso SK, Hesley GK, Hopkins MR, Brandt KR, Zhu Y, Stewart EA. Clinical limitations of the International Federation of Gynecology and Obstetrics (FIGO) classification of uterine fibroids. Int J Gynecol Obstet. 2017; 139: 143–148.
- 34Mutter GL. Endometrial intraepithelial neoplasia (EIN): Will it bring order to chaos? The Endometrial Collaborative Group Gynecol Oncol. 2000; 76: 287–290.
- 35Jarboe EA, Mutter GL. Endometrial intraepithelial neoplasia. Semin Diagn Pathol. 2010; 27: 215–225.
- 36Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynecol Obstet. 2009; 105: 109.
- 37Emons G, Beckmann MW, Schmidt D, Mallmann P; Uterus commission of the Gynecological Oncology Working G. New WHO Classification of Endometrial Hyperplasias. Geburtshilfe Frauenheilkd. 2015; 75: 135–136.
- 38Fraser IS. Bleeding arising from use of exogenous steroids. Baillieres Best Pract Res Clin Obstet Gynaecol. 1999; 13: 203–222.
- 39De Crem N, Peerlinck K, Vanassche T, et al. Abnormal uterine bleeding in VTE patients treated with rivaroxaban compared to vitamin K antagonists. Thromb Res. 2015; 136: 749–753.
- 40Bryk AH, Pirog M, Plens K, Undas A. Heavy menstrual bleeding in women treated with rivaroxaban and vitamin K antagonists and the risk of recurrent venous thromboembolism. Vascul Pharmacol. 2016; 87: 242–247.
- 41Yoon DJ, Jones M, Taani JA, Buhimschi C, Dowell JD. A systematic review of acquired uterine arteriovenous malformations: Pathophysiology, diagnosis, and transcatheter treatment. AJP Rep. 2016; 6: e6–e14.
- 42Bij dVA, van der Voet LF, Naji O, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: Systematic review. Ultrasound Obstet Gynecol. 2014; 43: 372–382.
- 43Tulandi T, Cohen A. Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol. 2016; 23: 893–902.
- 44Kadir RA, Economides DL, Sabin CA, Owens D, Lee CA. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet. 1998; 351: 485–489.
- 45Kouides PA, Conard J, Peyvandi F, Lukes A, Kadir R. Hemostasis and menstruation: Appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. Fertil Steril. 2005; 84: 1345–1351.
- 46Farquhar CM, Lethaby A, Sowter M, Verry J, Baranyai J. An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding. Am J Obstet Gynecol. 1999; 181: 525–529.
- 47Ash SJ, Farrell SA, Flowerdew G. Endometrial biopsy in DUB. J Reprod Med. 1996; 41: 892–896.
- 48An evidence-based guideline for the management of heavy menstrual bleeding. Working Party for Guidelines for the Management of Heavy Menstrual Bleeding. N Z Med J. 1999; 112: 174–177.
- 49Guidelines for the management of abnormal uterine bleeding. J Obstet Gynaecol Can. 2001; 104: 1–6.
- 50Wise MR, Jordan V, Lagas A, et al. Obesity and endometrial hyperplasia and cancer in premenopausal women: A systematic review. Am J Obstet Gynecol. 2016; 214(689): e1–e17.
- 51Lu KH, Broaddus RR. Gynecological tumors in hereditary nonpolyposis colorectal cancer: We know they are common–now what? Gynecol Oncol. 2001; 82: 221–222.
- 52Lu KH, Dinh M, Kohlmann W, et al. Gynecologic cancer as a “sentinel cancer” for women with hereditary nonpolyposis colorectal cancer syndrome. Obstet Gynecol. 2005; 105: 569–574.
- 53Leone FP, Lanzani C, Ferrazzi E. Use of strict sonohysterographic methods for preoperative assessment of submucous myomas. Fertil Steril. 2003; 79: 998–1002.
- 54Maheux-Lacroix S, Li F, Laberge PY, Abbott J. Imaging for polyps and leiomyomas in women with abnormal uterine bleeding: A systematic review. Obstet Gynecol. 2016; 128: 1425–1436.
- 55Bittencourt CA, Dos Santos Simoes R, Bernardo WM, et al. Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: Systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017; 50: 32–39.
- 56Critchley HO, Warner P, Lee AJ, Brechin S, Guise J, Graham B. Evaluation of abnormal uterine bleeding: Comparison of three outpatient procedures within cohorts defined by age and menopausal status. Health Technol Assess. 2004; 8: iii–iv, 1–139.
- 57Toth M, Patton DL, Esquenazi B, Shevchuk M, Thaler H, Divon M. Association between Chlamydia trachomatis and abnormal uterine bleeding. Am J Reprod Immunol. 2007; 57: 361–366.
- 58Villagrana Zesati JR, Lopez Hurtado M, Flores Salazar VR, de Haro Cruz MJ, Escobedo Guerra MR, Guerra Infante FM. Persistence of Chlamydia trachomatis in endometrium and peritoneal fluid of infertile patients with negative cervical culture. Ginecol Obstet Mex. 2013; 81: 23–28.
- 59Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Evaluation of the uterine cavity with magnetic resonance imaging, transvaginal sonography, hysterosonographic examination, and diagnostic hysteroscopy. Fertil Steril. 2001; 76: 350–357.
- 60Breitkopf DM, Frederickson RA, Snyder RR. Detection of benign endometrial masses by endometrial stripe measurement in premenopausal women. Obstet Gynecol. 2004; 104: 120–125.
- 61Togashi K, Nishimura K, Itoh K, et al. Adenomyosis: Diagnosis with MR imaging. Radiology. 1988; 166(1 Pt 1): 111–114.
- 62Exacoustos C, Brienza L, Di Giovanni A, et al. Adenomyosis: Three-dimensional sonographic findings of the junctional zone and correlation with histology. Ultrasound Obstet Gynecol. 2011; 37: 471–479.
- 63Luciano DE, Exacoustos C, Albrecht L, et al. Three-dimensional ultrasound in diagnosis of adenomyosis: Histologic correlation with ultrasound targeted biopsies of the uterus. J Minim Invasive Gynecol. 2013; 20: 803–810.
- 64Frank ML, Schafer SD, Mollers M, et al. Importance of transvaginal elastography in the diagnosis of uterine fibroids and adenomyosis. Ultraschall Med. 2016; 37: 373–378.
- 65Liu X, Ding D, Ren Y, Guo SW. Transvaginal elastosonography as an imaging technique for diagnosing adenomyosis. Reprod Sci. 2018; 25: 498–514.
- 66Mark AS, Hricak H, Heinrichs LW, et al. Adenomyosis and leiomyoma: Differential diagnosis with MR imaging. Radiology. 1987; 163: 527–529.
- 67Munro MG. Abnormal Uterine Bleeding. Cambridge: Cambridge University Press; 2010: 251.
- 68Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: Results regarding the degree of intramural extension. Obstet Gynecol. 1993; 82: 736–740.