The document discusses a new proposed approach for managing abnormal uterine bleeding (AUB) that is not yet classified or explained (AUB-N). It summarizes the recent FIGO classification system for causes of AUB, which includes 9 categories - the first 4 being visible structural criteria (PALM) and the next 4 being non-structural issues (COEIN). The last category is for entities not yet classified (AUB-N). The author proposes adding uterine scar defect and molecular-level endometrial causes to this AUB-N group. A study found this group accounted for 40% of AUB cases. To manage AUB-N, the author's work tried bilateral transvaginal ligation of

1. Management of the Not Yet Classified and
Unexplained AUB a New, Proposed approach
07/03/2015
Management of the Not Yet
Classified and Unexplained AUB a
New Proposed Approach
Prof.Refaat AlSheemy
Al Azhar University
Abstract:Abnormal uterine bleeding(AUB) isthe commonest presentingsymptomin
gynecology andthe leadingindicationforhysterectomy.The recentFIGOClassificationof
Causeso AUB has been published inIJGO2011 withadvice of 40 expertsinthe fieldat2
international workshops. Itisdesignedtobe flexible andsuitable forregularrevisionto be
, which is published in the June issue of thenew systemTheapplicationclinicaladaptable for
International Journal of Gynecology & Obstetrics, should facilitate basic science and clinical
research, as well as the practical, rational, and consistent application of medical and surgical
irst,the fCOEIN)-system(PALMOf the 9 categoriesinthe new FIGOclassificationtreatments
4 are definedasvisuallyobjective structural criteria(PALM:polyp,adenomyosis,leiomyoma,
and malignancyandhyperplasia).The second4are unrelatedtostructural abnormalities
(COEI:coagulopathy,ovulatorydysfunction,endometrial,andiatrogenic),andthe final
categoryis forentitiesthatare not yetclassified(N.)
"There has beengeneral inconsistencyinthe nomenclature usedtodescribe ...AUBin
reproductive agedwomen,andthere isa plethoraof potential causes—severalof whichmay
coexistina givenindividual,".Incontrast to the PALMgroup,the COEIN group
(coagulopathy,ovulatorydysfunction,endometrial,iatrogenic,andnotyetclassified)
includesnonstructural entitiesthatare notdefinedonimagingorhistopathologytesting.
The "iatrogenic"categoryreferstoAUB associatedwiththe use of exogenousgonadal
steroids, intrauterinesystemsordevices,orothersystemicorlocal agents
The Not Yet Classified (AUB-N,),reserved for causes that till poorly identified or not well
examined such as uterine arteriovenous fistula and myometrial hypertrophy, our work in
this field proposed to add to this group bleeding as a result of C S scar defect and causes
that act on endometrial molecular level. In this study we found this group in 40% of cases
presented with AUB As the management of. (AUB-N,),is challenging ,we tried to treat this
group by bilateral transvaginal ligation of uterine artery(VBUAL)operation, a minimally
invasive,simple,easytodone andlearn,with apromising results .After 2 years of follow up
there is a good satisfaction in the part of studied group for preservation of the uterus and
fertility with unremarkable pregnancy outcome. The studies recommend VBUAL for all
unexplained cases of AUB, and can be performed in such –AUB-N group.

2. Management of the Not Yet Classified and
Unexplained AUB a New, Proposed approach
07/03/2015
To my dear colleagues who are interested in these issues you can enter my site in Google,
and YouTube just write Refaat Alsheemy.,Also it is written and published in the American
Science Journal 2014 &2015)