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Metrorrhagia.com

Lesson 4

Modern terminology: FIGO and abnormal uterine bleeding

Why your placement says "intermenstrual bleeding" when your textbook says "metrorrhagia".

By the Metrorrhagia.com editorial teamUpdated Medical review pending
Illustration of a large magnifying glass over charts and category tiles, representing classification.

Educational content for students. Not medical or coding advice. Having symptoms? See the patient guide.

On this page
  1. The problem with the old words
  2. FIGO System 1: describing the bleeding
  3. FIGO System 2: classifying the cause
  4. Old term → new term
  5. Sources

If your textbook teaches "metrorrhagia" but your clinical placement says "intermenstrual bleeding," here's why.

The problem with the old words

Terms such as menorrhagia, metrorrhagia and dysfunctional uterine bleeding were used inconsistently around the world, which made research and communication confusing [FIGO 2011] [Frontiers 2022]. FIGO (the International Federation of Gynecology and Obstetrics) therefore recommended replacing them with plain descriptive terms. Its 2018 revision discards menorrhagia, metrorrhagia and dysfunctional uterine bleeding [FIGO 2018].

Illustrative bleeding patterns over three cycles: a typical cycle, menorrhagia with heavier or longer periods on time, metrorrhagia with extra bleeding between periods, and menometrorrhagia with heavy, irregular bleeding.
Timing versus amount: the core difference between the three terms. Illustrative, not to scale.

FIGO System 1: describing the bleeding

Bleeding is described on four parameters, plus intermenstrual bleeding [FIGO 2018]:

ParameterNormal (FIGO 2018)Abnormal descriptors
Frequency24–38 daysAbsent (amenorrhea), infrequent (>38 days), frequent (<24 days)
DurationUp to 8 daysProlonged (>8 days)
RegularityShortest to longest cycle varies by ≤7–9 days (depending on age)Irregular
VolumeNormal for the patientHeavy or light
Intermenstrual bleedingNoneRandom or cyclical (predictable early, mid or late cycle)
PALM-COEIN classification chart: structural causes polyp, adenomyosis, leiomyoma, malignancy and hyperplasia; non-structural causes coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and not otherwise classified.
FIGO's PALM-COEIN system (as updated in 2018) for abnormal uterine bleeding in non-pregnant patients of reproductive age.

FIGO System 2: classifying the cause

Causes are grouped with the acronym PALM-COEIN [FIGO] [StatPearls]. See causes.

Old term → new term

TraditionalFIGO-style description
MetrorrhagiaIntermenstrual bleeding (IMB), or irregular bleeding
MenorrhagiaHeavy menstrual bleeding (HMB)
MenometrorrhagiaHMB with irregular / intermenstrual bleeding
PolymenorrheaFrequent menstrual bleeding
OligomenorrheaInfrequent menstrual bleeding
Dysfunctional uterine bleedingAUB with a specific PALM-COEIN cause (for example AUB-O, ovulatory dysfunction)
Why coders still need the old word

ICD-10-CM still uses the traditional words as inclusion terms (for example "Metrorrhagia" under N92.1) [ICD-10-CM]. Coders need to recognise both vocabularies.

Sources

  1. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding Fraser IS et al., Semin Reprod Med 2011 (PubMed 22065325)
  2. Historical Perspectives and Evolution of Menstrual Terminology Frontiers in Reproductive Health, 2022
  3. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of AUB in the reproductive years: 2018 revisions Munro MG et al., Int J Gynecol Obstet 2018
  4. Abnormal Uterine Bleeding StatPearls, NCBI Bookshelf (NBK532913)
  5. ICD-10-CM N92 Excessive, frequent and irregular menstruation (N92.0–N92.6) ICD10Data.com, FY2027 code set

We link to primary medical sources so you can check our work. See the editorial policy and the full reference list.