Since there are so many causes of abnormal menstrual bleeding, your doctor will use a framework called “PALM-COEIN” to help determine the cause of your HMB. PALM-COEIN stands for polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not-yet-classified. More than one of the causes of HMB can be present at a time.

Glossary of PALM-COEIN terms

  • Polyp – an abnormal but benign growth of tissue
  • Adenomyosis – a condition where the type of cells that normally line the uterus are found in the muscle layer of the uterus
  • Leiomyoma – a fibroid; a benign growth in the muscle of the uterus
  • Malignancy – a cancerous growth
  • Coagulopathy – a problem with blood clotting
  • Ovulatory dysfunction – problems with the regular cycle that leads to the release of an egg from the ovary
  • Endometrial – conditions that affect the inner lining of the uterus (the endometrium), such as endometriosis
  • Iatrogenic – caused by medical procedure or treatment
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