Menstrual clots: Causes and when to see a doctor

Are blood clots normal during the menstrual cycle?

Many women may worry about noticing blood clots during their menstrual cycle. However, this is very normal and rarely causes problems.

Menstrual clots are a mixture of blood cells, tissues of the uterine lining and proteins that help regulate blood flow.
Some medical conditions can cause large blood clots, often accompanied by heavy menstrual bleeding or menstrual cramps. Women should consult their doctor if they are worried about the presence of menstrual clots.

What does it mean to have clots during your menstrual cycle?

Panty liner or menstrual pad with pink cotton ball on it to represent a blood clot.
Blood clots are a natural part of the menstrual cycle.
Although observing a large and thick portion of menstrual blood may be surprising, in most cases blood clots are a natural part of the menstrual cycle.
Usually, this does not mean there is a problem; However, sometimes they can be a sign of a medical condition.
Blood clots are a natural part of the body's defense mechanism. Thick in texture, similar to gelatin, these clots help prevent the loss of very large amounts of blood.
This is the same anticoagulant function that occurs in any part of the body when tissue injury occurs, such as a cut or laceration.
Blood clots usually occur when the flow is abundant. They are most common during the first two days of the menstrual cycle, usually the most abundant bleeding stage of the cycle.
The color of the clots may be bright or a denser or darker red. Larger clots may appear black. Menstrual blood becomes darker or more brown towards the end of the cycle, since this blood is older and leaves the body less rapidly.

When do clots appear?

Clots occur when the lining of the uterus expels large amounts of blood. When blood accumulates in the uterus or vagina, it begins to clot; This is similar to what happens when there is an open wound on the skin.
The consistency of menstrual blood varies during the cycle and from one cycle to another.
Women may experience a heavy flow with menstrual clots one month and the next month, have a light flow without clots.
These changes are natural and can occur due to factors such as diet and lifestyle.

Causes of menstrual clots

During the menstrual cycle, the endometrial cells that line the uterus break off and leave the body.
As this happens, the body releases proteins that cause the blood of the uterus to clot. This coagulation prevents the blood vessels in the lining from bleeding.
The blood that the body has already expelled also contains these coagulation proteins.
When the flow is more abundant, blood clotting proteins can begin to pile up and result in menstrual clots.
This usually occurs when menstrual blood accumulates in the uterus or vagina before leaving the body.

Possible conditions

Although it is normal to have blood clots during the menstrual cycle, sometimes this symptom can indicate a medical problem. It is recommended to consult a doctor if the clots:
  • they are larger than a quarter dollar coin;
  • they are very frequent;
  • they occur with an abnormally abundant flow that requires the person to change their hygienic wipe or tampon at least every 1 or 2 hours;
  • They are accompanied by intense pain.
The following conditions can cause abnormal menstrual clots:

Uterine polyps or fibroids

An obstruction in the uterus can prevent contractions from taking place as they should, that is, the uterus cannot expel blood as quickly as possible. Blood will leave the body more slowly, therefore, it will have more time to accumulate and form clots.
The blockage can also cause more abundant flow, resulting in increased blood accumulation.
Obstructions may occur as a result of growths in the uterus. These include uterine polyps and fibroids, which are not cancerous; However, without proper management, they can cause other health problems.
Uterine polyps and fibroids are made up of endometrial or muscular tissue that grows in the wall of the uterus. They can cause symptoms such as:
  • persistent low back pain,
  • pain when having sex (dyspareunia),
  • bloated feeling
  • fertility problems,
  • spotty irregular


Woman with endometriosis lying on side holding stomach because of abdominal pain.
Endometriosis can cause painful and abundant menstrual cycles.
The Endometriosis is a condition that makes the tissue of the uterine lining grow outside the uterus.
The symptoms of this abnormality may get worse during the menstrual cycle.
Symptoms of endometriosis often include:
  • pains and cramps in the pelvis or lower back;
  • very abundant menstrual cycles or menorrhagia;
  • painful periods or dysmenorrhea;
  • discomfort or pain when having sex;
  • fertility problems


In women with adenomyosis, the tissue that lines the uterus or endometrial tissue develops in the muscular wall of the uterus.
This can cause the endometrial tissue and uterine wall to thicken, causing more abundant flow during the menstrual cycle.
As a result, blood clots are very likely to appear during the menstrual cycle.

Hormonal imbalances

The hormonal balance of the body is essential to maintain a healthy uterus.
If the levels of specific hormones become unbalanced, some problems may occur, including a heavy period or with clots.

Pregnancy loss

During a miscarriage or loss of pregnancy, usually a woman will lose a large number of clots, depending on the stage of pregnancy.
Occasionally, pregnancy loss can happen before the woman knows she is pregnant, and it is likely that early abortion is confused with the regular menstrual cycle.

Enlarged uterus

After pregnancy, a woman's uterus often remains a little larger than it used to be. An enlarged uterus may also be due to structural problems, such as fibroids.
This causes additional space for blood to accumulate, which can produce more clots before blood leaves the body.

Bleeding disorders

Some bleeding disorders may be responsible for heavy menstrual flows, since these disorders affect the clotting proteins that the lining of the uterus needs to stop menstrual bleeding.
Conditions such as platelet function disorder and von Willebrand disease ( VWD ) can cause abnormally abundant menstrual cycles.

When to consult a doctor

Women who experience heavy menstrual bleeding or clots larger than the size of a quarter-dollar coin in their menstrual blood should consult a doctor, especially if they have any of the signs and symptoms of the conditions mentioned above.

What is abundant flow?

It is possible that a woman with an abundant menstrual cycle may have to change her hygienic wipe, tampon or menstrual cup more than once every 2 hours in part of her cycle. You may need to use two wipes at the same time and it is also possible that intense menstrual flow affects your daily activities.


Women with very heavy menstrual cycles have a high risk of suffering from iron deficiency anemia .
Anemia occurs when there are fewer red blood cells than normal in the body. Low iron levels may be the cause since the body needs iron to produce new and healthy red blood cells.
Other symptoms of iron deficiency include:
  • general fatigue
  • weakness,
  • difficulty breathing.
Any woman who has doubts or concerns about the origin of her menstrual clots should consult a doctor.

Diagnosis and treatment

Bean stew with spinach as an iron rich meal for vegans
A diet that includes iron-rich foods can help with menstrual clots.
To diagnose the cause of the abnormal menstrual clots, the doctor may ask questions about the signs and symptoms, order blood or imaging tests, and perform a physical exam or a combination of these.
Finding the cause will allow the doctor to recommend the most appropriate treatment for each case.
If the blood loss is very large or there is a risk of anemia, doctors may recommend an iron supplement.
They may also suggest some homemade treatments such as:
  1. stay hydrated with water;
  2. avoid aspirin, which can make bleeding worse;
  3. consume a healthy diet that includes foods rich in iron;
  4. Practice a physical activity regularly.


Doctors can prescribe hormonal medications that help balance hormones and control heavy bleeding.
They may suggest using or changing a contraceptive method. Intrauterine devices (IUDs) that contain progestin can reduce blood flow. Some birth control pills may also be useful.
They may also recommend that you take nonsteroidal anti-inflammatory drugs (NSAIDs) during the menstrual cycle to reduce symptoms, such as cramping, pain and discomfort. NSAIDs can also help control excessive bleeding.
Women who do not wish to use hormonal treatments can try medications that control blood clotting. It is best to talk with your doctor about it.


Menstrual clots are normal and are usually a symptom of heavy menstrual flow.
However, if the person notices an abundant flow pattern or clots accompanied by other symptoms, they should consult a doctor.
There are different causes of an abnormal menstrual cycle. A doctor can help find an effective way to treat underlying problems and control very frequent or large menstrual clots.


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