Menstrual blood clots are a common occurrence during menstruation, the body’s process of shedding the uterine lining. These clots are composed of blood, tissue from the uterine lining, and proteins that help the blood coagulate, giving them a jelly-like consistency. The body releases natural anticoagulants to thin the menstrual blood as it leaves the uterus. However, when the flow is particularly heavy, the volume of blood may overwhelm the body’s ability to produce these anticoagulants quickly enough, leading to the formation of visible clots. Small, occasional clotting, especially on the heaviest days of the cycle, is typically a normal part of the menstrual process.
When Menstrual Clots Signal a Problem
While small clots are a normal feature of menstruation, their size and frequency can sometimes indicate heavy menstrual bleeding, or menorrhagia. A common metric used to differentiate normal from problematic clotting is size: clots consistently larger than a quarter (about 2.5 centimeters) are a sign of excessive blood loss. Passing large clots frequently for several days also suggests that the flow is heavy enough to warrant medical evaluation.
Symptoms of severe blood loss include soaking through one or more sanitary pads or tampons every hour for several consecutive hours. Other signs include needing to use double sanitary protection to prevent leakage or waking up during the night to change protection. Heavy menstrual bleeding can ultimately lead to iron deficiency anemia, which presents with symptoms like unusual fatigue, shortness of breath, and dizziness.
Immediate Management: Reducing Heavy Flow at Home
For managing heavy flow and associated clotting in the short term, over-the-counter interventions can provide immediate relief. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be taken just before or at the start of the period to help reduce the intensity of the blood flow. These medications work by inhibiting the body’s production of prostaglandins, compounds that promote inflammation and are often elevated in people with heavy menstrual bleeding. Starting NSAID use at the onset of bleeding and continuing for the first few heavy days can reduce menstrual blood loss by up to a third. NSAIDs offer the dual benefit of reducing flow and alleviating painful menstrual cramps.
Hydration is also important during heavy flow, as significant blood loss can deplete the body’s fluid volume. Drinking an additional four to six cups of water per day can help maintain overall blood volume and energy levels.
Focusing on nutritional support is another practical step, particularly by increasing the intake of iron-rich foods to counteract blood loss and prevent anemia. Iron is necessary for producing hemoglobin, the protein in red blood cells that carries oxygen throughout the body. Foods like lean beef, spinach, lentils, and tofu are excellent sources of iron. Consuming vitamin C-rich foods, such as citrus fruits and strawberries, can further support the body’s ability to absorb non-heme iron from plant sources.
Underlying Conditions Causing Excessive Clotting
Long-term management of excessive clotting requires identifying and treating the underlying medical conditions that cause heavy menstrual bleeding. Structural issues within the uterus are common culprits, with uterine fibroids and adenomyosis being frequently diagnosed. Fibroids are benign growths in the muscular wall of the uterus that increase menstrual flow by enlarging the surface area of the uterine lining. Adenomyosis occurs when the tissue that normally lines the uterus grows into the muscular wall instead, leading to a thickened and enlarged uterus. Both conditions interfere with the uterus’s ability to contract effectively, allowing blood to pool and coagulate before expulsion.
Hormonal imbalances are another significant cause of heavy flow, often resulting from conditions like polycystic ovary syndrome (PCOS) or thyroid dysfunction. The balance between estrogen and progesterone regulates the buildup and shedding of the uterine lining. When this balance is disrupted, the lining can become too thick, leading to heavier and more prolonged bleeding. Less commonly, underlying blood clotting disorders, such as von Willebrand disease, can impair the body’s ability to clot effectively, ironically leading to a heavier flow and larger clots. A healthcare professional must determine the exact cause through blood tests and imaging studies to direct the most effective long-term treatment plan.
Clinical Options for Treating Menorrhagia
Once a medical cause for heavy menstrual bleeding is identified, a range of prescription and procedural interventions are available for long-term management. Hormonal treatments are often a first-line therapy, working to thin the uterine lining and regulate the menstrual cycle. Oral contraceptives, containing estrogen and progestin, stabilize the hormonal environment, resulting in less buildup of the uterine lining and subsequently lighter periods. Alternatively, progestin can be delivered directly via a levonorgestrel-releasing intrauterine device (IUD), which consistently thins the endometrium and reduces blood loss.
For women who prefer non-hormonal options, antifibrinolytic medications like tranexamic acid can be prescribed. This medication is taken only during the days of heavy bleeding and works by stabilizing existing blood clots, thus reducing the amount of blood loss. If heavy bleeding has led to iron deficiency anemia, prescription iron supplements are necessary to restore depleted iron stores.
If the excessive clotting is due to structural issues like large fibroids or severe adenomyosis, surgical procedures may be considered. Options range from less invasive procedures like endometrial ablation, which destroys the uterine lining, to more involved surgeries such as a myomectomy to remove fibroids, or a hysterectomy for severe, unresponsive cases.