Which statement correctly describes the PALM-COEIN framework?

• A. PALM refers to structural etiologies, COEIN to non-structural etiologies
• B. PALM and COEIN are both structural
• C. PALM-COEIN only applies to postmenopausal bleeding
• D. PALM-COEIN excludes malignancy

Answer: (A)

The main idea is that abnormal uterine bleeding is categorized by whether there is a discrete structural lesion. PALM covers structural etiologies such as polyps, adenomyosis, leiomyomas (fibroids), and malignancy or hyperplasia. COEIN covers non-structural etiologies, including coagulopathy, ovulatory dysfunction, endometrial factors not forming a discrete lesion, iatrogenic causes, and conditions not yet classified. Therefore, saying that PALM refers to structural etiologies and COEIN to non-structural etiologies is correct. It’s also important to remember that malignancy is included under PALM, not excluded, and the framework applies to abnormal uterine bleeding beyond just postmenopausal cases.