What Do Blood Clots During Your Period Mean?
Medically reviewed by Peter Weiss, MD
Seeing blood clots during your period can be alarming. Thankfully, passing blood clots while menstruating is usually normal, and it's more likely when you experience a heavier flow. Blood clots are often accompanied by increased cramping and pain.
Heavy bleeding during your period, including passing blood clots, is more common among people who’ve just started menstruating as well as people who are closer to menopause. Many people experience heavy menstrual bleeding. It accounts for about 18-30% of visits to gynecologists.
However, blood clots can also be a symptom of an underlying condition such as uterine or ovulation abnormality. Treatment depends on the condition. You can also take steps to manage a heavier flow.
What Do Blood Clots During a Period Look Like?
It’s common for period blood to look thick, clotty, jelly-like, or even stringy. This is because period blood isn’t just made of blood. Menstrual blood is made of the lining that builds up during your menstrual cycle to prepare your body for a possible pregnancy. The blood you see during your period is composed of blood, secretions from your vagina, and tissue from your uterine wall.
Losing 5-80 milliliters of menstrual blood during your period is normal. Bleeding tends to be heaviest during the first few days of your period. You are more likely to experience pain, cramping, and blood clots on those days.
According to the American College of Obstetricians and Gynecologists (ACOG), blood clots are typical during menstruation. However, clots the size of a quarter or larger may be a sign of heavy menstrual bleeding. Heavy menstrual bleeding can affect your quality of life, but it isn’t always a cause for concern. About one-third of people who menstruate experience heavy menstrual bleeding and large blood clots at one time or another.
Causes of Blood Clots During Period
Blood clots have various possible causes. They might occur as a result of normal menstruation variations, but they could indicate an underlying medical condition.
Normal Period Variations
Passing blood clots—even up to the size of a quarter—is a normal part of having your period. Contact a healthcare provider (e.g., a gynecologist) if you pass clots larger than a quarter and if you also have other signs of heavy menstrual bleeding.
ACOG defines heavy bleeding as bleeding that:
Lasts seven days or more
Permeates one or more pads or tampons hourly for several consecutive hours
Requires more than one pad or requires you to change your pad in the middle of the night
Includes clots the size of a quarter or more
Miscarriage
You are likely to pass blood clots if you experience a miscarriage. The blood clots may be quite large. Other symptoms of a miscarriage include:
Spotting
Intense cramps
A sudden gush of blood or other fluids from your vagina
Passing tissue through your vagina.
Contact your ob-gyn or midwife promptly if you think you are having a miscarriage.
Uterine Abnormalities
Several types of abnormalities in your uterus or uterine lining can result in heavy menstrual bleeding, which may include blood clots. Uterine abnormalities that can contribute include:
Uterine polyps: Benign growths that can occur in your uterus or cervix
Adenomyosis: When the lining of your uterus grows into the muscular layers of your uterus
Fibroids or leiomyoma: Benign (noncancerous) uterine masses
Malignant masses or hyperplasia: Uterine cancer
Irregular Ovulation
Irregular ovulation can increase your risk of a heavier menstrual flow and blood clots. This may include not ovulating at all or ovulating less frequently. Ovulation issues like these may happen when first begin menstruating or as you approach menopause. Other conditions that can cause abnormal ovulation include:
Polycystic ovarian syndrome (PCOS): A condition that occurs when the ovaries make more androgens (the male sex hormone) than it needs to, which affects female reproductive organs
Pituitary adenoma: A benign growth on your pituitary gland
Thyroid disease: Conditions like hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid)
Blood Clotting Issues
A blood clotting issue can sometimes cause a heavier period. Underlying causes of blood clotting issues include:
The use of anticoagulant (blood thinning) and antiplatelet (blood clot preventing) medications
Thrombocytopenia, which is when you have an abnormally low number of platelets (blood components that help form clots)
Any abnormality in your platelet function
Conditions that cause insufficient platelet factors, such as von Willebrand factor (VWF)
Contact your healthcare provider if think your heavy bleeding and clotting may be connected to a blood clotting issue.
When To See a Healthcare Provider
It’s very common to have concerns about heavy menstruation and blood clots. Always visit a healthcare provider if you have questions or concerns about your flow.
In general, it’s normal to bleed for four or five days, have cramps, pass small clots, and lose about 2-3 tablespoons of blood during your period. People with heavier flows usually bleed for about seven days and lose up to two times as much blood. Contact a healthcare provider if you have symptoms of heavy bleeding.
Your provider will discuss possible underlying conditions that might be causing heavy bleeding. They'll also want to ensure that you aren’t experiencing anemia as a result of blood loss. Anemia is a serious condition that results from excessive blood loss. The blood loss causes a reduced number of red blood cells or hemoglobin, the protein that helps your red blood cells transport oxygen from your lungs to the rest of your body. Severe anemia can cause symptoms like general weakness, fainting, shortness of breath, low blood pressure, and even shock or death.
Related: Can You Sleep With a Tampon In?
Diagnosis
Your healthcare provider will likely take a full medical history and ask you questions about your menstrual periods. This may include questions like:
When did you first start menstruating?
How frequently do you get your period?
How long do your periods last?
How much blood do you usually notice?
Any other symptoms?
They may also ask you about your sexual history, current sexual partners, history of sexually transmitted infections (STIs), current medications, and any medical conditions that might affect your period flow.
Possible testing includes:
Blood tests to check your thyroid function, look for anemia, or check for a blood clotting disorder
Pap smear to check for cervical inflammation, infections, or changes that might indicate cancer
Uterine biopsy (removing a sample of cells or tissue and examining it under a microscope) to look for abnormalities
Ultrasound to check your uterus, surrounding organs, and blood flow
Further testing may be required. This might include:
Sonohysterogram: Also known as saline infusion sonography (SIS), this imaging procedure uses sound waves to check for uterine lining abnormalities.
Hysteroscopy: The provider inserts a thin tube with a light into your vagina to view the inside of your uterus and check for fibroids, polyps, or other abnormalities.
Dilation and curettage (D&C): The provider lightly scrapes away uterine tissue to get a better view of your uterus.
Treatments for Blood Clots During Period
Treating heavy periods and blood clots depends on the underlying cause. Medical options—medications or surgeries—are usually the first line of treatment.
Medication options include:
Birth control pills: Help regulate the menstrual cycle and reduce flow
Iron supplements: Increase iron levels in people who have anemia
Intrauterine device (IUD) contraception: Helps regulate the menstrual cycle and reduce flow
Hormone therapy: Medications containing synthetic estrogen or progesterone to reduce flow
Stimate (desmopressin nasal spray): Prevents excessive blood loss by improving blood clotting (for people with bleeding disorders)
Antifibrinolytics: Medications like Cyklokapron (tranexamic acid) that reduce bleeding by preventing blood clots from breaking down
Surgical options include a D&C and:
Hysteroscopy: To remove polyps or fibroids can be removed or reduce the lining of the uterus
Endometrial ablation or resection: Removing the lining of the uterus to eliminate or reduce bleeding during periods (might eliminate your ability to carry a pregnancy)
Hysterectomy: Removal of the uterus
Tips for Managing Heavy Menstrual Periods
Managing a heavy flow and blood clots during your period can be challenging. Heavy periods can disrupt your life, cause significant distress, and make it hard to work or care for your family. Most people who have heavy periods also deal with intense menstrual cramps and pain, which can be disruptive as well.
Thankfully, there are several effective ways to manage your heavy flow and pain. Here are some ideas:
Try pain medication: Talk to your healthcare provider about over-the-counter or prescribed pain relief. In general, NSAIDS like ibuprofen and naproxen are most effective for period pain.
Rest: Whenever possible, get plenty of rest during your period. Know that it's okay to cancel non-essential plans or tasks if needed.
Exercise: For many people, exercise can help reduce pain and discomfort. This may include light walking or gentle exercises like yoga and stretching.
Apply heat: Heating pads or hot water bottles can help reduce pain.
Try a supplement: Some people find herbal supplements and teas for menstruation issues helpful. Supplements aren’t well regulated, so always talk to your healthcare provider before trying one.
Don't hesitate to reach out for support if your period affects your daily functioning.
A Quick Review
Passing a blood clot during your period can be distressing. However, many people who menstruate experience clots at some point or another. Blood clots are most common if you have a heavy flow as well as during the first few days of your period.
That said, large blood clots (larger than a quarter) and a heavy flow might indicate an underlying condition. Always reach out to your healthcare provider to discuss the next steps and to get some tips for managing your flow.
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