Period Blood Clots: Are they normal?

During your period small clots seen on a pad or tampon are considered normal. When we are bleeding, the platelets in our body help to clot our blood to stop the bleeding. Therefore, some small clots are considered normal. At the beginning phase of your period when the menstrual flow is faster, you may see bright red clots. As your period continues any clots will naturally darken in color. Period blood clots can appear like clumps or chunks of blood and/or a jelly-like consistency that can vary in size and number.

Having blood clots that are larger than the size of a quarter can categorizes your period as having menorrhagia (very heavy periods). Other signs of menorrhagia include: changing a pad or super tampon every hour for 3 or more hours in a single day, having to double up on menstrual products to control flow, waking up during the night to change menstrual products, needing to limit activities due to a very heavy period, period is prolonged and longer than 7 days. 

If you are experiencing blood clots that are larger than a quarter in size it may be an indication of an underlying health condition like fibroids, polyps, thyroid irregularity or endometriosis. It is recommended to see your medical provider for further investigation.

Uterine Fibroids

Fibroids are the development of benign tumors that can develop in the uterus in the endometrium. Fibroids can cause heavy bleeding, blot clots, painful periods, and long duration of period (lasting more than 7 days). Other symptoms that can accompany fibroids include difficulty urinating, pain with sex, pelvic pressure, constipation, lower back pain, infertility and miscarriage. Uterine fibroids can start to appear at any age but most commonly between 30s and 40s through till menopause (around age 50). The average age of diagnosis for fibroids in women is age 40. Fibroids can shrink after menopause when estrogen levels decline.

Endometriosis

Endometriosis is an inflammatory condition that occurs when tissue similar to the lining of the uterus (endometrium) grows outside of the uterus on various structures like fallopian tubes, ovaries, bladder or intestines. This overgrown tissue can cause severe pelvic pain, menstrual cramps, pain during intercourse, nausea/vomiting, bowel and urinary disorders, painful bowel movements or urination during menstruation, chronic fatigue and heavy menstrual flow with possible blot clots. Endometriosis is common in women during their reproductive years and an endometriosis diagnosis is commonly made between the ages of 25-35.

Uterine Polyps

Uterine polyps are similar to fibroids, but they are smaller. Polyps are small growths, benign tumors, that develop in the endometrium of the uterus. Additional signs of uterine polyps include bleeding between periods, frequent unpredictable periods where length and heaviness vary, heavy menstrual flow with possible blood clots and infertility. Uterine polyps can develop at any age but is more prevalent in women ages 40-49 years old.

Thyroid Imbalance – Hypothyroidism

Hypothyroidism (underactive thyroid gland) can be another underlying cause of experiencing heavy menstrual bleeding, i.e. needing to change your pad or tampon less than every 2 hours or passing large quarter size blood clots. An underactive thyroid gland means your body is not producing enough thyroid hormones.

When there are not enough thyroid hormones being produced, we produce less of our progesterone hormone. Progesterone during a period is helpful to reduce the amount of blood that we lose during our period. With less progesterone being produce this can put us at risk of have a more estrogen dominance picture happening in the body.

Adequate thyroid hormones are needed for making coagulation factors that are necessary to prevent heavy periods and prevent large blood clots. Hypothyroidism unfortunately causes poor coagulation to happen resulting in losing a lot of blood in a short amount of time and passing large blood clots.

Estrogen Dominance

It is important to remember that estrogen is a very important female hormone in the body and helps to support our health. However, it is when estrogen gets out of balance that causes symptoms to arise like large blood clots during your period. You could still have an estrogen dominance picture and symptoms in the body like having a heavy period without blood clots. Health conditions like endometriosis, fibroids, uterine polyps are linked to estrogen dominance patterns in the body.

Estrogen dominance is term used to describe having too high of estrogen levels in the body. A few examples of why you may be accumulating too much estrogen can be due to impaired clearance (detox), environmental toxins, lack of ovulation, an increase in adiposity (fat cells), constipation, gut dysbiosis.

When estrogen levels are dominant and your progesterone levels are low, this can cause the uterine lining to thicken. When a thick uterine lining sheds during menstruation, this is when you may experience a heavier blood flow and larger blood clots.  

Approaches a Naturopath can support you with to balance your estrogen hormones:

• Supporting detoxification processes in the body by nourishing your liver
• Heal the gut
• Adequate sleep
• Stress management
• Supplements to support healthy estrogen levels

Functional Medicine Testing for Large Blood Clots

Blood work would include:

• a full thyroid panel to run out any possible thyroid imbalance
• ferritin and CBC (complete blood count) – your iron level as heavy menstrual bleeding puts one more at risk for developing iron deficiency anemia.
• Day 3 of your menstrual cycle estradiol
• Day 19-22 progesterone and estradiol or DUTCH test https://dutchtest.com/info-dutch-complete/

Resources:

Kay, C. Healthline. [Internet.] https://www.healthline.com/health/stringy-period-blood

Brighten J. Beyond the pill. Harper One. 2019.

Poppe K, Velkeniers B, Glinoer D. Thyroid disease and female reproduction. Clin Endocrinol (Oxf). 2007 Mar;66(3):309–21.