Heavy Menstrual Bleeding, Improving Knowledge, Improving Lives

HMB Teaching and Resources Library

HMB Clinical Practice Guidelines per Country

NICE Guideline (UK)
National Institute for Health and Care Excellence


Heavy menstrual bleeding:

assessment and management 2018

ACOG Guideline (US)

American College of Obstetricians and Gynecologists


Management of Abnormal Uterine Bleeding Associated
With Ovulatory Dysfunction 2013

FSRH Guideline (UK)
Faculty of Sexual and Reproductive Healthcare 


FSRH Clinical Guidance: Intrauterine Contraception 
September 2019

CNGOF Guidelines (France)
Collège National des Gynécologues et Obstétriciens Français


Management of Abnormal Uterine
Bleeding before Menopause 2008

FEBRASGO Guideline (Brazil)
Federação Brasileira das Sociedades de Ginecologia e Obstetrícia


Orientações e recoMenDações Da
Febrasgo Sangramento Uterino anormal 2017

SOGC Guideline (Canada)
Society of Obstetricians and Gynaecologists of Canada


Abnormal uterine bleeding in
pre-menopausal women 2013


Women's attitudes towards heavy menstrual bleeding, and their impact on quality of life

Bitzer J, et al. Open Access J Contracept. 2013;4:21-28

Medical management of heavy menstrual bleeding: a comprehensive review of the literature

Bitzer J, et al. Obstet Gynecol Surv. 2015;70(2):115-130. 

Research and clinical management for women with abnormal uterine bleeding in the reproductive years: More than PALM-COEIN

Munro MG, et al. BJOG 2017;124:185–9

HELP Diagnostic Algorithm

PALM-COEIN Classification Infographic

Resources of HMB causes ordered by PALM-COEIN Classification

About the FIGO PALM-COEIN Classification

There is general inconsistency in the nomenclature used to describe abnormal uterine bleeding (AUB). The Menstrual Disorders Working Group was set up by the International Federation of Gynecology and Obstetrics (FIGO) to address these issues and to develop an agreed set of terms and definitions. The group developed a classification system – PALM-COEIN – which can be used to describe both structural and non-structural causes of AUB.


FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age

Munro MG, et al. Int J Gynaecol Obstet 2011;113:3–13

Select the letter to get to the respective resources of the cause you are interested in.

P – Polyps

Benign growths on the lining of the uterus

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A – Adenomyosis

A condition in which the endometrium grows into the myometrium

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L – Leiomyoma

Also known as fibroids, leiomyoma are benign fibromuscular tumours of the myometrium

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M – Malignancy and hyperplasia

The irregular proliferation of the endometrial glands

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C – Coagulopathy

Several disorders of hemostasis can affect blood coagulation

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O – Ovulatory dysfunction

Abnormal, irregular or absent ovulation

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E – Endometrial dysfunction

Can include alterations in local production of vasoconstrictors, plasminogen activators or prostaglandins

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I – Iatrogenic

Bleeding caused by medical interventions or devices

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N – Not otherwise classified

Bleeding caused by conditions that are rare or which have an undetermined relationship to abnormal uterine bleeding symptoms

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