2022-11-21

Blood clots during menstruation

Blood Clots Heavy Menstruation: Causes & Recommendations

Blood clots during menstruation can be normal. The amount, duration and frequency of menstrual bleeding varies from month to month and from person to person.

However, large blood clots can be a sign that something is wrong. If your period seems heavier than usual - for example you bleed with very large blood clots - see your doctor.

What are blood clots during menstruation?

Blood clots are a natural element by which the body defends itself. The thick, jelly-like texture of a menstrual clot helps prevent too much blood from leaking.

Clots occur due to the same blood clotting function that occurs anywhere else in the body when there is a tissue injury, such as a cut or laceration.

Menstrual clots are generally present when the flow is heavy. They are more common in the first 2 days of menstruation. They can be bright in color or they can be a darker, more intense red. Larger clots may appear black. Menstrual blood begins to appear darker, brown, toward the end of each period because the blood is older and leaves the body more slowly.

blood clots during menstruation ➤ Causes of menstruation with clots ➤ Complications & Risk Factors ➤ Learn more!

Blood clots during menstruation - How do they form?

Clots occur when the lining of the uterus sheds increased amounts of blood. When blood builds up in the uterus or vagina (discussed in detail in our All About Vagina article), it begins to clot , just like an open skin wound. The consistency of menstrual blood varies both during menstruation and from one menstrual cycle to another. You may experience a heavy flow containing menstrual clots one month and a lighter, clot-free flow the following month. This variation is natural. Changes due to diet and lifestyle factors may also occur.

Normal blood clots vs. abnormal menstruation

If the clots are small and occur occasionally, there is usually nothing to worry about. Unlike clots in veins, menstrual clots themselves are not dangerous.

Normal clots:

they are smaller than a coin
they appear only occasionally, usually towards the beginning of the menstrual cycle
they are bright or dark red in color

Regular occurrence of large clots during menstruation could signal a medical condition that requires investigation, especially if they occur frequently, month after month.

Large blood clots during menstruation

Menstruation is different for every woman, and occasionally passing a blood clot during menstruation is normal. HERE we have told everything there is to know about the menstrual cycle and the symptoms of menstruation.

But when the clots become very large and the bleeding is profuse, it can be a sign of more serious conditions. The most common causes are:

Uterine fibroids. Clots can be caused by many types of fibroids that affect bleeding, but the most common is a fibroid growing inside the uterine cavity (submucous fibroid).
Contraceptive method used. It's not just birth control pills that can affect the menstrual cycle. Even a non-hormonal intrauterine device can cause large clots and heavier bleeding than usual.
Miscarriage. A miscarriage in the early stages of a pregnancy or in the case of an ectopic pregnancy can be manifested by heavy blood loss that can be mistaken for a huge clot.
Endometriosis. In addition to severe cramping and abdominal pain, large clots can be another sign of endometriosis.
Polycystic ovary syndrome. It is a common cause of hormonal imbalances and irregular menstrual bleeding accompanied by large clots.
Other chronic diseases. Von Willebrand disease, sexually transmitted diseases, and pelvic inflammatory disease are two other possible causes.

Heavy menstruation with clots

Heavy menstruation is when the body sheds menstrual blood either in very large amounts or over a long period of time.

For example, the need to change the tampon or absorbent every 1-2 hours or the need to simultaneously use two different types of menstrual protection (eg: tampon + absorbent) can indicate heavy menstruation. And a period with clots that lasts more than 7 days can be considered heavy.

If they have always been like this and are not accompanied by worrisome symptoms such as ovarian pain , abdominal cramps or fever, they may simply be normal. But when it affects your daily life or when these changes occur suddenly, the symptoms should be reported to the doctor in order to find a suitable treatment.

Menstruation with pieces of membrane

Normally, the body removes small particles of tissue, blood and secretions through menstrual blood.

A rarer situation is decidual bleeding, or membranous dysmenorrhea, when the uterine lining stops breaking down to be gradually eliminated. This is expelled in one large piece, keeping the shape of the uterus. It contains endometrium, blood and secretions, and is characterized by:

Palm size
The shape of an inverted triangle, similar to the uterus
Appearance like a lump of red meat, or larger versions of menstrual blood clots

It is a very rare phenomenon, mentioned less than 25 times in the specialized literature. Observations so far do not indicate that decidual bleeding is masking other health problems. The pain usually goes away shortly after the endometrium is removed.

Menstrual clots with skin

Menstruation is made up of lots of different tissues, dead cells and clotted blood. So the presence of some decomposed particles from the uterine tissue can be visible in the form of blood clots in the cycle with skins and gelatinous fragments.

These "skin" in the menstrual blood are most often normal, do not constitute a cause for concern and do not require medical attention. But they should be brought to the attention of a specialist if they are accompanied by other symptoms.

An unusual consistency of menstruation, changes in flow or the presence of severe pelvic pain can indicate conditions such as endometriosis or certain infections in the reproductive system.

When is it recommended to go to the doctor?

See your doctor if you have heavy menstrual bleeding or larger than normal clots. Menstrual bleeding is considered heavy if the tampon or pad needs to be changed every two hours or less throughout the day.

blood clots during menstruation ➤ Causes of menstruation with clots ➤ Complications & Risk Factors ➤ Learn more!

Not all bleeding during pregnancy is a cause for concern. They can be normal, and we have prepared another article where we tell all about bleeding in pregnancy . Clots, on the other hand, can be a sign of a miscarriage and it is absolutely necessary to consult a doctor urgently.

Causes - Why do blood clots form during menstruation?

Most women of childbearing age shed their uterine lining every 28 to 35 days. This is also called the endometrium. When this is removed, it is mixed with:

blood
blood byproducts
mucus
woven

This mixture is then expelled from the uterus through the cervix and out of the vagina. As the endometrium is shed, it accumulates at the bottom of the uterus, waiting for the cervix to contract to expel its contents. To help break down this thickened blood and tissue, the body releases anticoagulants to thin the material and allow it to pass more freely. When the blood flow exceeds the body's ability to produce anticoagulants, menstrual clots occur and are eliminated during menstruation.

Physical and hormonal factors can affect the menstrual cycle and create heavy flow. Heavy flows increase the chances of developing menstrual clots.

blood clots during menstruation ➤ Causes of menstruation with clots ➤ Complications & Risk Factors ➤ Learn more!

Hormonal disorders

In order to develop and thicken properly, the lining of the uterus relies on a hormonal balance of estrogen and progesterone. If there is too much or too little of one or the other, you could have heavy menstrual bleeding.

A hormonal imbalance can be caused by:

perimenopause
menopause
stress
significant weight gain or loss

The main symptom of a hormonal imbalance is irregular menstruation. For example, it may come later, earlier, be longer, or skip a month entirely. On the Enroush blog, we talked more about the symptoms and types of hormonal disorders HERE .

ENDOMETRIOSIS

Endometriosis is a condition in which cells that resemble the lining of the uterus, called endometrial cells, grow outside the uterus and in the reproductive tract. Around the menstrual period, this condition can cause a number of unpleasant symptoms including painful, heavy bleeding that may include blood clots.
The exact cause of endometriosis is unknown, although heredity, hormones and previous pelvic surgery are thought to play a role. Learn more about endometriosis on our blog !

Fibroids or polyps

Uterine fibroids and polyps are usually noncancerous muscle tumors that grow in the uterine wall. In addition to heavy menstrual bleeding, they can also cause irregular periods, leading to blood clots.

Enlarged uterus

After pregnancy, a person's uterus often remains somewhat larger than it was before. An enlarged uterus can also be due to structural problems such as fibroids. This change creates extra space for blood to pool, which could lead to extra clotting and menstrual clots.

Uterine myoma (uterine fibroid)

Uterine polyps and fibroids affect about 70% of women and can often cause heavy periods with clots. Even if they are not cancerous, they can prevent normal contractions of the uterus. When the uterus does not contract properly, the blood is not removed as easily, but more slowly, which is why it may clot during this time.

Uterine fibroids that develop in the muscle tissue on the wall of the uterus can also cause other symptoms. These include persistent lower back pain, spotting, dyspareunia (pain during intercourse), bloating and fertility problems.

Loss of pregnancy

During a miscarriage or pregnancy loss, a person will usually pass a number of large clots, depending on the stage of the pregnancy. Pregnancy loss can sometimes occur before a person knows she is pregnant, so she may mistake an early miscarriage for a regular menstrual cycle.

Cancer

Although rare, cancerous tumors of the uterus and cervix can lead to heavy menstrual bleeding and large clots.

Adenomyosis

Adenomyosis occurs when the lining of the uterus, for unknown reasons, grows into the uterine wall. This causes the uterus to enlarge and thicken. In addition to prolonged and heavy bleeding, this common condition can cause the uterus to grow two to three times its normal size. Menstrual clots are often encountered in people suffering from this condition.

Blood coagulation disorders

Some blood disorders can be responsible for heavy menstrual flow because they can affect the clotting proteins that the lining of the uterus needs to stop menstrual bleeding. Conditions such as platelet dysfunction or von Willebrand disease (VWD) can cause abnormal, heavy periods with blood clots.

Iron deficiency, correlated with iron deficiency anemia, vitamins and minerals

Deficiencies of certain vitamins and minerals, especially iron deficiency, can lead to the formation of blood clots during menstruation.

Iron deficiency is the main cause of anemia, i.e. iron-deficiency anemia, and can affect the body's natural blood clotting process. This type of anemia can also cause menorrhagia, meaning heavy bleeding over long periods of time.

Women in this situation are often recommended an iron-based dietary supplement to replenish the body's stores. Other vitamins that contribute to the formation of red blood cells are vitamin C, folic acid and vitamin B12. The doctor may also recommend taking multivitamins if there are multiple deficiencies.

Von Willebrand's disease

Von Willebrand disease is an inherited and rare blood disorder. Von Willebrand factor deficiency is at the root of this problem, as the factor plays a very important role in clotting and how a blood clot forms. So unusual bleeding is the main symptom of this disease.

The condition can be easily identified after heavy blood loss from even minor injuries.

About 50% of women with von Willebrand disease pass blood clots during menstruation. Bleeding has an abundant flow, and it is necessary to change the tampon or absorbent once every 1-2 hours. It is one of the few conditions that can cause large blood clots during menstruation, measuring more than 2.5 cm.

Polycystic ovary syndrome

Clots can occur with menstruation and in women with polycystic ovary syndrome (PCOS). In addition to the reproductive system, PCOS also affects the metabolic and vascular systems. A common symptom is heavy bleeding that occurs because the follicles in the ovaries do not produce eggs regularly.

When this happens, the body cannot produce anticoagulants at a fast enough rate to keep up with such a large amount of blood and prevent clotting. Because of this, large blood clots can be removed during menstruation.

Irregular menstruation accompanied by severe pain is another common symptom of polycystic ovary syndrome.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the upper genital tract that generally begins in the vagina and ascends to the uterus, fallopian tubes, and ovaries. It can certainly affect a woman's periods, and the inflammation can be accompanied by pain, fever, and abnormal vaginal discharge. We discussed HERE more about the causes of vaginal secretions and their types.

BIP can also be responsible for unusual bleeding and periods with black blood clots. It is important to talk to a specialist as soon as possible if you notice black clots that persist or if they are accompanied by other symptoms associated with health problems.

Adverse reactions to the administration of certain drugs and hormonal therapies

When a person notices that they are having periods with very large clots, it is important to investigate any recent medications or long-term treatments. It is possible that the body has an adverse reaction and it is necessary to stop the treatment or change the medication.

Estrogen- and progestin-based hormone treatments, anti-inflammatory drugs, and anticoagulants are just some of the factors that can affect menstrual flow and regular bleeding. Menstruation can also be affected by thyroid medication and chemotherapy used to treat cancer. All adverse effects must be discussed urgently with the specialist doctor.

Diagnostic

To determine the underlying cause of menstrual clots, your gynecologist will ask you a series of questions about the factors that influence your period. For example, they may ask if you've had previous pelvic surgery, if you've used birth control, or if you've ever been pregnant. They will also examine the uterus for potential abnormalities.

In addition, the specialist doctor may recommend blood tests to look for hormonal imbalances. Imaging tests, such as MRIs or ultrasounds, may be used to check for fibroids, endometriosis, or other obstructions.

Treatment for blood clots during menstruation

Depending on the underlying cause of the blood clots, the specialist doctor can recommend a series of treatments, whether surgical, medicinal or hormonal.

blood clots during menstruation ➤ Causes of menstruation with clots ➤ Complications & Risk Factors ➤ Learn more!

Surgical treatment

Sometimes you may need surgery to treat heavy blood clots during your period.

A dilation and curettage procedure (D and C) may also be used to determine the underlying cause of heavy menstrual bleeding or as a treatment for various conditions. This involves dilating the cervix and scraping the uterine lining. It is usually done in an outpatient setting under sedation. While this won't cure the heavy bleeding permanently, it will give a few months of respite until the lining thickens again.

For women with uterine growths, such as fibroids, that do not respond well to drug treatment, surgery may be necessary to remove them. The type of surgery will depend on the size and location of the growths. Myomectomy is used for large uterine fibroids and polyps. It involves making a large incision in the abdomen to access the uterus.

If the growth is small, laparoscopic surgery is often possible. Laparoscopy uses small incisions in the abdomen that can speed healing time. Some women may choose to have their uterus removed. This is called a hysterectomy.

Drug treatment

Doctors may recommend taking NSAIDs during menstruation to help reduce symptoms such as cramping, pain, and discomfort. They can also help with excessive bleeding.

People who prefer not to use hormone treatments may want to try medications that control blood clotting. The most commonly recommended drug of this type is tranexamic acid.

Hormonal therapy

Hormonal contraceptives can inhibit the growth of the uterine lining. A hormone-releasing intrauterine device can reduce menstrual blood flow by 90%, and birth control pills can reduce it by 50%. Hormonal contraceptives can also be beneficial in slowing the growth of fibroids and other uterine adhesions. Learn more about IUDs and birth control pills on our blog.

Treatment and prevention alternatives

A cycle with small, occasional clots is not worrisome and does not require treatment. It is normal for the body to sometimes expel menstrual blood with a jelly-like consistency, especially if it has been in the body for a long time.

Some useful recommendations to prevent the formation of these clots are:

Hydration through sufficient fluid consumption
Ensuring the necessary daily intake of vitamins and minerals, especially iron, vitamin C, vitamin D and vitamin B12
An active lifestyle and regular exercise
Limiting consumption of foods rich in vitamin K, known for its ability to stop bleeding
Practicing stress management techniques
Sufficient rest

If, on the other hand, the clots are accompanied by pain, heavy flow, bleeding outside of menstruation or other uncomfortable symptoms, it is important to be investigated by a specialist doctor in order to treat the cause.

Complications - Menstruation with clots

Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. With this condition, you won't be able to take part in your normal day-to-day activities when you have your period due to cramping and heavy bleeding.

See your doctor if you regularly have large clots. One of the major complications of heavy menstrual bleeding is iron deficiency anemia. Anemia is a condition that occurs when there is not enough iron in the blood to produce healthy red blood cells. Symptoms include:

fatigue
weakness
pallor
breathing difficulties
chest pain

Questions and answers

Still have questions about blood clots? Find out the answer below!

Are blood clots a warning sign?

Blood clots are not a warning sign most of the time. As long as they are occasional and small - the size of a coin - they are a normal part of your period.

Is it normal for menstrual blood to have a thicker consistency?

Menstrual blood can sometimes have a thicker consistency and a darker color, especially towards the end of the period. However, if you notice that it has increased consistency every month, it is good to have some tests done to check if your blood count is within normal limits.