The sight of blood clots, when you have your period, can be quite alarming and you may not want to seek medical attention for such a personal ailment. In most cases menstrual clotting is normal and may be accompanied by stomach cramping.
The presence of blood clots may only be an indication of heavy periods which is known as menorrhagia. Excessive bleeding during a period may cause the formation of blood clots and this alone is not always a cause for concern unless the heavy bleeding leads to other complications such as anemia. However, if the bleeding is excessive and prolonged and you have been passing large clots too frequently, it would be advisable to consult with your doctor.
What Could Cause Menstrual Clotting?
During a menstrual cycle the uterus prepares itself to receive the fertilized egg if fertilization does occur. If pregnancy has not occurred, the thickened uterine lining mixed with blood is shed and this comes out as menstrual bleeding. These bits of uterine lining and blood clump together and may form clots.
The endometrium of the uterus contains an enzyme called plasmin which prevents the blood from clotting. If there is any problem with secretion of plasmin, blood clots may form in the uterus. Passing clots during menstruation may not be abnormal and usually indicates excessive bleeding, which is quite common in many women. However, heavy bleeding with clots may be due to other reasons as well, such as uterine fibroids, tumors, polyps, cancerous growths, dysfunctional uterine bleeding, adenomyosis, endometriosis or endometrial hyperplasias.
If you are a woman of childbearing age, bleeding in early pregnancy, possibly due to an impending abortion, may be a complication that has to also be kept in mind. In women approaching menopause there is often a change in the menstrual flow and the occurrence of menorrhagia with passage of blood clots is common.
Certain medication can increase chances of clots and women with thyroid problems may also experience menstrual clotting. Any abnormalities or defects in coagulation could lead to excessive clot formation. Intrauterine contraceptive devices (IUD), oral contraceptives and other hormone preparations may also cause menorrhagia and the passage of blood clots.
If your previous periods have been normal and you are now passing big clots, a medical examination is definitely advisable. Your doctor will examine you and will probably advise some tests to confirm or rule out any conditions which might be causing the problem. Treatment, as and when necessary, will help to take care of the problem.
Diagnosing the Cause of Menstrual Clotting
If you are concerned about your menstrual clotting, you should seek medical advice. Your doctor will ask about your periods, their duration, any changes from the previous ones, amount of blood loss, the date of your last menstrual period (to rule out pregnancy and miscarriage) and so on. Many causes of menorrhagia can be identified by the history alone. After taking the history, which will include questions about previous deliveries and any other concerns that you might have, your doctor will do a physical examination which will also include a vaginal examination.
After that, if your doctor thinks it necessary, you may be advised a number of tests such as blood tests (especially to check for clotting defects and anemia), and an ultrasonography to detect any abnormality in your uterus or vagina. A dilatation and curettage (D & C) may be necessary to take samples from your cervix and uterus for testing and a biopsy may also be done. Hysteroscopy can help in diagnosis by direct visualization of the uterus and also by helping to take the biopsy material from the correct site.
What is the Treatment for Menstrual Clotting?
Often menstrual clotting is associated with severe stomach cramping. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help to relieve the pain as well as reduce blood flow, but you should only take these drugs after consulting your doctor.
Iron supplements may be advised by your doctor if you are suffering from anemia due to excessive blood loss.
If other causes of menorrhagia such as a fibroid, polyp, cancerous growth and so on can be excluded and the bleeding is not as excessive as to be life-threatening, hormone therapy may be tried and often gives good results.
Surgery is a consideration for conditions such as fibroids. A myomectomy can be done to remove the fibroid while preserving the uterus if you wish to have future pregnancies. Hysterectomy (surgical removal of the uterus) may be done for certain conditions such as endometriosis, adenomyosis or dysfunctional uterine bleeding but is advised only if other treatments fail.
A D&C (dilation and curettage) may be done both for diagnosis as well as for treatment of excessive menstrual bleeding with clots.
If IUD is found to be the cause of clotting, it has to be removed. Oral contraceptive pills may need to be changed or discontinued if they are the offending agents.
For small amounts of menstrual clotting you may not need any treatment at all. In all likelihood the clots that you are passing during your periods are not a cause for concern but consulting with your doctor may help to put you at ease and clear up any doubts that you might have.