Skip to main content

Are Menstrual Clots Normal?

One of the “joys” of womanhood, our monthly menstrual flow, can sometimes come with some surprises. One of those occurrences for many women is menstrual blood clots. Most women want to know if this is normal – and why it is happening.

Your Period

During your monthly cycle the lining of your uterus (endometrium) grows thick and increases the blood supply to support a potential pregnancy. When a pregnancy does not occur the drop in hormones (especially progesterone) leads to a release of the innermost lining of the uterus and we experience a period. In an average period women lose 30-40ml (6-8 tsp) of blood, with women experiencing heavy periods losing more than 60ml (12 tsp).

Blood Clots During Your Period

In a typical menstrual flow, the blood is not clotted due to the release of anticoagulants. The contraction of the uterus also stops further bleeding from the remaining blood supply to the uterus, and helps to expel the menstrual blood. After 3 to 4 days of bleeding, most of the inner lining of the endometrium (the “stratum functionalis”) has been released and blood loss slows considerably.

Blood clots are often a consequence of heavy menstrual flow. When the blood loss is too much, or too fast, the anticoagulants produced are not adequate to breakdown the lining of the uterus and prevent further clotting. Most women who experience clotting do so on the heaviest days of their menstrual period.

Possible Underlying Causes of Menstrual Blood Clots

  1. Miscarriage

Sometimes clots are actually a very early stage miscarriage. These clots may be found along with small gray clumps of tissue. If you experience other signs or symptoms of pregnancy along with clots, you may consider having your beta HCG levels tested to determine if it was, indeed, an early miscarriage.

  1. Uterine Fibroids (Leiomyomas)

Uterine fibroids are benign (non-cancerous) growths that occur in the muscular layer of the uterus. Some women with fibroids experience no symptoms at all, but for many women with fibroids they experience heavy periods (and blood clots) as a result. Fibroids are more likely to occur as we get older, especially after having children. Fibroids are also more common in women of African descent, those who are overweight and those with a family history of fibroids.

  1. Adenomyosis

Adenomyosis occurs when the endometrium breaks through into the muscular layer of the uterus (the myometrium). This can cause cramping, bloating, heavier menstrual periods and the presence of blood clots. Adenomyosis is also more common with age, in women who have had children, and in those who have had uterine surgery (such as a Caesarean section).

  1. Iron deficiency

In one of the great injustices in women’s health one major consequence of heavy periods, iron deficiency, can also lead to heavy periods. If you are experiencing heavy periods it is vitally important to test your hemoglobin, hematocrit and ferritin (iron) levels and build up your iron levels if needed.

  1. Hormonal imbalances

Imbalances between the two main female hormones, estrogen and progesterone, can lead to increased thickening of the uterine lining, resulting in heavy menstrual periods and blood clots. Imbalances in these hormones can occur at any stage of the reproductive life span, but are most common during adolescence and through the 40s and perimenopausal years.

  1. Thyroid imbalances

The thyroid is a small, butterfly shaped gland in your neck that controls your metabolic rate and has significant impacts on your hormonal health. An underactive thyroid can cause many symptoms – fatigue, difficulty losing weight, hair loss, and heavy periods. And with these heavy periods may come menstrual blood clots.

Recommended Testing for Menstrual Clots

If you regularly experience blood clots during your period, having some laboratory and imaging studies done is a good idea. It can help you understand why you are experiencing blood clots and your Naturopathic or Medical Doctor can work with you to determine an appropriate treatment plan.

Complete blood cell count – including hemoglobin and hematocrit to look for healthy red blood cells

Ferritin – to assess for iron deficiency anemia

TSH and complete thyroid panel – to assess health of the thyroid

Female hormone panel – to compare levels of estrogen and progesterone, along with other reproductive hormones, to ensure balance

Transvaginal or pelvic ultrasound – to identify uterine fibroids or other abnormalities of the uterus and uterine lining

MRI – a further visual assessment of the uterus if ultrasound is not adequate

If you are experiencing heavy periods and menstrual clotting, speaking to your Medical or Naturopathic Doctor can help you understand why you are experiencing these symptoms and develop a treatment that is as unique to your body and your period.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

References:

Young, B. Wheater’s Functional Histology, 6th Edition, 2014.

Melmed, S. Williams Textbook of Endocrinology, 2016.

 

Understanding Spotting Between Periods

“Why am I spotting?” is a common question that comes up in my naturopathic practice, impacting up to 1 in 3 women at some point in their reproductive lifespan. Spotting is most common in women during adolescence and during the transition to menopause, but can occur at any point in a woman’s life. While most women are told spotting is not significant, speaking to your doctor is suggested to determine the underlying cause.

What is Spotting

Spotting, also called intermenstrual bleeding, or even more technically “metrorrhagia” occurs when there is bleeding from the uterus at irregular intervals, most often between expected menstrual periods.

Causes of Spotting

  1. Ovulation

Ovulation is the most common cause of spotting in women. Around ovulation estrogen levels drop off slightly as an egg is released from the ovary. This drop in estrogen can lead to bleeding that is most often significantly lighter than a period and lasts for a shorter time. The blood may also be a different colour – brownish or pink. This ovulatory spotting is considered to be normal, but you should discuss with your health care provider to ensure nothing else is causing this symptom.

  1. Birth control pill

Birth control pills, and other forms of hormonal contraception (IUDs, patches, injections and implants), commonly cause spotting (called “breakthrough bleeding”) during the first few months of use. Most common in the first three months, for some women it doesn’t improve – if this happens a higher dose birth control or different method of contraception may be needed. Breakthrough bleeding is also common if you don’t take your pills as directed (missing a day or not taking at the same time each day). Women who smoke and take birth control pills are more likely to experience breakthrough bleeding (and should consider other forms of contraception due to the increased risk of blood clots.)

Other medications have also been found to be associated with intermenstrual bleeding, including anticoagulants (warfarin, heparin), antipsychotics, corticosteroids, and selective serotonin reuptake inhibitors (SSRIs.)

  1. Polycystic ovarian syndrome

One of the hallmarks of PCOS is irregular periods. In PCOS women do not ovulate, which leads to a lack of progesterone production and unopposed estrogen causes continued growth of the uterine lining. The lining will continue to thicken until it outgrows its blood supply and degenerates. Different sections of the lining may outgrow their blood supply at different times, causing spotting.

This lack of ovulation can also have similar results in adolescent girls who do not yet have a mature reproductive hormone cascade, resulting in spotting.

  1. Local infections

Infections of the vagina, cervix and endometrial lining can all cause spotting between periods. The infection is most often secondary to a sexually transmitted infection, but can also occur with pelvic inflammatory disease. Inflammation of the cervix (cervicitis) or uterine lining (endometritis) can also cause bleeding after sexual intercourse.

  1. Uterine or Cervical Polyps

Polyps are soft growths that can occur on the inside surface of the uterus or on the surface of the cervix. These growths are benign but may cause irregular bleeding, especially after intercourse.

  1. Perimenopause

The changes in hormone balance that occur in the years prior to menopause can lead to irregular periods and spotting between periods. With the transition to menopause comes a decrease in egg quality, resulting in less progesterone production and shorter menstrual cycles. The decline in successful ovulation can also lead to longer cycles. And both of these states of hormonal imbalance can lead to spotting.

  1. Thyroid hormone imbalances

The healthy function of the thyroid directly influences the healthy function of the reproductive organs. Under functioning of the thyroid (hypothyroidism) has been known to cause menstrual spotting, and correcting the underlying imbalance typically resolves the symptom.

  1. Pregnancy

Spotting in pregnancy can be an alarming symptom, but for many women it is totally normal. Some women experience spotting associated with implantation that can be very similar to a menstrual period. If you do experience spotting in pregnancy, see a doctor immediately to ensure optimal safety for both mom and baby, and to rule out an ectopic pregnancy which can be life-threatening if not treated.

  1. Uncommon causes

Less common causes for intermenstrual spotting include foreign bodies in the vagina (most often toilet paper or tampons) and certain types of reproductive cancers, including cervical, ovarian, endometrial and vulvar cancers. Clotting disorders can also worsen spotting and should be considered in teen girls with heavy periods or frequent spotting.

Testing for Spotting

While most spotting between menstrual cycles is benign and normal, it is important to try to identify an underlying cause, and correct it if possible. Achieving hormone harmony is possible, and can be done with the support of your Naturopathic Doctor.

Discuss this checklist with your Medical or Naturopathic Doctor to help you achieve your personal hormone balance.

Menstrual spotting checklist

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

10 Tips to Treat PMS Naturally

PMS (premenstrual syndrome) sucks.  That’s not medical jargon, that’s just the way it is.  Once a month, up to three-quarters of women experience physical or emotional discomfort or pain which can last up to 14 days (two weeks!!).  Over 150 symptoms of PMS have been identified but the most common symptoms are:

Naturopathic treatment of PMS
There are over 150 symptoms associated with PMS
  • Decreased energy
  • Irritability, nervousness, anxiety and anger
  • Food cravings
  • Depression
  • Headache
  • Altered sex drive
  • Breast pain
  • Muscle aches and low back pain
  • Bloating
  • Diarrhea and/ or constipation
  • Swelling of the hands and feet
  • Trouble concentrating
  • Difficulty sleeping

What causes PMS?

Honestly, we don’t exactly know what causes PMS.   It’s most likely a combination of imbalances in our hormones, neurotransmitters and environment that leads to symptoms of PMS.

Balancing these diverse systems gives most women relief from their PMS symptoms.  It sometimes takes time to determine which treatment is right for you.  An experienced Naturopathic Doctor will be able to tailor an individualized plan to give you the best chance for success.

10 Tips to Treat PMS Naturally

1. Exercise

Exercise is important for your overall health, but it can also decrease symptoms of PMS.  Studies have shown again and again that women who engage in regular exercise have fewer PMS symptoms than women who do not.  And the exercise doesn’t need to be intense – it just needs to happen regularly (at least 3 times per week throughout the month).

Exercise is thought to reduce PMS symptoms by reducing estrogen levels, improving glucose tolerance and raising endorphin levels.  Aerobic exercise (swimming, cycling, running, etc), yoga or tai chi are all beneficial.

2.    Cut out sugar

Women who experience PMS have been reported to eat whopping 275% more refined sugar than women who do not get PMS symptoms.  Refined sugars deplete our magnesium levels, increase sodium and water retention and create imbalances in our insulin levels.  All of these processes have been linked to the development of PMS symptoms.

Eliminating refined sugar and limiting simple carbohydrates in favour of high fiber complex carbohydrates lowers blood levels of estrogen, improves magnesium levels and can significantly improve symptoms of PMS.   So cut out the cookies, cakes, bagels and breads in favour of oatmeal, popcorn, quinoa, brown rice and other fiber rich foods.

 3.    Eliminate caffeine

Caffeine consumption is associated with more and worse PMS symptoms.  Caffeine is linked especially to breast tenderness,anxiety, irritability and difficulty sleeping during PMS.  The impact is even worse when combined with sugar (pay attention all you Frappuccino drinkers!).  Eliminating caffeine, or limiting it during the premenstrual phase can improve PMS symptoms for a lot of women.

4.    Take a probiotic

Probiotics are not just for digestive health!  Having good bacteria in our intestines has wide ranging benefits for our health.  Healthy bacteria can decrease symptoms of PMS by increasing beta-glucuronidase enzyme activity and promoting estrogen excretion.

The best way to establish a healthy bacteria flora in your intestinal tract is to take a probiotic supplement.  Try for one with both Lactobacillus acidophilus and Bifidobacterium bifidum.  Taken with food, probiotics are extremely safe and have no negative side effects (you can experience bloating if you take too much – 1 to 10 billion is usually a safe amount).

 5.    Take a calcium and magnesium supplement

1k-7649 spinachThere is a direct relationship between calcium and estrogen.  Estrogen is involved in the absorption, metabolism and utilization of calcium in our bodies.  Clinical trials have found that both mood and physical symptoms of PMS are improved with daily calcium supplementation

Magnesium deficiency is a major concern and is seen in a majority of women with PMS.  Magnesium deficiency causes fatigue, irritability, mental confusion, menstrual cramps, insomnia, muscle aches and pains and heart beat irregularities.

Dietary sources of calcium include dark green leafy vegetables, dairy (cheese, yogurt, milk), tofu, and almonds.  Dietary sources of magnesium are similar and include green leafy vegetables, tofu, legumes, nuts, seeds and whole grains.  Calcium and magnesium supplements should be taken in the evening, away from iron supplements and thyroid medications.

6.    Take B vitamins

B vitamins are involved in hundreds of different processes in our bodies.  The liver uses various B vitamins to detoxify estrogen and allow our bodies to eliminate it.

Additionally, pyridoxine (vitamin B6) can ease symptoms of PMS by increasing production of the neurotransmitters serotonin and dopamine.  Low levels of these neurotransmitters have been suggested as a cause of many PMS symptoms including low energy, irritability and mood swings.

As if that wasn’t enough, B6 is also involved in transfer of magnesium into cells – without B6 magnesium wouldn’t be able to enter cells.  This is another reason why B vitamins, and especially B6 are so important in the relief of PMS symptoms.

7.    Dong Quai

Dong Quai (Angelica sinensis) is a traditional Chinese herb with thousands of years of use for imbalances in the female reproductive system.  It has been used for menopause, painful menstruation, no menstruation and as a uterine tonic.  Dong quai has phytoestrogenic properties and is best used for women who experience PMS symptoms in addition to painful menstruation.

 Dong quai is usually used from ovulation (day 14) until menstruation begins.  If you are also experiencing painful periods, continue it until your period stops.

 8.    Chaste tree

While best known as a treatment for menopause, chaste tree (Vitex agnus castus) is probably the single most important herb in the treatment of PMS.

The effects of chaste tree appear to be due to the impact it has on the hypothalamus and pituitary – the starting point for hormone production in the body.  As a result, chaste tree is able to normalize the secretion of many hormones, for instance, reducing prolactin levels and normalizing the estrogen to progesterone ratio.

Chaste tree is best taken daily throughout the menstrual cycle.  Studies have found it to be useful for almost all symptoms associated with PMS including irritability, mood swings, anger, anxiety, headache, and breast tenderness.

9.    Licorice

Licorice (Glycyrrhiza glabra) is an amazing herb!  It has been used in both Western and Eastern herbal medicine for thousands of years for a wide variety of ailments.  It also has impressive modern scientific research to back up its historical uses.

 Licorice is useful in the treatment of premenstrual syndrome because it lowers estrogen levels while simultaneously raising progesterone levels.  Licorice also blocks the hormone aldosterone, decreasing water retention.

 Licorice is usually taken from ovulation (day 14) until your period starts.  It should not be used if you have a history of kidney disease or high blood pressure.  You should be under the care of a Naturopathic Doctor while taking licorice.

10. See a Naturopathic Doctor

This is probably the best thing you can do to help manage your PMS symptoms.  Naturopathic Doctors are experts in correcting the underlying imbalances that lead to PMS symptoms.  Your unique set of symptoms will give an experienced ND a lot of information that can be used to individualize a treatment plan just for you.  NDs also can order comprehensive hormone panels that will identify imbalances in prolactin, estrogen, progesterone or testosterone that may be contributing to your symptoms.  You can find a licensed Naturopathic Doctor in your area by visiting the national association websites – CAND in Canada and AANP in the United States.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Photo credits:

Creative Commons License Mislav Marohnić via Compfight

Creative Commons License Ed Yourdon via Compfight

Tim Hamilton via Compfight