It’s that time of the month. While changing your pad, tampon or menstrual cup, you might notice you have some blood clots (gel-like clumps of blood) in your period blood. You may wonder if that’s normal. Occasionally having blood clots in your period blood is entirely normal. But if you are consistently experiencing clotting or noticing large blood clots, this can be a sign of another underlying condition, and it may be time to talk to your doctor. Here is what you need to know about menstrual blood clots.

What are period clots?

Menstrual bleeding originates in the uterus and is controlled by hormones produced by the ovaries. During your period, which typically occurs every 28 to 35 days, the lining of the uterus sheds, and this lining mixes with blood, mucus and tissue. This mixture then goes through the cervix and out of the vagina. To prevent your body from losing too much blood, plasma and platelets help form blood clots that can show up in your period blood. This is most common on heavier flow days which typically occur at the start of your period, but people with heavier flows may experience more prolonged clotting.

What causes period clots?

Those who experience heavy menstrual bleeding, also called menorrhagia, may have more issues with clotting. While blood clots aren’t a medical condition, they can be a sign of an underlying condition. Some causes of heavy menstrual bleeding include:

• Uterine Fibroids - Noncancerous growths of the uterus that often appear during childbearing years. They can cause heavy, painful periods.
• Endometriosis - A disease in which tissue, like the lining of the uterus, grows in other places in the body, such as the ovaries, fallopian tubes and the outer surface of the uterus. It is one of the most common gynecological diseases, and its primary symptoms include pain, heavy menstrual cycles and infertility.
• Adenomyosis - A condition where the tissue lining the uterus cavity grows inside the walls of the uterus. Because the tissue does not belong there, the uterine walls thicken, causing heavy bleeding and pain.
• After giving birth - Many people experience blood clots in their period after giving birth. Whether you have a vaginal birth or a cesarean section, you will experience vaginal bleeding, typically lasting four to six weeks. It is entirely normal for it to look like large blood clots. Disposable underwear or pads will be your friend because you cannot use tampons or any other product you need to insert.
• Miscarriage - A pregnancy loss that occurs early can cause heavy bleeding, cramping and clotting. While some spotting can occur during pregnancy, you should visit an emergency room if you experience passing blood clots.
• Cancer of the uterus or cervix - Although not as common, these cancers can cause heavy menstrual bleeding.
• Hormonal imbalances - The ovaries produce the hormones estrogen and progesterone. Estrogen plays a role in ovulation (when your ovaries release an egg) and thickens the lining of your uterus. Progesterone helps regulate your cycle. If either of these hormones becomes imbalanced, it can cause irregular shedding of the uterus, leading to blood clots. Some conditions affecting hormonal balance are hypothyroidism, polycystic ovary syndrome, menopause and stress.

Diagnosing and treating blood clots in your period

While occasional period clotting is typical, if you are experiencing excessive or large blood clots, you should consult your OB/GYN. They will likely first perform a pelvic exam to see if you have another underlying condition. They may also order a blood test if hormonal imbalances are thought to be the cause or perform an ultrasound or magnetic resonance imaging (MRI) to check for uterine fibroids, endometriosis or other conditions that can obstruct the uterus.

The best treatment for the blood clots will depend on the underlying condition. Some treatment options may include:

Over-the-counter nonsteroidal anti-inflammatories (NSAIDs) - Ibuprofen (Advil or Motrin) can ease cramping and reduce blood flow by 20%-50%.

Hormonal Contraceptives - Certain hormonal contraceptives can help control heavy bleeding by inhibiting the growth of the uterine lining:

• Levonorgestrel Intrauterine Device (IUD) contains progestin and can help treat heavy menstrual cycles. In fact, most women have little to no menstrual cycle after three months of use.
• Oral contraceptives can make menstrual cycles more predictable, shorter and lighter. Menstrual pain is also often improved with the use of oral contraceptive pills.
• For women who don’t want to take hormones, tranexamic acid (TXA) is an oral medication that does not have hormones and reduces heavy periods. It works with your clotting system to decrease bleeding. While TXA doesn’t treat fibroids directly, it works well in reducing bleeding.

Surgery - Some causes of blood clots, such as fibroids or polyps, may require more advanced surgical treatment. Some surgery options can include:

• Myomectomy - A procedure that removes the uterine fibroids while conserving the uterus for fertility. There are several options depending on the location and size of the fibroids, including:
• Abdominal myomectomy – For large fibroids, your surgeon goes through the stomach to access the uterus.
• 1. Robotic myomectomy – Your surgeon makes four small incisions, each about 1 centimeter in length. This robotic system gives the doctor the visualization and precision of an abdominal myomectomy and gives the patient the benefits of laparoscopic surgery. 
  2. Hysterectoscopic myomectomy – An outpatient procedure. Your surgeon will place a camera through the vagina and into the uterus through the cervix. The doctor can see the fibroids and remove them.
• Hysterectomy – If you are past your childbearing years or wish to no longer have children, a hysterectomy may be recommended to treat some of the underlying causes of blood clots, like fibroids or endometriosis. During a hysterectomy, the surgeon removes your uterus and fallopian tubes. The cervix is also usually removed during this surgery. Depending on your age and your medical and family history, the surgeon may also remove your ovaries.
• Endometrial ablation - Endometrial ablation is a treatment for heavy, prolonged vaginal bleeding. This procedure destroys the endometrial lining (the lining of the uterus). It is only recommended for those who no longer wish to have children.

While blood clots are a regular aspect of the menstrual cycle, if you are experiencing excessive heavy bleeding with blood clots or think you could have another underlying condition, schedule an appointment with your OB/GYN to discuss your best treatment options.