Abnormalities
How bleeding itself is described
2 min read
FIGO System 1 describes bleeding along four independent axes — frequency, duration, regularity and volume — plus bleeding that occurs outside the period altogether. The point of separating them is that a woman can be abnormal on one axis and entirely normal on the other three, and the combination narrows the cause considerably.
| Axis | Normal | Abnormal — current term |
|---|---|---|
| Frequency | 24–38 days | Under 24 days: frequent menstrual bleeding Over 38 days: infrequent menstrual bleeding No bleeding for 6 months: amenorrhea |
| Duration | 8 days or fewer | Over 8 days: prolonged menstrual bleeding |
| Regularity | Shortest to longest cycle varies by 7 days or less (ages 26–41), or 9 days or less (ages 18–25 and 42–45) | Greater variation: irregular menstrual bleeding |
| Volume | Not excessive by the patient's own judgment | Heavy menstrual bleeding · light menstrual bleeding |
| Outside the period | None | Intermenstrual bleeding (cyclic or random) · postcoital bleeding · unscheduled bleeding on hormonal therapy · postmenopausal bleeding |
FIGO System 1: Munro MG, Critchley HOD, Fraser IS. Int J Gynaecol Obstet. 2018;143(3):393–408.
Words that were retired
FIGO deliberately abandoned a set of terms because they were used inconsistently, often meant different things to different clinicians, and mixed description with implied cause. If you have been given one of these, it is not wrong — it is simply no longer the standard.
| Retired term | What it used to mean | Say instead |
|---|---|---|
| Menorrhagia | Heavy or prolonged periods, variously defined | Heavy menstrual bleeding, and/or prolonged menstrual bleeding — stated separately |
| Metrorrhagia | Bleeding between periods | Intermenstrual bleeding |
| Menometrorrhagia | Both of the above at once | Name each finding on its own axis |
| Polymenorrhea | Cycles that come too often | Frequent menstrual bleeding |
| Oligomenorrhea | Cycles that come too seldom | Infrequent menstrual bleeding — note the term persists in endocrine and PCOS literature |
| Dysfunctional uterine bleeding (DUB) | Abnormal bleeding with no structural cause found | Nothing — the concept is replaced by naming the actual PALM-COEIN category, usually AUB-O, AUB-E or AUB-C |
Terminology retirement per FIGO Systems 1 and 2: Munro MG, et al. Int J Gynaecol Obstet. 2018;143(3):393–408; Jain V, Munro MG, Critchley HOD. Int J Gynecol Obstet. 2023;162(Suppl 2):29–42.
Why this matters to you. "Menorrhagia" told a doctor that something was too much, but not whether it was volume or duration, and not why. The newer terms force each part of the problem to be stated separately — which is what makes it possible to work out the cause instead of just treating the bleeding.
Why this matters clinically. The retired vocabulary conflated symptom axes and, in the case of DUB, encoded a diagnosis of exclusion that was never operationalised. System 1 forces axis-specific description; System 2 then assigns cause. A patient may carry several System 1 descriptors and more than one PALM-COEIN category simultaneously, and the notation accommodates that.