FIGO System 1, System 2 and Matrix

FIGO Updates
FIGO-AUB system 1
Revision of terminologies and definitions of symptoms of
abnormal uterine bleeding
 FIGO-AUB system 2
PALM-COIEN classification of causes of
AUB

Munro MG, Critchley HO, Fraser I, FIGO Menstrual Disorders Committee. The Two FIGO Systems for Normal and Abnormal
Uterine Bleeding Symptoms and Classification of Causes of Abnormal Uterine Bleeding in the Reproductive Years: 2018 Revision
Int J Gynaecol Obstet. 2018 Dec;143(3):393-408. doi: 10.1002/ijgo.12666. Epub 2018 Oct 10
FIGO AUB system 2 diagnostic matrix
Examples of the
use of a matrix to
guide FIGO based
evaluation of
patients with
chronic AUB.
Diagnostic Approach
History, Physical Examination, and Laboratory
1. Medical History

• Menstrual history:
• frequency, duration, and amount of bleeding

• inquire whether and when the menstrual pattern changed.

• 6 months are considered chronic

• Describe the menstrual abnormality

• Menstrual calendar
• Social history

• Family history

• Past medical history

• Sexual history
• contraception and condom use
• number of partners
• history of sexually transmitted infections or current symptoms (eg, vaginal
discharge, pelvic pain);
• previous pregnancy or abortion
• history of sexual abuse or assault
• Complete physical examination strongly advised on all patients to
identify any structural pathology or systemic disease as the etiology
for AUB
Laboratory Tests
• Pregnancy should be excluded in women of reproductive age

• An initial CBC with platelet count, PT, PTT are indicated for all
adolescents with acute AUB including adult patients with positive
screening history for bleeding disorder
• Coagulation tests should be considered in women with AUB since
menarch, and/or have personal or family history suggestive of
coagulopathy
• Chlamydia trachomatis and Neisseria Gonorrhea

• Female hormone testing (E2, progesterone, LH, FSH) should not be

routinely done on women with AUB

• Thyroid screening should only be obtained in the presence of signs

and/or symptoms of thyroid disease
Imaging Procedures

A B

• Ultrasound is the first line diagnostic tool for identifying

structural abnormalities
• Saline infusion sonography is a useful tool in providing a more
accurate evaluation of the uterus with intracavitary lesions
Diagnosis: Others

A B C

• Hysteroscopy should be performed when the ultrasound results are

inconclusive or when focal lesions are seen within the endometrium
Biopsy
• The following are indications for endometrial biopsy
• Age >45
• Risk factors for endometrial cancer
• Failure of medical treatment
• Breast cancer patient on tamoxifen with AUB