General Health

Things You Need to Know About Menstrual Clots

Almost every female has experienced menstrual clots at some point in their lives. Menstrual clots are aggregation of coagulated blood, tissue, and blood that are expelled our from the uterus during menstruation. The color of the menstrual clots vary from bright to dark red.

What are normal and abnormal clots?

The size of the menstrual clots are usually small and occasional. They do not cause any complications. Unlike the clots formed in the veins, menstrual clots are not dangerous. However, passing menstrual clots regularly can signal a medical condition that needs further investigation.

Normal clots are smaller than a quarter and occur occasionally, usually towards the beginning of the cycle. On the other hand, abnormal clots are larger than a quarter in size and occur more frequently. Heavy menstrual bleeding or clots in menstrual blood usually signifies an underlying medical condition. Menstrual bleeding is considered heavy when the need to change tampon or menstrual pad increases.

What leads to menstrual clots?

Menstruation is a physiological process in which the uterus sheds the endometrium every 28-35 days. The uterine lining is refers to the endometrium. The endometrium, under the influence of the hormone estrogen, grows and thickens throughout the month. Estrogen supports the fertilized egg and makes the conditions in the uterus suitable for the development of the egg. In absence of pregnancy, hormonal events take place in the uterus leading to shedding of the endometrium. This process is referred to as menstruation.

As the blood comes out of the cervix, certain anticoagulants are released in the body leading to breakdown of thickened blood and tissue and allowing it to pass more freely. However, when the formation of clots outpaces the action of anticoagulant in the body, menstrual clots are formed.

Causes of abnormal menstrual blood clots

Several physical and hormonal factors play an important role in forming menstrual blood clots. Some of the most common causes are:

  • Obstructions in the uterus:-Uterine obstructions can be caused by fibroids, endometriosis, adenomyosis, and cancerous tumors. Obstructions can disrupt the ability of the uterus to contract. In the absence of proper contraction of the uterus, blood can collect and coagulate in the uterus. These clots are expelled our later.
  • Hormonal imbalance:- The lining of the uterus depends on estrogen and progesterone to grow and thicken properly. In case of disrupted balance of the two hormones, heavy menstrual bleeding can occur. Some conditions in which hormonal imbalance is seen are perimenopause, menopause, stress, and weight gain. The most important symptom of hormonal imbalance is irregular menstruation.
  • Miscarriage:- In case of loss of early pregnancy, heavy bleeding, cramping, and clotting can occur.

Complications of menstrual clots:

One of the most common complications of menstrual clots is onset of iron deficiency anemia. Anemia is a condition in which there is not enough iron in the body to make healthy red blood cells. Symptoms of anemia include fatigue, lethargy, paleness, shortness of breath, and chest pain.

How can menstrual clots be treated?

Treating menstrual clots primarily involves controlling heavy menstrual bleeding.

  • Medical management

Oral hormonal contraceptives can inhibit the growth of the endometrium. It has been reported that intrauterine devices can reduce menstrual blood flow by 90 percent and birth control pills can reduce it by 50 percent.

Hormonal contraceptives play a vital role in slowing down the growth of fibroids and other obstructions in the uterus that increase the menstrual blood flow. In case of women who cannot take hormonal pills, tranexamic acid can be used. It has similar role in affecting the formation of blood clot.

  • Surgical management

Dilatation and curettage (D and C) procedure can be adopted to determine the underlying cause of heavy menstrual bleeding or as a treatment of various other causes. It is usually done after a miscarriage or childbirth.

D and C is a procedure in which the cervix is dilated and the uterine lining is scraped. It is usually done in an outpatient setting and after putting the patient under. Although it is not used as a treatment option for heavy menstrual bleeding, it can resolve the symptoms temporarily for a few months.

In case of female who have fibroids that does not respond to medical management, surgical removal of such mass is required. The type of surgery depends on the size and location of these growths. If the growth is large, myomectomy can be done. Myomectomy is a surgical procedure in which a large incision is made the abdomen to access the uterus and the fibroid is removed. Alternatively, laparoscopy can be used to remove small fibroids. Laparoscopy improves the recovery time as well.


Although menstrual clots sound alarming, they are a normal part of a woman’s reproductive life. However, females passing large clots regularly should consult a doctor to find the underlying cause behind heavy bleeding. There are any effective ways that can treat heavy bleeding and reduce the incidence of clots.


Tuhina Mishra

Dr. Tuhina Mishra completed her MBBS from Grant Government Medical College in the year 2021. She has published several research papers in Indian and international journals. She is a recipient of the ICMR-STS award in the year 2019. She is a staunch believer in making research an integral part of the medical curriculum. She has volunteered in several NGOs, healthcare startups, and awareness programs.

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