Hysteroscopy for Abnormal Uterine Bleeding (Diagnostic, Polyps, Visually Guided Biopsy, Myomectomy)

Le résumé fourni par la source

Any change in menstrual volume, flow duration, rhythm, and frequency in premenopausal women falls within the definition of abnormal uterine bleeding (AUB) ( 1 ). Up to 30% of women of reproductive age experience at least one episode of AUB, and evidence shows that this can negatively impact their quality of life ( 2 ). The bleeding could be acute, requiring immediate intervention, or chronic, with changes in terms of quantity, regularity, and frequency, which can persist even for 6 months or more. Both acute and chronic AUB represent a significant cause of morbidity in premenopausal women, negatively impacting their quality of life ( 3 ). Traditionally, many terms were used to describe AUB, such as menorrhagia, metrorrhagia, intermenstrual bleeding, dysfunctional uterine bleeding, and polymenorrhagia, among others. However, such a variety of definitions and inconsistency of the nomenclature is now considered outdated and confusing. In order to provide a more standardized method of investigation and improve the accuracy of the diagnosis, new classification methods have been proposed over time. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) proposed the PALM-COEIN classification to standardize the diagnostic approach of AUBs and improve communicative effectiveness among specialists ( 4 – 6 ). The PALM-COEIN classification system highlights the possible etiologies of AUB in nongravid women of reproductive age. PALM-COEIN is an acronym for polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified. The first part of the acronym (PALM) encompasses structural entities that can be diagnosed using imaging/physical exam or histopathological confirmation. The second part (COEIN), on the contrary, defines nonstructural entities ( 7 ). In 2018, a revision of the 2011 PALM-COEIN classification was published ( 8 ) ( Table 27.1 ).

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