Heavy Menstrual Bleeding With Clots

Some women experience excessive bleeding with clots during their periods, which is known as heavy menstrual bleeding with clots. When there is no organic cause that justifies this problem, it is called menorrhagia.

SMA is characterized by bleeding during the menstrual period that is too intense – 80 or more milliliters of blood are lost, when losses of less than 60 ml are usual.

If there is an excessive duration of bleeding – the rule or period lasts more than a week, the most correct term, according to the CDC, is that of prolonged menstrual bleeding.

According to this same source, abundant menstrual flow is a very frequent reason for medical consultation, both in Primary Care and in hospital consultations, as well as one of the most important causes of anemia.

In addition, it associates an important component of anxiety derived from the affectation of the quality of the woman. In fact, the SEGO defines it as an excessive loss of menstrual blood that interferes with normal physical, emotional or social activity, or worsens the quality of woman’s life.

According to Dr. Ashwani Kumar MD, the prevalence of heavy menstrual bleeding with clots ranges from 14% to 25% from the first menstruation to menopause, a percentage that increases to 30%-35% in the age range of 25 to 44 years. However, in our environment we do not have prevalence data and it is thought that this condition is underdiagnosed.

On the other hand, heavy menstrual bleeding with clots and intermenstrual bleeding (which is when bleeding occurs between two periods) are part of a term called abnormal uterine bleeding (AUB).

Why do blood clots appear during menstruation?

Many women have heavy menstrual bleeding with clots and this can be considered normal. These clots are usually due to heavy bleeding, are usually not large, and do not cause pain.

However, there are certain situations in which clots in the period may indicate an underlying pathology, so it is advisable to consult a specialist so that they can assess the causes of clots in menstruation.

What are clots in menstruation?

Menstruation marks the beginning of a woman’s menstrual cycle. It is the desquamation and expulsion of the endometrium, which is the mucosa that covers the uterus, as a result of not having had a pregnancy in the previous menstrual cycle.

The endometrium will grow again to be in the best conditions in the next cycle, since it is the layer where the embryo must implant.

Although this menstrual bleeding is usually expelled in a fluid way, some women notice small clots or “lumps” in their menstruation. The consistency of these clots can be jelly-like or thick and their size is usually no larger than a coin.

In terms of color, the clot can be bright red or a stronger red than the rest of the menstrual bleeding. In addition, this color can vary depending on the day of menstruation, since at the end of the period the clots will tend to have a darker color, almost brown.

In general, the expulsion of these clots in the rule is something totally normal in many women and should not be a cause for concern.

However, clots in menstruation are a reason to consult a specialist if they are frequent, large or occur with other symptoms. The reason is that, in these cases, the presence of clots may be related to some pathologies.

Why are there clots in the period?

Clots in menstruation usually appear when menstrual bleeding is very heavy. In fact, it is more common for women to observe these clots in the first days of menstruation, when the bleeding is usually more intense.

However, the presence of clots in the rule can be something punctual. The amount of menstrual bleeding is different in each cycle for the same woman. In this way, it is possible that there are clots only in a certain period or due to a temporary hormonal imbalance.

What are the symptoms of heavy menstrual bleeding with clots?

Women who experience heavy menstrual bleeding with clots can completely soak through, a pad or tampon in sixty minutes for several hours at a time. They may also need double hygienic protection to control menstrual flow or have to get up at night to change it. Sometimes they expel blood clots larger than an inch in diameter.

As a result of this blood loss, they may experience mood swings and/or feel very tired. And on a psychological level, to this fatigue is added, sometimes, the fear of staining the clothes with blood, which can end up limiting them in their daily life. In addition, the bleeding may be accompanied by a swollen belly and/or painful menstrual cramps, known as dysmenorrhea, which sometimes require medical attention.

Another frequent complication is anemia, since excessive blood loss decreases the number of red blood cells in the blood, which the body tries to alleviate by drawing on iron stores.

In short, heavy menstrual bleeding with clots seriously affects a woman’s quality of life, both physically and emotionally. It can even interfere with her sexual, social, and work or academic life.

When can they indicate pathology?

Heavy Menstrual Bleeding With Clots
This menstrual alteration is a frequent reason for medical consultation.

A woman should see a specialist if she has large or very frequent clots during her menstruation. Likewise, the woman should also go to the clinic if the clots occur together with symptoms such as the following:

  • Heavy menstrual bleeding with clots, which requires changing the pad, tampon or menstrual cup every so often.
  • Period pains.
  • Tiredness and fatigue.

In this case, it may be useful for the woman to write down the characteristics of her menstruation (duration, time at which she renews the pad, tampon or menstrual cup…) and of the clots (texture, size, color, days of appearance, if it is the first cycle that they are expelled…), as well as all the symptoms that they have experienced.

Possible Causes

There are different situations that can lead to the appearance of menstrual clots. Among them, we can mention the following:

  • Hormonal imbalance : the alteration of the levels of sexual hormones can be the cause of the appearance of clots in the menstrual blood.
  • Fibroids or polyps : Uterine growths in the form of fibroids or polyps can be accompanied by heavy menstrual periods with clots and expulsion of clots.
  • Endometriosis : this is a pathology in which endometrial tissue grows outside the uterine cavity. A woman with endometriosis has very painful menstruations that, in addition, can be abundant.
  • Adenomyosis : is the presence of endometrial tissue in the muscular layer of the uterus and can also cause heavy periods with clots.
  • Blood problems : Certain blood conditions such as von Willebrand disease can cause very heavy menstrual bleeding.
  • Infections in the uterus, as well as, rarely, cancer of the uterus or cervix, can trigger abnormal uterine bleeding.
  • Medications, excessive menstrual bleeding with clots can be triggered by various medications. Among them are anti-inflammatories such as acetylsalicylic acid, hormonal drugs and anticoagulants.

Similarly, heavy menstrual bleeding with clots can be a side effect of wearing a non-hormonal intrauterine device for birth control. A somewhat late period with a single heavy bleed may be due to miscarriage. Other complications of pregnancy such as ectopic pregnancy or those pregnancies that occur with abnormalities in the placement of the placenta can also cause abnormal uterine bleeding.

However, the frequent appearance of blood clots and abundant periods can also be caused by the fact that the woman has a larger uterus or iron deficiency anemia.

On the other hand, if the woman is trying to get pregnant, heavy bleeding and the appearance of large yellow or grayish clots could indicate a miscarriage.

Diagnosis of heavy menstrual bleeding with clots

When a patient goes to the gynecologist for the heavy menstrual bleeding with clots, he will ask her about her medical history and may perform different tests depending on the symptoms she presents.

In general, an ultrasound will be performed on the woman to assess the uterine cavity in search of any alteration such as fibroids. In addition, the patient will be asked to have a blood test to see if she has, for example, anemia.

Thus, the specialist will be able to investigate the causes of heavy menstrual bleeding with clots, in order to indicate the woman the appropriate treatment if necessary, which will depend on the situation and the reproductive wishes of the patient.

How can it be treated?

The treatment of heavy menstrual bleeding with clots depends on its cause and other issues that must be individualized with the woman (age, desire to have children, consequences of changing your lifestyle, personal medical condition, preferences…).

If the cause of the disorder is related to a hormonal imbalance, pharmacological treatment is usually necessary and based on the administration of contraceptives -capable of regulating menstrual cycles- or oral progesterone -which helps to restore hormonal balance-. Another option is the placement of a hormonal IUD, an intrauterine device that releases a type of hormone capable of reducing the amount of menstrual flow.

Likewise, drugs called antifibrinolytics, such as tranexamic acid and mefenamic acid, can be effective in reducing the intensity of bleeding. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are also sometimes given, which help reduce blood loss while relieving cramps.

In the event that the cause of heavy bleeding is an infection, it may be necessary to resort to antibiotics. If the bleeding is a sign of a disease such as those that affect the thyroid gland –hyperthyroidism or hypothyroidism, the associated pathology should be treated. When anemia or risk of developing it is detected, iron supplements are usually necessary.

In the most severe cases of heavy menstrual bleeding with clots or those caused by a large fibroid or cancer, surgery to remove part or all of the uterus (hysterectomy) may be necessary.

In general, in other cases of organic pathology such as polyps, endometriosis or adenomyosis, or more manageable fibroids, the treatment will be specific to each process.

When there is no organic pathology that justifies the bleeding and medical treatment has failed to control the symptoms or cannot be applied, the most effective options are endometrial ablation (removal of the endometrium) and hysterectomy.

As Dr. Ashwani Kumar MD tells us: Clots in menstruation usually appear when menstrual bleeding is very heavy.

Are clots more frequent in menstruation taking contraceptives?

They are not usually the usual, since contraceptives cause menstruation to be less than normal. With contraceptives, the phase of estrogenic endometrial proliferation after menstruation is less abundant. The endometrium grows less because the level of circulating estrogen has decreased, follicular selection is mediated by the contraceptive, and ovulation does not occur, so there is no circulating progesterone to act on the endometrium and produce secretion over an estrogenic impregnation.

What can be transparent or whitish clots in menstruation?

Sometimes women are concerned when they notice heavy menstrual bleeding with clots. However, this is normal and is rarely related to a problem.

Can clots in menstruation indicate infertility?

You don’t have to. If it is ruled out that there is a cause that could also affect fertility, you can have abundant periods, with clots, without these indicating a problem. Of course, it must be controlled that it does not lead to anemia and, if so, treat it.

Is it normal to have blood clots during menstruation?

Yes, most women have had clots in their menstrual bleeding at least once and usually several times. The size as well as the color varies between women and between periods of the same woman depending mainly on the cause.

Could blood clots in my period be the cause of my period pain?

The clots themselves do not cause pain, but they usually appear when the bleeding is abundant and dense and this can influence menstrual pain. Both pain and clots can be symptoms of increased vaginal bleeding.

How can I reduce clots in menstruation?

There is no clear way or method for the appearance of heavy menstrual bleeding with clots in the rule. However, it is advisable to lead a healthy life that allows adequate general blood circulation. It is recommended to reduce stress and consume foods rich in bioflavonoids such as broccoli, grapes, citrus fruits, cherries, tomatoes or green peppers to help strengthen blood vessels and reduce clotting.
On the other hand, if the appearance of heavy menstrual bleeding with clots is very common or is accompanied by pain, it is advisable to consult your doctor. Normally, in these cases the specialist will prescribe a medication to help control vaginal bleeding such as birth control pills, aspirin or mefenamic acid.

Could the fibroid be the cause of the clots in the rule?

Yes, fibroids and cysts can increase the appearance of bleeding or cause alterations in it that lead to the appearance of clots. In any case, having a fibroid does not necessarily indicate that the vaginal bleeding has clots.

Does menstruation with or without clots favor pregnancy?

Typically, clots do not affect conception. The fact that vaginal bleeding has clots does not indicate that pregnancy will be more or less easy to achieve. In the event that clots are common and the pregnancy does not occur, it is advisable to consult a specialist in case there is any problem in the receptivity of the endometrium.

Is it bad to have a period with brown clots?

You don’t have to. It is true that clots in menstruation may be more frequent in the first days of menstruation, when the bleeding is more abundant and, therefore, they tend to have an intense red or darker red color than the rest of the bleeding. Thus, dark brown or brown clots may appear at the end of the period, since the blood is “aged”.
In general, heavy menstrual bleeding with clots are normal and appear in many women. However, if these clots appear frequently, are large and/or are accompanied by symptoms such as heavy bleeding, pain or fatigue, it is best to consult a specialist, as they could be caused by an underlying pathology.

Dr. Ashwani Kumar is highly skilled and experienced in treating major and minor general medicine diseases.