In FIGO recognized two systems designed to aid research, education, and clinical care of women with abnormal uterine bleeding AUB in the reproductive years. This page is a summary of the systems and their use in contemporary gynecology. FIGO System 1. The system for definition and nomenclature of normal and abnormal uterine bleeding AUB in the reproductive years. Abnormal uterine bleeding AUB in the reproductive years, unrelated to pregnancy, is rarely life-threatening, but is frequently life altering. The symptoms frequently interfere with quality of life and those girls and women afflicted with chronic AUB spend significant amounts of personal resources on menstrual products and medications.
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In FIGO recognized two systems designed to aid research, education, and clinical care of women with abnormal uterine bleeding AUB in the reproductive years.
This page is a summary of the systems and their use in contemporary gynecology. FIGO System 1. The system for definition and nomenclature of normal and abnormal uterine bleeding AUB in the reproductive years. Abnormal uterine bleeding AUB in the reproductive years, unrelated to pregnancy, is rarely life-threatening, but is frequently life altering. The symptoms frequently interfere with quality of life and those girls and women afflicted with chronic AUB spend significant amounts of personal resources on menstrual products and medications.
Such women are 30 per cent less productive at work, and, consequently, suffer a similar reduction in income. The problem of AUB burdens the economy, employers, as well as women and their families. With the massive worldwide impact of both acute and chronic AUB, the relevance of safe and effective clinical care cannot be overestimated.
Although common sense interventions such as iron therapy are often underused in developed countries and frequently unavailable in developing nations, these and related therapies deal with reducing the consequences HMB the symptom, not the cause itself. Abnormal uterine bleeding in the reproductive years comprises a complex set of disorders that include abnormalities in endocrine, endometrial and hemostatic function and a number of structural anomalies that include polyps, adenomyosis and leiomyomas or fibroids.
Determination of the causes of AUB in the reproductive years remains a major challenge for investigators, clinicians and educators. Investigators have to conceive and then execute relevant bench and clinical investigation; clinicians must deal with the patient in their office or hospital and educators of medical students and postgraduate trainees such as residents and fellows are encumbered with the task of providing a mechanism for understanding AUB that facilitates proper investigation and therapy.
For a number of investigators and educators, it became apparent that there were at least two major impediments to dealing with these challenges. The first was a disjointed collection of poorly defined and inconsistently used terms and definitions that undermined effective communication among investigators, clinicians and trainees alike. These circumstances lead to difficulties with the interpretation of both basic science research and clinical trials as since specimens and patients could be "contaminated" with potential confounders.
As a result, in order to obtain clearly informative basic science as well as translational and clinical investigation, a comprehensive approach to both investigation and categorization was needed. Starting in , a group of experts that comprised those from the FDA, related professional societies and gynecologic medical journals, and representatives from the basic, translational, and clinical sciences were assembled to tackle the issues in a systematic fashion.
The results allowed for a collective recognition of the disparity and inconsistency in definitions and terminology a circumstance that was a surprise to many. The result of this process was a near unanimous decision to create a new set of descriptive and unambiguous terms that could be translated into a wide spectrum of languages.
Coagulopathies require confirmation by laboratory testing, while, at least for the present, ovulatory and endometrial disorders are primarily, and at least clinically, defined by a structured history. Irregular ovulation or anovulation can be supported by a number of laboratory and histopathological assessments, not typically applied in clinical settings. It is recognized that each of the major categories may include subgroups that are known or suspected to have clinical relevance.
Added was a category for submucous myomas that make contact with the endometrium but do not distort the endometrial cavity Type 3 , and subclassification for intramural leiomyomas and the various types of subserous myomas.
American Journal of Obstetrics and Gynecology. Value in Health. International Journal of Gynaecology and Obstetrics. Fertility and Sterility.
FIGO’s New Classification of Causes of Abnormal Uterine Bleeding Benefits Patients
Until now, there has been no universally accepted method for classifying such patients, which has impeded basic science and clinical investigation, as well as the practical, rational, and consistent application of medical and surgical therapy. As the result of a stringent 5-year review process, a multinational group of clinician—investigators with broad experience in the investigation of AUB has now agreed on a classification system to facilitate multi-institutional investigation into the epidemiology, etiology, and treatment of women with acute and chronic AUB. Another requirement is the development of a classification system for the causes of AUB, which can be used by clinicians, investigators, and even patients themselves to facilitate communication, clinical care, and research. The basic system comprises 9 categories: The first 4 are defined by visually objective structural criteria PALM: polyp; adenomyosis; leiomyoma; and malignancy and hyperplasia ; a second 4 that are unrelated to structural anomalies COEI: coagulopathy; ovulatory dysfunction; endometrial; and iatrogenic , and a final category reserved for entities that are not yet classified N. A draft system was developed and revised, distributed for comments, and then discussed at a face-to-face meeting held in association with the FIGO World Congress in Cape Town, South Africa. The process was systematically designed to create a practical system that could be used by clinicians in most countries worldwide to classify patients with AUB readily and consistently.
FIGO classification of the causes of AUB
FIGO Committee for Menstrual Disorders