As you probably know from living life with a vagina, having your period looks nothing like how it does in most tampon commercials. For one, period clots can happen during that lovely time of the month, and the jelly-like glob doesn’t usually come out in a tidy little splash. While it’s expected to have some blood clots during your period, especially if you’re prone to heavy menstrual bleeding, there are certain times when they might be a sign that something is off in your body. Here’s how to tell the difference between what’s normal and what’s not.
What causes period blood clots during your cycle?
First, a mini primer on blood clots in general. When you think about clots of blood, you might imagine the kind that come together when you have a cut. Your body springs into action, combining enough platelets (blood cells that adhere to each other) and proteins from plasma (the liquid part of your blood) to plug the injured blood vessel.1 This is how clots help to stop bleeding.
Blood can also clot in your veins, especially if you have risk factors like being pregnant, which causes hormone changes that increase your blood clot risk, or recently having surgery, because moving less also contributes to this health hazard. These clots can dissipate without harm, but sometimes they can be life-threatening.
The blood clots that can emerge from your vagina during your period are a bit different than these other types, though. Menstrual blood clots are composed of the endometrial lining that builds up in your uterus in preparation for pregnancy, then sloughs off during your period when you don’t conceive.
“Clots are normal, but they typically happen when a [person] has a heavy flow,” G. Thomas Ruiz, M.D.,2 lead ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, California, tells SELF.
This is in part because a gushing period prompts your body to form clots so you don’t lose more blood than you should (around two to three tablespoons over the course of your entire period). Also, the opening of your cervix (the narrow passage at the lower end of your uterus) is pretty small. If you have a substantial flow, that allows the blood to build up in your uterus, Dr. Ruiz explains, giving components like platelets and plasma proteins time to congeal.
How big should period clots be?
For the most part, period clots are a completely normal part of menstruation, Mary Jane Minkin, M.D.,3 a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF.
But if you’re seeing clots the size of a quarter or larger, you should visit your doctor, according to the Centers for Disease Control and Prevention (CDC).4
“If someone is passing quarter-size clots, that tells me that there could be something wrong [in] the uterus that needs further investigation,” Dr. Ruiz says. You can even take a picture of what you’re seeing so that your doctor can look during your visit. “It helps show me the magnitude of what’s been going on,” Dr. Ruiz says.
When should I be concerned about blood clots during my period?
Period clots the size of a quarter or larger actually indicate that you’re officially in heavy bleeding territory, also known as menorrhagia. According to the CDC, other menorrhagia symptoms include:
The reason why all of this matters (other than making your life borderline hell during your period): Having heavy, drawn-out bleeding can lead to anemia, a blood issue that can leave you feeling tired or weak, the CDC says. It can also be a sign of an underlying health condition that requires treatment (but more on that in a sec).
Okay, are large blood clots ever normal during your period?
It’s important to remember that “normal” is a relative term for everyone, Christine Greves, M.D.,5 a board-certified ob-gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. If your usual is to pass occasional larger clots, then that may simply be your usual, as long as you are not anemic and your quality of life is not affected, she explains.
Meaning, if you’ve always had one period clot that you’re tempted to take a photo of or pester your best friend about every month, but you otherwise feel okay and aren’t soaking through tampons or pads like it’s your job, it’s probably nothing to be too stressed about. Still, Dr. Greves says, it’s not a bad idea to bring it up during your next checkup with your ob-gyn, just to get their take. And, remember, if you’re bleeding heavily, are in pain, or have any other symptoms of menorrhagia, you should get it addressed sooner rather than later.
What health conditions cause larger period blood clots?
Even though a variety of health conditions may cause period clots larger than quarter-size, they usually have other characteristics that give them away.
Polycystic ovary syndrome (PCOS)This hormonal disorder can cause incredibly heavy periods, according to the Mayo Clinic,6 because the hormone imbalance involved can prevent you from menstruating for some time. When your period does finally arrive, you may have accumulated many months’ worth of tissue. PCOS can cause irregular periods (that may be exceedingly long and heavy when they arrive), hormonal acne, male-pattern baldness, and excess facial or body hair. Research suggests the condition is also associated with metabolic complications, increasing the risk of conditions like type 2 diabetes and cardiovascular disease.7 If your doctor suspects your symptoms are due to PCOS, they may recommend a physical exam, a pelvic exam, blood tests, or an ultrasound to confirm a diagnosis.
EndometriosisAt this point the general medical consensus is that endometriosis happens when the tissue that lines your uterus (endometrium) begins to grow on other organs. However, some experts believe there may be other causes behind endometriosis, as SELF previously reported. One theory is that people with endometriosis grow misplaced tissue that is similar to the endometrium, but that it responds differently to hormones. No matter the cause of endometriosis, frighteningly heavy bleeding is one possible symptom.8
Endometriosis is also notorious for debilitating pelvic pain, especially during sex or while using the bathroom when you have your period. (Though you should know that this pain can strike at any time.) Because endometriosis can be tricky to diagnose, your doctor may need to do several tests to be sure it’s the cause of your symptoms, including a pelvic exam, ultrasound, MRI, or laparoscopy, a procedure that helps your doctor look for endometrial tissue outside of your uterus.
AdenomyosisThis condition is yet another issue behind heavy bleeding that can cause large clots, as your endometrial tissue spreads into the walls of the uterus, according to the National Institutes of Health (NIH).9 Adenomyosis can also cause pelvic pain, and it may make your lower abdomen feel swollen, tender, or like it’s under some kind of pressure.10 Like endometriosis, confirming an adenomyosis diagnosis may require various tests, like a pelvic exam, MRI, or ultrasound.
Uterine fibroidsThese benign (noncancerous) tumors can grow in and on the uterus, sometimes leading to extremely heavy menstrual bleeding.11 Along with heavy, long, and painful periods, fibroids can lead to a constant urge to pee, feeling like you can’t fully empty your bladder when you do urinate, constipation, and even back or leg pain. Your doctor may order various lab tests, including a complete blood count to rule out other bleeding disorders, as well as an ultrasound to help identify the location and size of the possible fibroids.
MiscarriageThere’s also a chance that large “period” clots actually indicate a miscarriage you’re undergoing without realizing you were pregnant. A miscarriage is a pregnancy loss within the first 20 weeks of pregnancy.12 After that, a pregnancy loss is known as stillbirth.
Since both periods and miscarriages can cause bleeding and cramping, it may be hard to tell the difference between the two, depending on your situation. Your doctor should be able to help determine whether what you thought were period clots are actually a sign of miscarriage. It’s important to give them any relevant information, like if you are sexually active and usually don’t experience heavy periods or large clots except for now. Also, if you think there’s a chance a clot could be tissue you’ve miscarried, put it into a clean container and taking it to your doctor’s office to know for sure.13
HypothyroidismHeavy bleeding during your period can also be a sign of hypothyroidism, a condition whereby your thyroid (the butterfly-shaped gland in your neck) doesn’t make enough thyroid hormones, according to the U.S. Office on Women’s Health.14 When people throw out the term “hormonal imbalance” in the context of heavy periods, they’re usually referring to thyroid problems or PCOS, Dr. Greves says. Along with heavy periods, hypothyroidism can cause unexplained weight gain, fatigue, thinning hair, and a hoarse voice.
To diagnose a potential problem with your thyroid, your doctor will likely order a blood test to examine the level of your thyroid-stimulating hormone, which can signal that your thyroid is overactive or underactive. A thyroid scan or ultrasound will also help your doctor get a sense of how large your thyroid gland is.
Uterine cancerThis is rare, so you shouldn’t panic, but heavy, drawn-out bleeding can sometimes be a sign of uterine cancer or precancerous changes, particularly if you’re older than 40, overweight, or postmenopausal, according to the Cleveland Clinic.15 Other symptoms might include bleeding between periods and lower abdominal pain or cramping in your pelvis. These symptoms can be a bit ambiguous and don’t often point to cancer, but if they feel new or different, be sure to talk to your doctor for the next best steps.
You should also mention symptoms like heavy fatigue or weakness to your doctor. While that may not point them to the direct cause behind your period clots, it could be a sign that you’re dealing with anemia due to your heavy bleeding, the CDC says.
What does period blood clot treatment look like?
Treatment for heavy menstrual bleeding depends on the underlying reason you’re having a heavy flow and clots in the first place, Dr. Greves says. Here are a few options your doctor may recommend:
- Hormonal birth control: Doctors can typically treat intense bleeding that causes large period clots with hormonal birth control that contains progestin (a synthetic version of progesterone, a key hormone in your menstrual cycle) to thin your uterine lining, Dr. Minkin explains. That could be in the form of oral contraceptives, oral progesterone, or a hormonal IUD.16 While this can help ease many of the issues listed above, it’s not the best option for all of them. With miscarriage, for example, if it turns out that what seemed like a period clot is a pregnancy loss, your doctor will need to run tests to make sure all of the tissue has been expelled from your uterus so it can’t cause an infection, then remove any remaining tissue if necessary.
- Iron supplements: If your doctor determines that you’re iron deficient due to heavy menstrual bleeding, they’ll likely recommend that you start taking an iron supplement to make up the difference. Important to note: Supplements won’t help with the heavy flow, but they will help “replace what you’ve lost,” Dr. Greves says, as iron is an essential mineral for your overall health.17
- NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium, if taken at the onset of your menstrual period, can help reduce how much you’re bleeding, the Mayo Clinic says. As an added perk, they can also help relieve the pain of menstrual cramps in the process.
- Tranexamic acid: This prescribed medication is a clot promoter and helps reduce how much you bleed, the Mayo Clinic says. You need to take it only when you’re on your period if your doctor recommends it for you.
- Surgery: If you’ve tried different medications and you’re still not getting relief, your doctor may recommend that you get surgery, depending on the root cause of your clots. This can include a range of options, including removal of any problematic fibroids, and if you are not interested in future pregnancy, endometrial ablation, uterine artery embolization to shrink fibroids, or, in some cases, a hysterectomy to remove your uterus, per the Mayo Clinic.
Regardless of what’s behind your heavy bleeding, Dr. Minkin stresses that you can’t get help if you don’t tell your doctor what’s going on. Seeing a trusted physician is your first step any time something feels a bit off with your body, especially when it comes to your vaginal health.
Sources
Related:
- Can I Get a Pelvic Exam or Pap Smear on My Period?
- 7 Period Problems You Shouldn’t Ignore
- The Types of Birth Control to Consider if You Want to Stop Your Period
ncG1vNJzZmivp6x7qLjApqauqp2WtKLGyKecZ5ufY8Kse8Crq6KbnJp8sbHRoqadZZOhvLW%2F