Causes of Abnormal Uterine Bleeding


Non-pregnant bleeding that is inegular in timing, frequency, or flow 


Mnemonic: PALM-COEIN 

STRUCTURAL CAUSES 
Polyps 
 - Endometrial 
 - Cervical

Adenomyosis 
 - Painful heavy periods in women 30s-40s 

Leiomyoma 
 - Increase in size in pregnancy or with OCPs 

Malignancy / hyperplasia 
 - Consider in all peri- and postmenopausal women

NON-STRUCTURAL CAUSES 
Coagulopathy 
 - Undiagnosed coagulopathy in adolescents 
 - Acquired (anticoagulants, cirrhosis) 

Ovulatory dysfunction 
 - Adolescents 
 - Perimenopause 
 - PCOS 
 - Hypothyroidism 
 - Anorexia 
 - Athletes 

Endometrial causes 
 - Diagnosis of exclusion 

Iatrogenic 
 - Hormonal contraceptive use 
 - Hormone replacement therapy 
 - Post-GYN surgery 

Not otherwise classified 
 - Endometritis 
 - Cervical erosions, cervicitis 
 - Vaginal trauma 
 - Foreign bodies 

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