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Hormones & Menstrual Health: Understanding Clotting & Its Causes

In certain situations, there is heavy bleeding with clots and this really may worry a woman at times

The menstrual cycle is like an orchestra which is a harmony of the brain, ovaries and uterus to develop an egg and endometrium for pregnancy. If a pregnancy doesn’t occur, there is shedding and you get your period. In certain situations, there is heavy bleeding with clots and this really may worry a woman at times. 

Understanding your hormones

Hormones play an important role in managing this. At the beginning of your cycle, there is the follicle-stimulating hormone (FSH), promoting the growth of the eggs. The eggs in turn produce oestrogen which helps thicken the uterine lining (endometrium). Mid cycle, there is a surge of luteinizing hormone which causes the egg to rupture. Oestrogen levels are at their highest during this time. After ovulation, progesterone levels begin to rise. Progesterone stabilises the uterine lining and prepares it for a pregnancy. If pregnancy doesn’t occur, then oestrogen and progesterone levels decrease, and you get your period.

 

Clots during your period

Menstrual clots are lumps of blood which once collected come out together as a clot. Clotting is normal in periods usually, unless they are frequent and large. Clotting of blood is natural in the body. Clots usually happen when the flow is heavy and blood collects in the uterine cavity.

One of the most common causes is when there is excess oestrogen or lack of progesterone in the body. This can occur especially in patients with PCOS or patients who are obese. 

Another cause can be fibroids, especially fibroids growing on the inner side of the uterus (sub mucous fibroids). Fibroids may increase blood flow and can also disrupt the shedding process which leads to clotting. Endometriosis, adenomyosis, and miscarriage are other gynaecological conditions which can cause clots

Besides these, blood clotting disorders such as Willebrand disease or thrombophilia can affect body’s ability to regulate clotting leading to increased menstrual clot formation. 

Certain medication like anti-coagulants, hormonal therapies and devices such as IUD’s can influence menstrual flow and clotting.

When to Seek Medical Attention

As I mentioned before, clotting during periods is usually normal but sometimes it does require medical attention. Please be aware of these warning signs so you know when you need to visit your gynaecologist.

  • Clots larger than a quarter: Frequent expulsion of large clots may indicate excessive blood loss or an underlying condition.
  • Prolonged or heavy bleeding: Menstrual periods lasting longer than seven days or requiring frequent changes of menstrual products (soaking through in less than two hours) should be assessed.
  • Severe pain or discomfort: Intense cramps or pelvic pain accompanying clotting could signal conditions like endometriosis or fibroids.
  • Irregular cycles: Sudden changes in cycle length, flow, or the appearance of clots should not be ignored.
  • Symptoms of anaemia: Fatigue, dizziness, or shortness of breath may indicate excessive blood loss and the need for treatment.

Managing and Preventing Menstrual Clotting

At first, we need to understand the cause of this bleeding and treat it. However, there are some simple changes you can make at your end to help manage this. 

Ensuring that your BMI is normal is a good way to regulate hormone levels and ensure a good balance. Stress is another factor which impacts hormonal balance, so finding some time to meditate or any other activity which reduces your stress is a good way to manage these clots. A healthy nutritious diet rich in macronutrients and micronutrients will help also maintain hormonal balance in your body. 

The other treatment options which would be commonly recommended by your gynaecologist are hormonal therapies such as oral contraceptive pills, patches, IUD etc. In some cases where there is pain, they may give you Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce menstrual flow and alleviate pain. If the medication doesn’t work, surgery may have to be considered. 

Once your symptoms are relieved, don’t forget to follow up regularly with your gynaecologist to ensure your health is well maintained.

 

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Dr. Rohan Palshetkar

Guest Author Head of Unit Bloom IVF, Professor, Dept of OBGy, DY Patil School of Medicine

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