Abnormal uterine bleeding is not one problem, it is nine — and the letter you land on tells you what to look for next. Light up clues and watch PALM-COEIN sort itself. Then quantify a real bleed into a priority sequence and an iron plan, and finish by deciding who needs a progestin, who needs a biopsy, and who must never receive oestrogen at all.
Turn on every clue this patient actually has
Why bother with a mnemonic? PALM-COEIN is not trivia. The letter you land on decides your next move — a coagulation panel, a thyroid and androgen workup, a medication review, a sonogram, or a biopsy. Naming the category is how you stop treating “heavy periods” as one undifferentiated complaint.
Quantify the bleeding — “heavy” is useless
Saturated pads or tampons per hour1
Saturating a pad every hour for two or more hours is an acute bleed
Hours she has bled at that rate4hr
0 — 12 hours
The numbers
Heart rate104/min
Tachycardia is the earliest vital-sign change in blood loss
Haemoglobin8.4g/dL
Female reference 12–16 g/dL
Ferritin9ng/mL
Iron deficiency below roughly 30 ng/mL
Who is she
What is being considered or reported
Endometrial stripe on transvaginal ultrasound6mm
Greater than 4 mm with postmenopausal bleeding requires biopsy