Abstract:
Abnormal uterine bleeding (AUB) affects 30% of reproductive age women globally. How ever, there are limited local studies evaluating the management of these women. The diag nostic guideline using structural and functional causes of AUB adopts the PALM-COEIN
criteria, namely: Polyp; Adenomyosis; Leiomyoma; Malignancy and Hyperplasia; Coagulo pathy; Ovulatory dysfunction; Endometrial; Iatrogenic; and Not yet classified. This study
aimed to determine the clinical bleeding patterns, adherence to PALM-COEIN diagnosis
guidelines and management of AUB among women in their reproductive age. This was a
cross-sectional study among 108 women with AUB aged 18–45 years was conducted at the
gynaecology department of Moi Teaching and Referral Hospital in Western Kenya between
April 2018 and April 2019. Their sociodemographic and clinical characteristics were col lected using interviewer administered structured questionnaire and chart reviews. Adher ence to diagnosis recommendations was assessed using PALM COEIN classification.
Descriptive and inferential data analysis was conducted at 95% confidence interval. The
median age was 30 (IQR: 22, 41) years with prolonged bleeding as the most predominant
pattern at 41.7%. Bleeding patterns were significantly associated with age (p = 0.04). Only
16.7% were diagnosed as per the PALM-COEIN criteria with PALM and COEIN accounting
for 60% and 40% respectively. Leiomyoma (44.5%) was the common cause of AUB. Labo ratory evaluation included: pregnancy tests, full haemogram, hormonal profile and biopsy.
Most (79.6%) of the women had abdominopelvic ultrasound done. Medical management
was provided for 78.7% of women. Prolonged bleeding was the most common pattern with
medical management preferred. There is need for in-hospital algorithms to ensure adher ence to PALM-COEIN guidelines
