Blood clots during periods

Menstrual clots are usually jelly-like: dense but squishy. Clots that are smaller than a new Rs 2 coin are common on heavy flow days—usually the first or second day of your period. That said, you may want to see a doctor if you experience any of these symptoms:

• If the size of the blood clots is much bigger than a new Rs 2 coin and you’ve been passing a lot of big clots.
• If you have unbearable stomach pain or abdominal cramping.
• If your bleeding is a lot heavier than usual, or if you need to change your sanitary pad/tampon or empty your menstrual cup after one or two hours for several hours.
• If the bleeding goes on for much longer than usual. (Three to five days is the usual for most women. However, for some women, seven-day periods are the norm.) 
• If you feel weak or unusually tired.
• If you thought you might be pregnant, but then you got vaginal bleeding with big clots.

Remember, the experience of periods can vary from one person to another and from one month to the next. If your period looks or feels different than usual, there is no harm in checking in with a gynaecologist.

Clotting factors in blood slow down and then eventually stop the bleeding when we bleed from a wound. Clotting plays a similar role in menstruation, by making the blood thicker (coagulate) and slowing the amount and rate at which blood is lost from the body. So while small and occasional blood clots during periods are perfectly normal, there are some underlying causes of blood clots during periods that may need medical attention:

• Hormonal imbalance: Estrogen and progesterone are the female sex hormones that regulate periods. An imbalance in these hormones can result in heavy or abnormal bleeding, often with clots. Hormonal imbalance can occur for a number of reasons:
  • Stress
  • Obesity
  • Polycystic ovary syndrome
  • Fibroids: non-cancerous growth in the uterus.
  • Menopause
  • Thyroid problems
  • Anovulation: ovulation is an important part of the menstrual cycle. If ovaries are unable to produce eggs (anovulation), the body doesn’t produce progesterone. This hormonal imbalance can disrupt the cycle. One of the symptoms of this is big blood clots in period blood.
• Obstructions in the uterus: Big clots may occur if the menstrual blood can’t get out quickly for any reason. Uterine fibroids (non-cancerous growth in the uterus) and endometrial polyps (a benign bump on the uterus lining) could create such a blockage.
• Endometriosis: In endometriosis, cells from the uterus lining (endometrium) start growing in another part of the body. These cells can bleed and cause a lot of discomfort during periods. Plus, in the absence of a clear route out, the menstrual discharge from these cells can collect and eventually come out in the form of big clots.
• Adenomyosis: This is a condition in which the lining of the uterus breaks through the uterine muscle wall. It can cause heavy blood loss and clotting, which can increase the chances of complications like anaemia.
• Miscarriage or chemical pregnancy: Chemical pregnancy refers to a miscarriage before the fifth week of pregnancy (before tests can even confirm if you are pregnant). This is very common, and usually, nothing to worry about. That said, it may result in hormonal imbalances, heavy bleeding and big clots.
• Cancer: Cervical cancer and endometrial cancer can sometimes lead to menstrual problems, including big blood clots.
• Afterpains: After pregnancy, the uterus can take up to six week to shrink back to its normal size. Experts say that the enlarged uterus can also cause blood to pool and form clumps (when coagulant proteins in blood join and make larger clots). (Read more: Contractions during pregnancy)

To be sure, blood clots aren’t a problem by themselves. However, if they turn out to be a sign of an underlying condition or if they cause a lot of blood loss, they can have a negative outcome for women’s health.

Blood clots are both a cause and effect of heavy bleeding: too many blood clots can amount to heavy bleeding, and a heavy flow means there are more chances of blood collecting in the uterus and cervix before being expunged. Women lose anywhere between 5 ml and 80 ml of blood in each cycle, with 80 ml considered to be heavy menstrual bleeding.

In addition to blood clots, other common causes of heavy bleeding during periods include:

• Taking blood thinners while on your period.
• People with Von Willebrand Disease, a blood clotting disorder, do not have the Von Willebrand clotting factor in their blood—these patients can also experience more bleeding during periods. Around 1% of the Indian population has this disease.

It is important to keep an eye out for these risk factors for heavy bleeding during periods, to prevent blood clots as well.

Small and occasional blood clots don’t need medical attention. However, if you feel like you are having a heavier or longer period than usual, do visit your gynaecologist for a check-up. The check-up may involve:

• The doctor will ask you questions about your usual cycle and current symptoms.
• The doctor may carry out a physical examination, including a pelvic exam, or order a blood test.
• The doctor may advise imaging techniques like an ultrasound or MRI scan to rule out conditions like endometriosis, adenomyosis and fibroids.
• In some cases, the doctor may recommend a laparoscopy or biopsy to get a closer look at the tissue.

Any underlying conditions for heavy blood clots will require proper treatment for that condition. In addition to that there are some therapies and devices that you can try:

• Talk to your gynaecologist about birth control pills that can help to regulate periods in some cases.
• Intrauterine devices with progestin (synthetic progesterone) can also regulate the cycle and reduce the formation of large clots.
• Antispasmodic drugs can help with symptoms like menstrual cramping.
• You could also take iron supplements to prevent anaemia, if you have heavy bleeding.

Tips

You can also make some changes in your routine to reduce large blood clots and other symptoms of heavy periods:

• Do light exercises that help to deal with the stomach pain and cramps. However, avoid heavy exercising during this time (heavy here means exercises in excess of what you are already used to).
• You can also use a heating pad or drink warm liquids to reduce cramps.
• Avoid blood thinners like aspirin during your periods, to prevent heavy bleeding.
• Stay hydrated and get at least 7-8 hours of sleep a day.
• Try using a menstrual cup: it may help to maintain better hygiene and stay dry.

People living with thyroid problems, PCOS and blood disorders are at higher risk for blood clots during periods.

Age is also one of the risk factors for blood clots during periods: young girls who have just started their period and older women in the perimenopause and menopause stages may experience irregular periods. And when they do get periods, the bleeding may be heavier and accompanied by blood clots.

Smoking also increases the risk of anovulation and shortens the luteal phase of the cycle. This, too, can eventually lead to blood clots during periods.

The biggest complications of blood clots during periods are painful periods (dysmenorrhea) and heavy bleeding, which in turn can lead to anaemia. More than half of India’s female population has anaemia—a disorder of the red blood cells which affects the availability of oxygen in the body. People with anaemia often complain of fatigue, shortness of breath, headache, irregular heartbeat, dizziness and difficulty concentrating.

The experience of menstruation can vary from one woman to another: for instance, some may have a lot of period pain whereas others are able to go about their day without much inconvenience. Periods can also vary slightly from month to month.

Small and occasional blood clots during periods are normal and occur in most women—in fact, they are a sign that the clotting factors are working well. This is important because, in the absence of clotting factors (example, in Von Willebrand Disease), women may experience very heavy bleeding during periods.

That said, large and recurring clots in menstrual blood could be a sign of an underlying condition. Blood disorders, thyroid disorder, dysfunctions in the reproductive organs, hormonal imbalance and even some types of cancer could be the reason for large clots in period blood.

Your doctor may diagnose your condition on the basis of a physical examination or by recommending some tests. It is important to find out the reason if you are passing large and recurring blood clots in period blood—diagnosing any underlying condition could be the first step to resolving the health problem. It could also save you from a host of health problems like anaemia that can occur due to heavy bleeding.