Regarding the pathophysiology and management of abnormal uterine bleeding (AUB) in reproductive-age women, all of the following are recognized causes of AUB according to the FIGO classification EXCEPT:

Explanation

## FIGO Classification of Abnormal Uterine Bleeding The FIGO classification (2011, revised 2018) categorizes causes of AUB using the acronym **PALM-COEIN**: ### PALM (Structural) - **P**olyps - **A**denomyosis - **L**eiomyoma (fibroids) - **M**alignancy ### COEIN (Non-structural) - **C**oagulopathy - **O**vulatory dysfunction - **E**ndometrial (e.g., endometritis) - **I**atrogenic (e.g., hormonal contraceptives, anticoagulants) - **N**ot yet classified ### Key Point: **Uterine artery embolization (UAE) is a *treatment* for AUB (particularly fibroid-related bleeding), NOT a *cause* of AUB.** It is an interventional radiological procedure used to reduce blood flow to fibroids or adenomyotic tissue, thereby decreasing menstrual bleeding. It is not part of the FIGO classification of causes. ### High-Yield: The three distractors are all legitimate FIGO-classified causes: - **Coagulopathy** → COEIN (C) - **Adenomyosis** → PALM (A) - **PCOS** → COEIN (O) — anovulation and irregular cycles ### Clinical Pearl: When taking a history in a patient with AUB, always ask about: - Family history of bleeding disorders (coagulopathy) - Regularity of cycles (anovulation in PCOS) - Severity and duration of bleeding (adenomyosis vs. fibroids) ### Warning: Do not confuse *treatment modalities* (UAE, hysterectomy, ablation) with *causes* of AUB. The FIGO classification addresses etiology, not management.