Prevalence and Clinical Spectrum of Abnormal Uterine Bleeding in Reproductive-Age and Perimenopausal Women: A cross-sectional study from a tertiary care centre in South India

Abstract

Background:  Abnormal uterine bleeding (AUB) occurs in 1030 percent of women during their fertility and is the least cause of gynecological inpatient worldwide reproductive years and has significant effects on the quality of life and health-care use. FIGO PALM-COEIN system offers an acceptable structure to categorize AUB etiologies and manage them.  The purpose of this study was to define the occurrence rates of abnormal menstrual cycles and the prevalence rates of PALM-COEIN categories in women of reproductive age and perimenopausal women presenting with AUB.

Methods: The study was a cross-sectional study based in a hospital (Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute) in July-December 2025. Women aged 15 years old through non-pregnancy-related AUB were recruited consecutively (n=200) at the ages of 15 to 55 years. A structured proforma was used to take sociodemographic information, menstrual history, examination, laboratory tests, ultrasonography, and endometrial sample where necessary. Figure 1 FIGO AUB System 1 was used to classify menstrual patterns, and PALM-COEIN (System 2) was used to designate etiologies. The use of descriptive statistics and chi-square tests were used.

Results:  One hundred and twenty women (60) out of 200 (100) women were of reproductive age and 80 (40) were perimenopausal. The most common pattern was that of heavy menstrual bleeding (48%), prolonged bleeding (16%), intermenstrual bleeding (11%), frequent-cycle (10%), infrequent-cycle (9%), and a considerably abnormal cycle (6%). Out of the 52 percent in the structural causes (PALM), the leading causes were leiomyoma (20 percent), polyps (12 percent), adenomyosis (11 percent), and malignancy/hyperplasia (9 percent). Non-structural causes of COEIN included 48 percent, mostly ovulatory dysfunction (19 percent) and endometrial (12 percent) causes. Perimenopausal women were found to have structural etiologies that was much higher than ovulatory dysfunction that was more common in women of reproductive age (23 v 13; p=0.04).