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The menstrual cycle is usually variable among women. While some perceive absolutely no change in their body beyond bleeding, others are completely unable to carry out their daily activities.

These cycles are marked by menstrual flow, which can also vary from a very small amount to heavy bleeding that may require several towels throughout the day.

In addition to the characteristics of the cycle, it is possible that it is accompanied by some discomfort, mainly pain, called dysmenorrhea. In addition to this, another associated factor that can cause a certain level of anxiety is the presence of blood clots that accompany menstrual flow.

Why do blood clots occur?

Blood has a system in charge of limiting bleeding, it is the coagulation system.

This is made up of platelets, a type of blood cell, and a series of proteins called clotting factors.

Every time tissue damage occurs, collagen fibers (the main protein in lining tissues, including the skin) are exposed, which is a powerful stimulator of the activity of the coagulation system.

Women who have very heavy bleeding are the ones who usually have clots in their menstrual flow. This pattern can be normal in those who have always had a very heavy menstruation.

However, in women who generally have mild to moderate bleeding without clots, a change in pattern to a very heavy and clotted period is a sign that some type of disorder may be occurring that warrants attention.

Main conditions related to increased menstrual bleeding

There are many reasons why this change in menstrual pattern can occur. To be able to identify them correctly, it may be necessary to carry out a complete evaluation by the gynecologist that includes laboratory tests, gynecological physical examination and a pelvic ultrasound.

These studies are carried out in order to identify any of the following conditions:

• Hormonal alterations. Hormonal changes have a great impact on menstruation, mainly sex hormones such as estrogens and progesterone. Changes in other types of hormones, such as thyroid hormone and cortisol, can affect menstruation.
• Presence of uterine fibroids. Uterine fibroids are benign tumors that are made up of muscle. These are caused by various factors, including genetic ones, and can grow to a large size. Fibroids make the uterus unable to contract properly to stop menstrual bleeding, leading to very abundant menses and therefore accompanied by the presence of clots. It is even possible for fibroids to detach from the wall of the uterus and move towards the neck, exiting into the vagina through it, which is known as an abortifacient myoma.
• Use of intrauterine device. The presence of these elements within the uterine cavity produces an inflammatory effect that leads to increased menstrual bleeding while the device is present.
• Injuries to the lining of the uterus. The inside of the uterus is completely lined by a layer called the endometrium. Lesions such as small nodules known as polyps can develop in it, which can interfere with normal uterine contraction during menstruation. It is also possible that the tissue of this layer is abnormally located in other structures such as the ovaries, which causes very painful periods with abundant clots.
• Use of medications. Many medications can affect the blood clotting process, causing it to release a greater volume of blood. This is related to the use of common medications such as anti-inflammatories (aspirin, ibuprofen, naproxen, diclofenac, etc.) or medications used to prevent complications of cardiovascular disease such as acetylsalicylic acid, warfarin and clopidrogel, among others.
• Injuries to the cervix. Another cause of clots in menstruation is the presence of lesions such as severe infections or even malignant lesions such as cancer of the cervix.

Health consequences of menstruation with clots

Clots as such do not carry any health risk. The problem lies in the cause that gave rise to them and that led to a change in the pattern of menstruation.

Faced with this manifestation it is important to go to the gynecologist, so that he can carry out an investigation of the problems or conditions that may have led to this phenomenon.

Once the problem has been identified, its correction should lead to the clots disappearing and menstruation normalizes.

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