Volume 143, Issue 3 p. 393-408
FIGO SPECIAL ARTICLE

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

Malcolm G. Munro

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]

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Hilary O.D. Critchley

Hilary O.D. Critchley

MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK

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Ian S. Fraser

Ian S. Fraser

School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia

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for the FIGO Menstrual Disorders Committee

the FIGO Menstrual Disorders Committee

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First published: 10 September 2018
Citations: 540
Participating Members of the FIGO Menstrual Disorders Committee, 2015–2018 are listed at the end of the paper.

Abstract

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.