Which of the following is NOT a PALM cause of abnormal uterine bleeding (AUB)?

• A. Polyp
• B. Adenomyosis
• C. Coagulopathy
• D. Leiomyoma

Answer: (C)

Abnormal uterine bleeding is categorized using the PALM-COEIN framework. PALM covers structural causes inside the uterus: Polyp, Adenomyosis, Leiomyoma, and Malignancy or Hyperplasia. Coagulopathy is a non-structural issue—a systemic problem with blood clotting—not a lesion or architectural change in the uterus. That’s why it is not a PALM cause. The other options are all structural conditions that can alter the uterine lining or its mechanics and lead to AUB. Recognizing whether the bleeding stems from a PALM lesion versus a non-structural issue helps guide treatment: structural problems are often managed by targeted procedures or surgeries, while non-structural causes require systemic management of the underlying bleeding disorder.