Is it normal to have blood clots during menstruation?

By Dr. Ambuja Govindaraj, Consultant, OBG, Columbia Asia Referral Hospital, Yeshwanthpur (A unit of Manipal Hospitals)

Menstruation is a natural process which women go through each month from the time they hit puberty till they get menopause. Each woman may face different kind of problems like stomach ache, cramps, back pain during her periods. Though these are common during menstruation, discharge of blood clots is something which many women worry about but are hesitant to discuss openly. Is it normal to get menstrual clots? The question many women have.

Most women experience the discharge of menstrual clots during their periods. This is a combination of blood cells, tissue from the lining of the uterus, and proteins in the blood that help regulate its flow. In most of the cases, the clots are small in size. It is normal to have such clots during the heavy flow days or the initial days of menstruation. However, if the clots are larger than a golf ball and if a woman is passing the clots more often during her periods it is a cause for concern.

How do the menstrual clots form?

Clots happen when the uterine lining sheds increased amounts of blood. The lining which sheds gets pooled in the bottom of the uterus waiting to get expelled through cervix. As this blood is thick, the body releases anticoagulants to thin them which will help in the free flow of blood. However, when the blood flow outpaces the body’s ability to produce anticoagulants, menstrual clots are released.

Women with normal periods might experience these blood clots during the beginning of the menstrual cycle which is usually the heavy blood flow days. For them, the heavy flow will be short-lived and the periods will last for about 4-5 days.

Women who experience continuous heavy flow of blood during the periods may also face the problem of prolonged clot discharge. Many women with heavy flow soak through a pad or tampon every hour for several hours. If they pass large size of blood clot for a prolonged time, then it is important to consult a gynaecologist for further check-up.

When to worry about clots?

There is no need to worry if the clots are

  • smaller in size
  • only occur occasionally, usually toward the beginning of the menstrual cycle
  • appear bright or dark red in colour

However, if you have to change your pads or tampons every two hours due to heavy flow, experience frequent clots and the clot size is really big, then seek immediate help from an expert.

Possible health conditions:

The enlargement or engorgement of the uterus can put extra pressure on the uterine wall leading to increase in menstrual bleeding and clots. The causes for increased bleeding during cycles are:

  • Fibroids
  • Endometriosis
  • Adenomyosis
  • Hormonal imbalances
  • Enlarged uterus
  • Bleeding disorders

Fibroids: These are the noncancerous, muscular tumours that grow in the uterine wall. They are present in 40% of reproductive age group women. All fibroids don’t require treatment. Women with very large fibroids, causing pain during cycles, excessive bleeding or not able to conceive with fibroids need to consult gynaecologist for further treatment.

Endometriosis: Endometriosis is a condition that causes the tissues of the uterine lining to grow outside of the uterus. Though there is no exact reason to develop endometriosis, heredity, hormones, and previous pelvic surgery plays a major role.

Adenomyosis: In this condition, the uterine lining grows into the muscular wall of the uterus. This can make the endometrial lining and uterine wall much thicker leading to a much heavier flow and pain during the cycles.

Hormonal imbalance: In order to grow and thicken properly, the uterine lining relies on a balance of estrogen and progesterone. The imbalance in this can affect the blood flow. Thyroid abnormalities can cause excessive bleeding during cycles.

Enlarged uterus: After pregnancy, a woman’s uterus often remains larger than it was before. An enlarged uterus can also be due to structural issues, such as fibroids.

Bleeding disorders: Some bleeding disorders may be responsible for heavy menstrual flow, as they can affect the coagulation proteins that the uterine lining needs to stop menstrual bleeding.

Menstrual clots and heavy flow can affect the day today life. Therefore, it is crucial to discuss with your gynaecologist and get the treatment.

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