It is common for women at any time to discover clots in their menses with concern. What is the cause of the formation of these blood clots? It is normal? Menstrual blood clots can be a normal and habitual thing in menstruation for many women.
The amount, size and regularity of the appearance of these clots. Fluctuate with the particular person. They often appear when the rule is more abundant and / or longer. Quantitatively a more abundant rule is known as menorrhagia. Menorrhagia is defined as the loss of more than 80 ml of blood per cycle.
Is it normal to have clots in menstruation?
You may notice that your menstrual blood turns dark brown or almost black as the end of your period approaches. This is a normal color change. This happens when the blood is not expelled from the body quickly and begins to break down before it leaves.
Abundant menstruation occurs in 9% of women and the presence of clots in more than 50%. Women who have menstrual periods lasting five days or more are 2.3 times more likely to have more heavy menstrual periods.
Abundant menstrual bleeding and clots are associated with advanced age, obesity, and a greater number of pregnancies. A period abundant in a timely manner, is not necessarily cause for concern. However, abundant periods over time justify a visit to the doctor. Many women get used to the abundant periods, considering it normal. Over time, however, excess monthly blood loss leads to anemia, which can cause weakness or fatigue.
Why do clots appear in menstruation?
Naturally, the body usually prevents the onset of blood clots by releasing anticoagulants, but when the menstrual flow is more important, anticoagulants do not have enough time to stop the formation of clots.
What causes menstrual clots?
Excessive menstrual blood loss, called menorrhagia, may be the cause of clots. Menorrhagia is associated with many causes:
- Hypothyroidism,
- Menopause,
- Significant changes in weight,
- Deficiencies in blood clotting: von Willebrand's disease (manifested already in the first menstrual cycles)
- Uterine fibroids,
- Obstruction of the discharge of menstrual blood by polyps or by very narrow uterine necks,
- Low levels of estrogen and progesterone,
- Pelvic inflammatory disease (PID),
- Polycystic ovary syndrome,
- Endometriosis,
- Certain drugs: anticoagulants, acetylsalicylic acid (aspirin), antidepressants (selective serotonin reuptake inhibitors, tricyclic antidepressants), hormone replacement therapy, tamoxifen, phenothiazines, corticosteroids, thyroxine, contraceptives, herbs (ginseng, ginkgo , Soy products)
- Change of contraceptives. If you switch from one contraceptive method to another, the change in hormone levels can lead to changes in menstruation with the appearance of clots.
- Intrauterine contraceptive devices (IUDs) can cause more menstrual periods and also, ultimately, blood clots.
- An early miscarriage can also lead to bleeding with clots. In these cases, lower back pain and abdominal discomfort may also occur. If there is a chance that you are pregnant and you notice excessive bleeding or clots, tell your doctor. However, mild bleeding and spotting during pregnancy is not abnormal.
There are many menstrual periods with clots that do not have an organic explanation.
Diagnostic tests on heavy menstrual bleeding
Blood tests, iron levels, anemia, clotting factors
Ultrasound in search of uterine (polyps, fibroids) or ovarian disease and
Clotting menstruation
Ultrasound showing a uterine fibroma in the wall of the uterus
Hysteroscopy and endometrial biopsy (the annual incidence of endometrial cancer is 19.5 per 100,000 women)
In women close to menopause, it is sometimes challenging to distinguish between irregular cycles prior to the complete disappearance of cycles and problems in the uterus (fibroids or polyps, endometrial hyperplasia, or carcinoma of the uterus). In 10% of cases, it will be cancer. That is why it is important to carry out an exhaustive analysis.
Risk Factors for Endometrial Cancer
- Age over 40
- Weight greater than 90 kg
- Anovulatory cycles
- Childless
- Sterility
- Use of tamoxifen
- Family history of endometrial cancer or colon cancer
Treatment of clots in menstruation
The anti-inflammatory drugs mefenamic acid and naproxen are equally effective in reducing menorrhagia. If they begin to take day 1 of the menstrual cycle and for 5 days or until menstruation stops, these drugs can reduce bleeding by 22% to 46%.
Anovulatory bleeding may require endometrial protection with a combined oral contraceptive pill (ACOC), a progestin pill, or a progestogen-IUD.
Anemia will be treated symptomatically by prescribing iron pills. Asymptomatic myomas do not require treatment. Fibroids can be treated with tranexamic acid, low-dose contraceptives, androgens, or GnRH agonists. Androgens can reduce menstrual blood loss by 80%, but should be limited to 6 months of treatment due to androgenic side effects. GnRH agonists also decrease menstrual blood loss, but decreasing bone mineral density limits its use to 6 months. The most common cause of bleeding after menopause is vaginal atrophy. Atrophic vaginitis can be treated with topical cream, tablets or a vaginal ring of estrogens, lubricants or moisturizers. Itching is not a treatment option.
In fact, menstrual blood loss returns to earlier or even higher levels after the second menstrual period after the procedure.
Endometrial ablation is achieved through a variety of mechanisms, such as the laser, electric scalpel, heat, or radiofrequency. It is performed as an outpatient procedure under general anesthesia. After endometrial removal, about 85% of women have fewer symptoms, 10% require repeat ablation, and about 10% end up hysterectomy (elimation of the uterus).
Hysterectomy is a permanent cure for menorrhagia and is the recommended treatment for endometrial carcinoma. Uterine artery embolization and myomectomy are additional options for the treatment of fibroids. Embolization of the uterine artery is a relatively new procedure. It resolves menses with clots in 80% and 90% of cases. The myomectomy removes fibroids and preserves the uterus, but may affect the ability to have vaginal births.
Tranexamic acid prolonged release allows reduction of hemorrhage which reduces menstrual blood loss by more than 50%. Tranexamic acid is taken only during the menstrual cycle and does not interfere with ovulation. Therefore, it can be used by women who want to get pregnant, but who are also worried about heavy bleeding. The problem is that the treatment with traxenamic acid is expensive.