Are blood clots during menstruation normal or not? Why are there large blood clots during menstruation?

Sometimes in a woman’s life the problem of heavy periods with clots arises, which makes it impossible to lead a full life. What kind of disease this is and how to deal with it can be understood by considering the problem from all sides.

Significant blood loss during menstruation can be either a separate disease or a symptom of a disorder in women's health. Heavy periods with clots, or dysfunctional uterine bleeding, is a disease that is characterized by the presence of abnormal bleeding from the uterine cavity, which is not caused by the presence of pathology of the pelvic organs, systemic diseases or disruption of pregnancy.

ICD-10 code

N92 Heavy, frequent and irregular menstruation

Epidemiology

Heavy periods with clots can occur at any time in a woman’s life, regardless of her age, place of residence and race. During the hot season, the risk of bleeding increases significantly due to the increased load on the cardiovascular system. There is also an influence of changes in atmospheric pressure on the development of menstrual irregularities.

Causes of heavy periods with clots

The etiological factors for the occurrence of heavy menstruation are:

Stress, severe psycho-emotional shock;
Eating disorders such as obesity, hypo- and avitaminosis, starvation;
Chronic diseases of the liver, cardiovascular system, etc.;
Hormonal imbalance;
Previous gynecological operations;
Infectious diseases of the pelvic organs;
Radiation exposure;
Congenital anomalies of the development of the genital organs.

Risk factors

A variety of unfavorable factors affect the female body during different periods of development, formation, formation and decline of reproductive function. Most often during periods of greatest vulnerability - puberty and menopause. The main risk factors for the development of uterine bleeding are:

During puberty:

Excessive physical activity;
Malnutrition, hypovitaminosis;
Mental stress and stress;
Acute and chronic diseases of infectious origin.

During reproductive age:

History of abortion;
Complicated childbirth;
Inflammatory diseases of the pelvic organs;
Neuroendocrine diseases;
Hormonal imbalance;
Occupational hazards;
Mental and emotional stress.

During menopause:

Acute and chronic infectious diseases;
Education of the pelvic organs;
Stress;
Presence of pelvic organ prolapse;
Diseases of the cardiovascular system and endocrine glands.

Pathogenesis

Normally, menstruation is regular, cyclical, painless uterine bleeding, which occurs when the functional layer of the endometrium is rejected due to a decrease in the level of progesterone and estrogen and does not exceed 80 ml of total blood loss during menstruation.

The following concepts are used in medicine:

Hyperpolymenorrhea is a disorder of menstrual function, which is manifested by regular heavy bleeding exceeding the total blood loss of 80 ml per menstruation.
Acute menorrhagia is unexpected heavy uterine bleeding not associated with the cycle.
Metrorrhagia is heavy, prolonged, irregular bleeding between menstruation.

Heavy menstruation may indicate such disorders of women's health as: the presence of uterine fibroids, cervical tumors, pathological menopause, pregnancy complications, etc.

The main pathogenetic aspect of the development of uterine bleeding is an imbalance of the main hormones against the background of changes in the function of the most important parts of the hypothalamic-pituitary and ovarian systems.

The female reproductive system is built according to a hierarchical type, the main links of which are: the cerebral cortex, hypothalamus, pituitary gland, ovaries, uterus and other target organs (breasts, thyroid gland). So in the cerebral cortex, the main regulators of the menstrual cycle are dopamine and norepinephrine, which control the hypothalamic gonadotropin-releasing hormone (GnRH), and serotonin, which controls luteinizing hormone (LH). The hypothalamus is one of the main structural formations of the brain, which produces releasing hormones that release pituitary hormones and statins that suppress their release. GnRH is the main hypothalamic hormone involved in the menstrual cycle. It is released into the bloodstream once every 60 minutes and the maximum frequency of its release is recorded in the preovulatory period, and the lowest in the second phase of the cycle. Directly involved in the regulation of the menstrual cycle are gonadotropins - pituitary hormones such as: prolactin (PRL) - the lactation hormone, follitropin (FSH) - the hormone of growth and maturation of follicles, and lutropin (LH) - the hormone of the corpus luteum. The ovaries synthesize estrogens, gestagens and androgens - hormones that have a vegetative (development and vital activity of the genital organs) and generative (hormonal background) effect on the female body. Thus, if at least one of the links - the cycle regulators - falls out or is disrupted, the hormonal levels will fail and the proliferation of the endometrium of the uterus will change. Excessive stimulation of the uterus by estrogen will lead to an increase in the thickness and hypoxia of the endometrium, which, due to increased contractility of the uterus, will be rejected continuously and non-simultaneously, one area after another, which in turn is accompanied by heavy uterine bleeding with long-term clots.

Symptoms of heavy periods with clots

Depending on the cause of bleeding from the genital tract, a woman may experience various symptoms, ranging from pain to dizziness and loss of consciousness. In more detail regarding the cause of occurrence, a detailed description of the symptoms, first signs and complaints is presented below.

Heavy periods with clots after a delay

Sometimes, after a delay in menstruation, a woman experiences heavy bleeding with clots from the genital tract, and there may be aching pain in the lower abdomen with radiation to the anus. The cause of this symptom complex may be a disrupted pregnancy or the use of an oral contraceptive. Determining the level of human chorionic gonadotropin in the blood will help determine the cause. Even with complete spontaneous abortion, its numbers, for some time, remain at a high level. This occurs due to the fact that the non-viable embryo is rejected by the prepared endometrium and is accompanied by a large amount of blood loss. In this case, the woman experiences weakness, dizziness, nausea, and sometimes vomiting. If you have such symptoms, you must immediately call an ambulance for hospitalization in a specialized medical facility.

Heavy periods with clots during pregnancy

The appearance of bleeding from the genital tract in a pregnant woman usually indicates a spontaneous abortion. In this case, the first symptom is a nagging pain in the lower abdomen, which radiates to the rectum; in the second half of pregnancy, the pain can be cramping. Bloody discharge, however, in significant quantities with clots of varying intensity. Depending on the stage of pregnancy, vacuum aspiration of the uterine contents is performed in the first trimester; after the sixteenth week of pregnancy, the fertilization product is evacuated under adequate anesthesia and hemodynamic control. In the absence of contraindications, it is permissible to prescribe uterotonics to accelerate the expulsion of uterine contents.

In later pregnancy, vaginal bleeding may indicate placenta previa. In this case, bleeding varies in intensity and is absolutely painless. If a woman is more than 20 weeks pregnant, this condition occurs, she should immediately call an ambulance.

Heavy periods with clots after childbirth

Usually, immediately after childbirth, a woman experiences physiological bleeding - lochia. It can be of varying intensity and will continue until the postpartum uterus is completely reduced to normal size. After this, if the woman in labor breastfeeds her newborn, she does not have menstruation. This phenomenon is called lactational amenorrhea and, as a rule, it continues until complementary foods are introduced into the infant’s diet. And so, after 6-12 months, the woman’s menstrual cycle is restored. Due to physiological changes that have occurred in a woman’s body, such as shortening of the cervix, dilation of the cervical canal, an increase in the size of the uterus, an increase in the volume of the endometrium, menstrual flow becomes more intense and abundant.

Immediately 2-4 weeks after birth, heavy bleeding with clots may occur due to the presence of placental remnants in the uterine cavity. In this case, bloody discharge is bright scarlet in color with an unpleasant odor and is accompanied by pain in the lower abdomen radiating to the lower back. In this case, it is necessary to seek qualified medical help, since infection of the remnants of the placenta and the development of endometritis - inflammation of the uterus - are possible.

Heavy periods with clots after cesarean section

Often, heavy bleeding with clots is observed after a cesarean section. This is due to the presence of a scar on the uterus, reduced contractility of the uterus and an unchanged cervical canal and cervix, which is an obstacle to the free discharge of lochia, as after normal childbirth. As a result, bleeding becomes longer with more clots. Over time, the menstrual cycle will improve and the amount of menstrual blood released will become more normal.

Heavy periods with clots after curettage of the uterine cavity

Heavy periods with clots after curettage of the uterine cavity may be the result of an instrumental abortion. In this case, curettage of the uterine cavity is carried out with a curette, removing the endometrium with the fertilized egg layer by layer. If during such a procedure the surgeon missed any part of the cavity, bleeding with scarlet clots may develop on days 2-4, accompanied by aching pain in the lower abdomen. In this case, you need to contact the medical institution where the termination of pregnancy was performed.

If bleeding occurs 7-10 days after curettage of the uterus, it is also necessary to seek medical help, since this condition may be caused by the presence of a placental polyp, which occurs at the site of the remains of the fertilization product. In this case, a woman may experience bleeding of varying intensity, pain in the lower abdomen, low-grade fever and nausea. To eliminate this symptom complex, in the inpatient gynecological department, against the background of adequate antibiotic therapy, repeated curettage of the uterine cavity is performed, with further prescription of oral contraceptives.

Heavy periods with clots after hysteroscopy

Hysteroscopy is a gynecological procedure using an optical device, with which the doctor is able not only to visualize the inside of the uterus, but also to take material without traumatizing the entire uterine cavity, as with curettage. Hysteroscopy is performed for both diagnostic and therapeutic purposes. However, in the case of diagnostic hysteroscopy, there are no changes in the menstrual cycle. As for surgical hysteroscopy, here the cycle lengthens, and often periods become heavier than usual. But sometimes bloody discharge changes the smell, clots appear in it and their color changes, which may indicate an infection. If heavy bleeding turns black against the background of severe pain, this may be a symptom of the disease – endometriosis. Endometriosis is a complex hormone-dependent disease in which endometrial tissue is located not only in the uterine cavity, but also outside it. In this case, the woman is bothered by severe pain in the first days of menstruation. The doctor will make an accurate diagnosis after additional diagnostic examinations.

Heavy periods with clots due to fibroids

Uterine fibroids are a benign formation that consists of connective tissue or muscle elements. If muscle fibers predominate in the structure of the formation, we are talking about fibroids, if connective tissue predominates, we are talking about fibroids. One of the first symptoms of uterine fibroids is heavy menstruation. The nature of the discharge depends on the location of the myomatous node in the uterus. So, when it is located in the submucosal layer from the very beginning of its formation, the woman is bothered by heavy, prolonged menstruation with clots, which is also associated with impaired uterine tone.

Sometimes the growth of a submucosal myomatous node in the uterine cavity is directed towards the cervical canal, which over time leads to its exit from the uterine cavity. This process is accompanied by profuse uterine bleeding, cramping pain in the lower abdomen, general weakness, a drop in blood pressure and loss of consciousness. In this condition, assistance can only be provided in a medical facility. The main goal of treatment in this case is to stop uterine bleeding, pain relief and surgical removal of the nascent myomatous node, followed by curettage of the uterine cavity.

Heavy periods with clots after 45-50 years

During premenopause, women often experience heavy uterine bleeding. This is due to the aging of the hypothalamus, in which hormonal levels are disrupted towards hyperestrogenism against the background of reduced levels of progesterone, which leads to excessive growth of the endometrium and disruption of its transformation and is manifested by long, heavy periods with clots. In this case, the cyclicity is disrupted, and the time interval between menstruation lengthens. Treatment of this category of patients is mainly surgical and is presented in the form of curettage of the uterine cavity and cervical canal. In the future, hormonal therapy is prescribed to suppress menstrual function.

Heavy periods with clots during menopause

The appearance of bleeding in postmenopause may be a symptom of a malignant tumor of the pelvic organs. Therefore, if you have such a symptom, you must immediately contact a gynecologist to carry out the necessary examinations. Such bleeding occurs for no reason and can be of varying intensity and duration.

Another cause of bleeding during menopause may be senile colpitis, which occurs due to a decrease in the level of estrogen in the blood, which leads to thinning of the vaginal mucosa and increased vulnerability. Such bleeding occurs after physical activity, heavy lifting, or sexual intercourse. In any case, if bloody discharge from the genital tract appears, you should seek medical help from a gynecologist.

Heavy, prolonged periods with clots

Menorrhagia, or prolonged heavy periods, can occur in the presence of pathology of the uterus, endometriosis, endometrial hyperplasia, diseases of endocrine origin and blood clotting disorders. Also, the cause of this symptom may be an intrauterine contraceptive or an incorrectly selected oral contraceptive. The disease can occur at any age and is not cyclical. This condition is dangerous because, against the background of prolonged heavy bleeding, anemia usually develops, which is difficult to correct due to the presence of a genital cause of bleeding. If recurring episodes of prolonged periods occur, you should contact a gynecologist who will prescribe the necessary diagnostic procedures and treatment.

Heavy, painful periods with clots

Algodysmenorrhea is a disease that plagues a large number of women and is manifested by painful, heavy cyclic menstruation. There are many reasons for this disease. Painful periods can bother women with uterine fibroids, endometriosis, intrauterine contraceptives, abnormal development of the genital organs, as well as inflammatory diseases of the pelvic organs and diseases of the endocrine and nervous systems. Pain, as a rule, occurs a couple of years after the onset of menarche and begins on the first day of the menstrual cycle or the day before it. Pain of a cramping, spastic nature, radiating to the rectum, lower back, and ovarian region. Sometimes, with severe pain and bleeding, a woman experiences nausea, vomiting, and dizziness. This symptom complex leads to temporary disability and requires drug treatment.

Complications and consequences

The main complication that occurs as a result of heavy periods with clots is anemia. Due to the significant amount of blood loss, the reserves of hematopoietic cells are depleted, erythropoiesis is disrupted, which leads to persistent anemia with all the ensuing symptoms: weakness, dizziness, nausea, loss of appetite. In addition, this condition reduces the effectiveness of hemostatic therapy. With profuse bleeding, hemorrhagic shock often develops, which requires immediate administration of blood products.

In the absence of anti-relapse treatment, heavy periods with clots may resume, with the exception of conditions after hysterectomy.

Diagnosis of heavy periods with clots

Heavy periods with clots is a disease that requires immediate medical and sometimes surgical treatment. But in order to begin its treatment, it is necessary to conduct a diagnosis and establish an accurate clinical diagnosis.

Diagnosis of this disease is carried out by an obstetrician-gynecologist, upon initial contact with complaints of heavy periods with clots. First of all, the doctor collects a detailed somatic anamnesis (history): the presence of diseases of the liver, cardiovascular and endocrine systems, trauma and surgery on the female genital organs. Then the menstrual and gynecological history: age at which menarche began, cycle quality, onset of sexual life, sexual activity, gynecological diseases and contraceptive methods. It is also important to take medications such as estrogens, antidepressants, anticoagulants, corticosteroids, digoxin and propranolol, which could cause heavy bleeding from the genital tract.

After a detailed interview, the doctor conducts functional diagnostic tests, such as: basal temperature control, hormonal colpocytology, estrogen saturation tests, which make it possible to determine hormonal levels.

Laboratory examination

A pregnancy test or determination of human chorionic gonadotropin is carried out to exclude pregnancy pathology, or trophoblastic disease, or ectopic pregnancy.

A general blood test, biochemical blood test, and coagulogram are carried out to determine the degree of anemia in the body for further correction of anemia.

Hormonal examination over time is recommended for all women suffering from heavy periods to determine their hormonal status. To do this, the levels of FSH, prolactin, LH, testosterone, progesterone and estradiol in the blood serum are determined over time. It is important to examine thyroid and adrenal hormones.

Instrumental diagnostics

Ultrasound examination of the pelvic organs and hysteroscopy are reliable and accessible methods for diagnosing pathologies of the female reproductive organs. Sometimes hysterosonography is performed (filling the uterine cavity with saline solution under the control of an ultrasound machine), which makes it possible to identify submucosal myomatous nodes of the uterus, endometrial polyps, etc.

Diagnostic curettage of the cervical canal and uterine cavity is performed on all menopausal women who have complaints of bleeding from the genital tract. In other cases, it is performed in the presence of ultrasound signs of endometrial pathology.

It is also possible to perform MRI, computed tomography, laparoscopy, hysterosalpingography and other diagnostic methods if there are indications for them.

Differential diagnosis

Differential diagnosis of heavy periods with clots is carried out in accordance with the woman’s age, since each period of a woman’s life is characterized by the occurrence of certain diseases.

Thus, in the puberty period, a differential diagnosis is made with diseases of the hematopoietic system, accompanied by blood clotting disorders and bleeding; dysfunction of the liver and gastrointestinal tract, abnormal development of the genital organs, diseases of the endocrine system (adrenal glands, thyroid gland), foreign bodies of the genital tract and vaginal neoplasms.

Differential diagnosis in reproductive age is carried out with ectopic pregnancy, uterine fibroids, adenocarcinoma, endometrial hyperplasia, endometrial injury from an intrauterine contraceptive.

In the menopausal period, differential diagnosis is carried out with endometrial adenocarcinoma, adenomyosis and hormone-producing ovarian tumors.

Treatment of heavy periods with clots

The method of treating heavy periods with clots is prescribed by the doctor in accordance with the patient’s age, the cause of occurrence, the amount of blood lost and the duration of bleeding. But, in any case, the first stage is hemostasis - stopping bleeding, which can be done surgically or medically.

How to stop heavy periods?

The first thing to do is to calm down, since with excitement the blood vessels dilate and the bleeding may increase. If bleeding occurs in a pregnant woman, you need to take a horizontal position with the foot end of the bed raised, relax, and call an ambulance. It is allowed to take the tablet form of ethamsylate “Ditsinon” 1-2 tablets with water.

For other reasons for heavy periods with clots, pre-medical measures should be as follows:

Call an ambulance.
Take a horizontal position with the foot end of the bed raised.
Place a heating pad, bottle or any other vessel with cold water on the lower abdomen, which helps to constrict blood vessels and reduce bleeding.
Drink plenty of fluids to replace blood loss.
Taking medications that stop bleeding, such as: Dicinone 1-2 tablets, maximum 4 tablets per day, 0.25 mg each, Tincture of water pepper, 25 drops 3 times a day, Shepherd’s purse extract, 25 drops 3 times a day., Calcium gluconate 1-2 tablets 3 times a day.

Further treatment will be prescribed by the gynecologist in accordance with the indications.

Hemostatic therapy is aimed at stopping bleeding, for which fibrinolysis inhibitors are used - Aminocaproic acid and Tranexam.

Aminocaproic acid is an effective antihemorrhagic agent, the action of which is aimed at inhibiting fibrinolysis, which provides a hemostatic effect. The effect of the drug occurs 15 minutes after intravenous administration. The drug is prescribed intravenously in a drip of 100 ml of a 5% solution of no more than 8 g per day or orally 30 ml 4 times a day. Contraindications for use are coagulopathies, a tendency to thrombus formation, a history of cerebrovascular accidents, and coronary heart disease. The drug should be prescribed with caution with estrogen-containing contraceptives, which increases the risk of thromboembolism.

Tranexam is an antifibrinolytic drug with local and systemic hemostatic effects. The effect of the drug occurs 3 hours after oral administration and lasts up to 17 hours. Take 1 tablet 4 times a day for 4 days. Tranexam is administered intravenously at a dose of 15 mg/kg every 6 hours no faster than 1 ml/min. Contraindications for use are subarachnoid bleeding and renal failure. Prescribed with caution for deep vein thrombophlebitis and thromboembolic syndrome. Side effects occur when the recommended doses are increased or with individual hypersensitivity to the active substance of the drug, and can manifest as nausea, vomiting, dizziness, the development of thrombosis, tachycardia, skin rash, itching, and urticaria.

Hormone therapy indicated for use based on age and examination results.

During puberty, hormones are prescribed if there is no effect from hemostatic therapy. Preference is given to combined oral contraceptives: Microgynon, Lindinet 20, Yarina, 2-3 tablets per day with a gradual reduction in the dose to 1 tablet over 21 days.

It is possible to prescribe gestagens: Duphaston, Norkolut, Utrozhestan, 2 tablets per day, followed by a dose reduction.

In reproductive age, it is performed only on nulliparous women if the M-echo of the endometrium does not exceed 8 mm on ultrasound. The drugs of choice are: 17OPK 12.5% 2 ml IM 1 time per day for 7 days, Duphaston 1 tablet 3-5 times per day, Norkolut 1 tablet 3-5 times per day, followed by a gradual reduction to 1 tablet per day .

17 OPC (oxyprogesterone capronate) is a synthetic progesterone of gestagenic origin in high doses that inhibits the secretion of gonadotropins, which helps reduce bleeding and has a prolonged gestagenic effect. The drug is administered intramuscularly with 2.0 ml of a 12.5% solution every day until bleeding stops and 0.5-1.0 ml on day 21 to prevent the development of recurrent bleeding. After intramuscular administration, the effect of the drug begins after 5 hours and lasts up to 14 days. Contraindications to the administration of 17OPK are liver dysfunction, a tendency to thrombosis, and malignant tumors of the pelvic organs and mammary glands.

During menopause, women over 45 years of age are not recommended to undergo hormonal hemostasis. It is acceptable to prescribe gestagens, such as: 17OPK 250 mg on days 14 and 21 of the menstrual cycle, Depo-Provera 200 mg on days 14 and 21.

In case of bleeding associated with impaired ovarian function, intramuscular administration of progesterone is prescribed at a dose of 5-15 mg/day for 7 days, followed by a dose reduction if the dynamics are positive.

Gonadotropin-releasing hormone agonists, such as Goserelin and Diferelin, are not used so often to stop heavy periods with clots, but have proven themselves well in further treatment regimens for uterine bleeding. The fact is that with constant administration of drugs, LH synthesis decreases and the concentration of estradiol in the blood decreases. This helps reduce the growth and proliferation of the endometrium, which leads to minimizing the risk of bleeding until the development of menopause. Goserelin is injected subcutaneously into the anterior abdominal wall once every 28 days, which ensures that the effective concentration of the drug is maintained in the body. The drug is contraindicated in pregnant women, lactating women and children. The drug was well tolerated. In rare cases, headaches, mood swings, dryness of the vaginal mucosa, cessation of menstruation, and demineralization of bone tissue may occur.

Vitamin therapy. Prolonged, heavy uterine bleeding, as a rule, leads to depletion of the body's resources of vitamins and microelements. First of all, iron deficiency occurs and, as a result, iron deficiency anemia develops. To eliminate it and replenish iron, the following is prescribed:

Vitamin B12 200 mcg/day.
Folic acid 0.001 g 2-3 times a day.
Totema 1-5 ampoules per day orally.
Globiron 1 tablet once a day.
Sorbifer Durules 1 tablet 1 time per day.
Maltofer 1 tablet 1 time per day.
Venofer intravenous drip.

The duration of taking iron supplements depends on the degree of anemia and is carried out under the control of blood counts.

Among vitamin preparations, it is justified to prescribe vitamins B6 and B1 alternating for intramuscular administration. It is also recommended to prescribe vitamin E 200 mg per day and routine 200 mg 3 times a day.

Medicinal drugs have found wide application in the treatment of heavy periods with clots. herbs and traditional medicine.

Dry nettle leaves pour half a liter of water and boil for 10 minutes, leave for 30 minutes. Take 1 tbsp internally. spoon 5 times a day.
Shepherd's purse grass 50g, knotweed grass 50g, mistletoe grass 50g. Pour the mixture of herbs into 200 ml of water, boil for 5 minutes, cool. Drink 1 glass 2 times a day from the 3rd day of menstruation.
Oak bark 30g, wild strawberry leaves 20g, raspberry leaves 20g, yarrow herb 30g. Brew in 200 ml of water and drink 200 ml. morning and evening from the 1st day of menstruation.
Buckthorn bark 30g and raspberry bark 30g. Pour boiling water over the collection, leave and drink 1 glass morning and evening.

In folk medicine, to treat heavy periods with clots, not only herbal infusions are used, but also other components for the preparation of medicinal potions.

A decoction of orange peels has good hemostatic properties. Boil the peels of 5 oranges in 1 liter of water for 1 hour over low heat. Add a little sugar and drink 1 tablespoon three times a day.
Mix fresh rowan berries and mint leaves 1:1 and brew as tea. Drink this tea 3 times a day until your period ends.
Brew 30g of dried and finely chopped herbs and parsley roots with boiling water in 400 ml of water and boil for 15 minutes, then strain. Take half a glass three times a day 15 minutes before meals.

Physiotherapy.

The following types of physiotherapeutic treatment are widely used in treatment regimens for heavy uterine bleeding with clots:

Electrophoresis with copper sulfate provides a vasoconstrictor effect
Cervicofacial galvanization increases the contractile function of the uterine myometrium
Endonasal electrophoresis with vitamin B1 increases uterine muscle tone
Vibration massage of the paravertebral zones has a complex effect on the vessels of the uterus and muscle tone, which helps reduce blood loss.

Homeopathy.

If the cause of heavy periods with clots is functional disorders, the following drugs are used for treatment:

Ovarium compositum. It is a complex homeopathic remedy that regulates hormonal levels. It has metabolic, sedative and anti-inflammatory functions. Prescribed 2.2 ml intramuscularly 2 times a week, from the third week 1 time every 5 days. The course of treatment is 10 injections. Contraindications – hypersensitivity to the components of the drug, children under 12 years of age. Prescribed with caution to pregnant and lactating women. Among the side effects, increased salivation was noted, in which case it is recommended to reduce the dose of the drug or discontinue it.
Mulimen is a complex homeopathic drug, the action of which is aimed at regulating the balance of gonadotropic and steroid hormones, normalizing the autonomic nervous system and stabilizing the mental state of a woman. It has hormone-regulating, antispasmodic, sedative and drainage pharmacological properties. Indicated for use in menstrual disorders, mastopathy, treatment of side effects of hormonal contraception, premenstrual and menopausal syndrome. Prescribed 10-12 drops 2 times a day during the intermenstrual period and on menstrual days 10-15 drops 3-5 times a day, depending on the degree of bleeding. Take 15-20 minutes before meals, holding briefly in the mouth. Contraindicated in children under 12 years of age and in case of hypersensitivity to the components of the drug. Prescribed with caution to pregnant and lactating women. The drug is usually well tolerated; allergic reactions may occasionally occur.

With the development of heavy periods with clots against the background of an inflammatory process of the pelvic organs, the following are additionally prescribed:

Gynekoheel is a basic anti-inflammatory agent with vasotonic, anti-edematous and analgesic pharmacological properties. Promotes completion of the inflammatory process, restoration of microcirculation and the formation of new tissue at the site of inflammation. Reduces the risk of complications. Has a regulating effect on the menstrual cycle. Prescribed 10 drops 3 times a day every day, except for menstrual days. Course of treatment 3 cycles. The drug is contraindicated for persons who are allergic to the venom of bees, wasps and bumblebees. No side effects were identified.
Traumeel S is the first choice drug for any damage to body tissue. It has anti-inflammatory, anti-exudative, regenerating and analgesic pharmacological properties. The drug is contraindicated for use in persons with hypersensitivity to the components of the drug, those suffering from tuberculosis, leukemia, or AIDS. Prescribed 1 tablet 3 times a day. Adverse reactions in the form of redness and rash on the skin are possible.

Surgical treatment.

Surgical intervention for heavy periods with clots, regardless of the cause, is carried out for hemostatic purposes to stop bleeding.

Therapeutic and diagnostic curettage of the walls of the uterine cavity is carried out under general anesthesia, followed by sending the resulting scraping for pathohistological examination, which makes it possible to determine the cause of bleeding in 80% of cases. After the operation, the patient is prescribed hemostatic and antibacterial therapy.

Endometrial ablation is a surgical method for treating uterine bleeding, which is carried out using a laser or electrode under the control of a hysteroscope and involves removing the entire layer of the endometrium.

Hysterectomy is a radical surgical procedure that involves removing the uterus. It is the last stage of treatment for uterine bleeding, when the condition cannot be treated with other methods.

During menstruation, almost every woman experiences blood clots. They are often accompanied by prolonged and painful bleeding, but doctors believe that this is normal. However, when a woman experiences too strong clots during her period, this may be a sign of a gynecological disease, and let’s try to figure out how to distinguish a deviation from the norm.

Why do clots come out during menstruation?

During the menstrual cycle, the walls of the uterus thicken in preparation for fertilization. If pregnancy does not occur before menstruation, the endometrial layer is shed, which is accompanied by bleeding. During menstruation, the body loses up to 250 ml of blood, but if the blood loss is larger, then this is considered to be excess of the norm. With strong discharge, blood clots form, which are essentially small blood clots.

Causes of menstrual clots

If a large number of large clots form during menstruation, then this is a reason to contact a gynecologist. After an examination, the doctor will identify their cause, because there may be several possible pathologies:

bend of the uterus;
blood clots;
uterine fibroids;
endometriosis;
diseases of the pelvic organs;
abnormal development of the uterus;
hormonal imbalance;
blood clotting disorder.

Myoma

Myoma is a benign tumor that develops due to hormonal imbalance. Due to myomatous nodes, the area of the endometrium increases, so the uterus is enlarged, and during heavy periods, clots are released, the patient experiences pain when urinating or defecating. The peak of the disease occurs at 35-50 years of age, and is usually diagnosed in women of reproductive age.

Typically, fibroids do not produce pronounced symptoms and are detected during a medical examination. Vivid symptoms mean that the size of the fibroids is large, and therefore surgical intervention is required. But there are some symptoms that should alert a woman:

Long and heavy periods.
Large blood clots with mucus.
Pain in the lower back and lower abdomen.
Dysfunction of the gastrointestinal or urinary tract.

Endometriosis

Large blood clots can cause endometriosis, when the endometrium lining the inside of the uterus grows too much, affecting internal organs. Dense endometriosis is caused by multiple abortions, iron deficiency, obesity, hormonal disorders or genetic predisposition. The symptoms of endometriosis are so varied that they sometimes confuse even the most experienced gynecologists. However, there are also pronounced symptoms:

pain symptoms in the lumbar girdle or lower abdomen;
during menstruation, severe blood clots and menstrual irregularities;
infertility;
intoxication: vomiting, weakness, chills, sometimes fever.

Anomaly of the uterus

Heavy periods with blood clots occur if a woman has a congenital anomaly of the uterus. This disease occurs in 2% of women, and plays a decisive role in whether they can have children. Sometimes a woman with this pathology manages to conceive and give birth, but pregnancy and childbirth are accompanied by complications: miscarriages are often observed at different stages. Abnormal structures of the uterus:

two-horned;
saddle-shaped;
one-horned;
with partition;
agenesis;
complete doubling.

Saddle-shaped and bicornuate uteri are common. In the first case, the part of the organ under the upper arch has not a convex, but a bottom compressed inward, in which partitions are formed. With this anomaly, it is possible to carry the fetus to term, but the septum usually causes many problems. As for the bicornuate organ, it has 2 cavities that connect in the center or near the neck. Learn more about the bicornuate uterus in the video:

Pelvic organ disease

Inflammatory processes in the female pelvic organs include any combination of pelvic peritonitis, endometritis, tubo-ovarian abscess or salpingitis. Typically, these diseases are transmitted sexually, but can also be formed by microorganisms of the vaginal microflora. Inflammatory processes are diagnosed based on complaints and clinical examination. Treatment of diseases is carried out using conservative therapy, depending on the clinical form of the disease.

Blood coagulation disorder

The hemocoagulation (blood clotting) system activates fibrinogen dissolved in the blood plasma and forms firbin blood clots in the blood vessels, stopping any bleeding. Various vascular or blood diseases lead to blood clotting disorders, which manifest themselves in the form of causeless bruises, unstoppable bleeding due to injuries or heavy periods with blood clots in women.

Hormonal imbalance in the body

Hormones are produced by the ovaries, pituitary gland, adrenal glands, pancreas and thyroid gland. The combination of all hormones is responsible for women's health. If the body lacks any type of hormones, then the following deviations begin:

disruption of the menstrual cycle, as well as blood clots and heavy discharge during menstruation;
sudden weight loss or, conversely, excess weight;
indigestion;
breast swelling;
tumor development;
prostration.

There are many reasons for hormonal imbalance. For example, in adolescents this is a temporary physiological process associated with the development of the body. And in women, hormonal storms occur after childbirth, after a missed period or after a miscarriage, during pregnancy, at the onset of menopause or during breastfeeding. Also, hormonal imbalance can easily be caused by poor diet, bad habits or chronic fatigue.

In what cases should you visit a doctor?

If you are planning a pregnancy, then blood clots during menstruation should be a cause for concern. The appearance of clots indicates the inability of the fertilized egg to attach to the uterus. If during your period not only clots appear, but also aching pain in the lower abdomen, then you need to visit a gynecologist in any case: whether you are planning a pregnancy or not.

Treatment

Treatment of gynecological pathologies requires correct diagnosis. The examination includes MRI, ultrasound of the pelvic organs, laboratory and cytological studies. If the diagnosis does not show anything serious, the doctor will prescribe iron-containing drugs that will restore low hemoglobin levels from blood loss during menstruation. In other cases, either conservative treatment or surgical intervention is prescribed if the situation is particularly advanced.

Each menstrual cycle begins with the renewal of the uterus, which starts the process of preparing it for fertilization. The discharge consists of blood, endometrium and an unfertilized egg. The endometrium peels off from the wall of the uterus, and a wound surface forms at this site and blood is released. For some women, periods are accompanied by the appearance of clots. Are such conditions dangerous? Not always. Sometimes this may not be a signal of a disease, but a feature of physiology. However, the occurrence of unusual bleeding requires increased attention. Blood clots during menstruation - causes, normal limits, methods of elimination - we will consider further.

Normal menstrual flow

In addition to the endometrium, blood is present in the discharge. It remains liquid due to the active work of substances that prevent clotting - anticoagulants. If their work is disrupted, a woman may observe lumps called clots.

They appear when staying in a static position for a long time without changing position. Why do clots come out in this position? Prolonged immobility provokes stagnation and coagulation of blood in the uterus, as a result of which they are formed. Clots are released after lying or sitting for a long time.

The average amount of discharge during critical days ranges from 80 to 150 ml. Such blood loss is considered normal and does not cause inconvenience. The duration of the entire menstruation is 5–6 days. Mild pain may occur on the first day of the cycle, but there should be no further unpleasant symptoms. Is it normal for clots to appear during menstruation? If there is no deterioration in health during blood clotting, then they should not bother the woman.

Know! The heaviest bleeding is observed on days 2–3 of the cycle. Later, the damage to the uterine wall heals and stops bleeding as much.

Causes of clots

Clots are clotted blood and in this state take on a dark red hue. They look like jelly and are usually small in size - less than 10 mm. Usually their appearance does not affect the entire process of menstruation: they do not make it more painful or longer.

There are a number of different reasons for the occurrence or intensification of this phenomenon, including:

Colds. With the development of flu and colds, as a rule, body temperature rises, which leads to intense blood clotting.
Puberty period. In adolescents, active hormonal changes are just beginning, which sometimes leads to heavy bleeding. The peculiarity of this period is that such intense discharge sometimes gives way to scanty discharge. It usually takes at least 2 years for the menstrual cycle to stabilize.
Age-related changes. The premenopausal state, which is typical for older women, can also affect the presence of clots in the discharge. During this period, this phenomenon occurs frequently.
Congenital pathologies. A bicornuate uterus and other abnormalities of the reproductive system can cause blood stagnation and increased clotting. Also, during menstruation, the ability of the uterus to contract is impaired, as a result of which the bleeding becomes stronger and clots are observed in it. Due to their anatomical features, they may be black.
Abortion. If the pregnancy is interrupted for some reason at 1–2 weeks, the fertilized egg is released during the first menstruation. In this case, large clots are observed in the discharge, similar in consistency to liver.
Blood diseases. Diseases increase the viscosity of the blood, which interferes with its normal clotting.
Childbirth. After childbirth, heavy bleeding appears for 3–10 days and is accompanied by clots. Their size can be different: very small or huge. If they continue to be released for a long time in large quantities, this is a reason to seek medical advice.

In addition to these reasons, there are various diseases in which such a phenomenon would be considered an unfavorable symptom. To diagnose them, you need to contact a specialist; only he will be able to understand the real reason for the appearance of clots. Your doctor will also determine whether these symptoms are dangerous.

Know! The size of clotted blood can range from 2–4 mm to 12 cm.

Diseases that require mandatory treatment are:

Iron-deficiency anemia. The disease is characterized by a low amount of iron, which leads to a decrease in hemoglobin. Cell oxygen saturation decreases. As a result, a gradual decrease in performance and fatigue develops. Symptoms in a woman: weakness, nausea, change in taste preferences, tendency to frequent illnesses. Iron deficiency anemia develops against the background of heavy, painful menstruation. In this case, blood with small clots (less than 4 cm) is observed in the discharge.
Uterine fibroids. Nodes, which are benign tumors, form in the uterus and prevent the natural detachment of the endometrium. In women, severe bleeding is observed, and there may be huge clots resembling liver.
Endometriosis. A disease in which the endometrium grows in atypical places, which leads to severe pain. A characteristic feature of endometriosis is heavy periods, which are accompanied by clots from the first days
Ovarian cysts. Expressed in painful sexual contacts, prolongation of the entire menstrual cycle, irregular periods. Without proper treatment, the cyst promotes the appearance of clots along with heavy bleeding, which means that the disease is progressing.

Such pathologies, if treated inadequately or not, can lead to serious consequences.

How can you stop heavy periods?

There are several ways to regulate the menstrual cycle. This:

oral contraceptives - when used, the duration of menstruation and the amount of blood loss are reduced;
hormonal pills - help to adjust the cycle schedule, allow bleeding to pass faster and not so profusely;
complete, proper nutrition;
active physical exercise;
regular sexual intercourse.

Important! If the appearance of clots is accompanied by pain, heavy menstrual bleeding, weakness, or high fever, you should see a doctor.

When to see a doctor

Consultation with a gynecologist is required in the following situations:

there is a lot of discharge, and it continues for more than 7 days in a row;
bleeding did not start at the beginning of the cycle;
the smell becomes unpleasant and pungent;
attacks of tachycardia and shortness of breath occur;
weakness and constant fatigue appear;
severe pain syndrome is observed.

All these signs can be a signal of serious blood loss, and therefore require prompt medical attention.

Important! Heavy prolonged bleeding, during which more than 150 ml of blood is lost, can be dangerous to the life and health of a woman.

If you have been experiencing clots in your periods for a long time, you should not worry and give yourself a terrible diagnosis. This condition is often normal and does not require drug therapy. However, if the clinical picture is supplemented by severe pain and other manifestations, consultation with a specialist is required. Only he can prescribe the correct treatment.

The reproductive cycle begins with menstruation - renewal of the mucous membrane of the uterine cavity and preparing it to receive a fertilized egg. When removing dead endometrium, bleeding occurs, which normally does not cause particularly unpleasant sensations in a woman. But the type of discharge varies significantly depending on many factors. The reasons can be both completely harmless and dangerous. For example, the appearance of clots in a woman’s menstrual blood is sometimes explained by physiological characteristics, and in some cases it is a symptom of a disease.

Content:

Normal menstrual flow

The secretions during menstruation include particles of the rejected endometrium, blood from small blood vessels damaged when it is peeled off, and mucus produced by the glands of the cervix. The blood contains anticoagulants (enzymes that prevent clotting). They ensure that the discharge has a liquid consistency and is quickly removed. If menstruation is too heavy or mucus stagnates in the uterus, then anticoagulants do not cope with their role, the blood coagulates, and clots appear in the secretions.

Stagnation can occur, for example, if a woman remains in one position for a long time. Therefore, clots appear when you get out of bed or after sitting for a long time.

If the volume of blood discharge for all days of menstruation does not exceed 80-100 ml (with the maximum occurring on days 2-3), and they last no more than 5-6 days, then we can assume that menstruation is proceeding without deviations, and the appearance of clots - this is the norm. In this case, the discharge should not have an unpleasant odor and there should be no other painful symptoms.

Natural causes of clots

Sometimes blood clots appear during menstruation for natural reasons. These include:

Increased blood clotting when body temperature rises (during a cold or flu, for example).
Infectious diseases that provoke increased clotting (sore throat, inflammation of the bladder and others).
Increased intensity of menstrual bleeding during the period of hormonal changes in the body. Heavy bleeding may alternate with scanty bleeding during the formation of the menstrual cycle in teenage girls or in women during premenopause. Therefore, the appearance of blood clots in menstrual flow during these periods is inevitable and natural.
Congenital abnormality of the shape of the uterus (the so-called “bicornuate uterus” - its cavity is divided by a septum into 2 parts), as well as abnormal location (bending) of the uterus.
Termination of pregnancy at 1-2 weeks, when the fertilized egg could not stay in the endometrium. In this case, a woman’s menstruation occurs with a slight delay, and remnants of the fertilized egg in the form of blood lumps are observed in the discharge.
Blood diseases, the presence of cardiovascular pathologies, leading to an increase in its viscosity.
Contraception using an intrauterine device. It prevents the normal flow of blood.
Iron-deficiency anemia.

If a metabolic disorder occurs in the body, then iron deficiency forms in the blood and the level of hemoglobin decreases. This protein provides oxygen to the body's cells. Due to its deficiency, the normal functioning of all organs is disrupted. With anemia, a woman suffers from frequent headaches, dizziness, weakness, nausea and vomiting. Menstruation becomes painful. Menstrual discharge contains clots up to 4 cm in size.

Note: The formation of clots in menstrual blood is facilitated by a woman’s low physical activity and insufficient fluid intake.

Video: Natural causes of clots during menstruation

Signs of pathology in the presence of clots

Often, menstrual discharge with clots is a symptom of pathology in the condition of the reproductive organs. Particular attention should be paid to this sign if a woman has cycle disorders, blood clots are observed throughout menstruation, their size exceeds 5 cm. Pathological discharge with blood clots during menstruation smells bad, there are yellow, green or white impurities in it mucus.

Signs of pathology may include severe pain in the back and lower abdomen during and between periods, blood loss of more than 150 ml, weakness and dizziness after the end of menstruation.

If you have such symptoms, you should definitely consult a doctor and undergo an examination.

The appearance of clots due to hormonal imbalances in the body

The condition of the endometrium, the amount and composition of mucus produced in the cervix, depend entirely on the ratio of ovarian sex hormones. In turn, the production of estrogen and progesterone is regulated by pituitary hormones and is closely related to the work of all endocrine organs.

Any imbalance of hormones affects the course of the menstrual cycle and the nature of menstruation. The appearance of blood clots during menstruation may mean that a woman has abnormalities in the functioning of the endocrine system. Copious discharge with clots occurs in women with diabetes, as well as those with thyroid disease.

The occurrence of hormonal disorders is facilitated by the use of steroid drugs, surgical intervention in the functioning of the genital organs (diagnostic or therapeutic curettage of the uterus, abortion), as well as violation of physiological norms. Stress also affects the nature of your periods, as it increases hormonal imbalance.

The risk of hormonal disorders is high in women prone to obesity. Adipose tissue produces estrogens, which causes increased development of the endometrium, promotes its loosening and facilitates the detachment of individual pieces.

Note: Inflammatory kidney diseases can provoke heavy bleeding with clots during menstruation. These organs are not only responsible for removing excess fluid from the body, but also participate in the synthesis of hormones. The composition and coagulability of blood is also affected by the condition of the liver.

Clots in menstrual blood as a sign of disease

Clots in menstrual flow may be a symptom of pathological processes occurring in the uterus or ovaries.

Endometrial hyperplasia

Abnormal proliferation of mucosal cells in the uterine cavity leads to changes in the structure of connective tissue and glands. The thickness of the epithelial layer increases and its density decreases. Pathology occurs as a result of hormonal changes, trauma to the uterus, congenital anomalies of its development, and metabolic disorders.

Incorrect growth of the endometrium occurs due to the fact that menstruation comes irregularly, lasting less than 3 days. The spent cells are not completely removed from the uterus. New layers grow, the structure of the mucous membrane changes. The loose endometrium is destroyed more quickly, causing dense dark red clots to appear in the blood during menstruation.

Endometriosis

This disease is also associated with the proliferation of the epithelium, but the endometrium not only increases in thickness, but also grows into the tubes and cervix. It may grow into the muscular layer of the uterus (adenomyosis), and subsequently through the outer lining of the uterus into the abdominal cavity.

The characteristic signs of this disease are:

increased duration of menstruation (10 or more days);
increased intensity of menstrual flow (more than 150 ml) with large clots;
presence of intermenstrual bleeding;
the appearance of brown spotting 3 days before menstruation and for 2-3 days after it;
increased pain during menstruation;
the appearance of symptoms of anemia due to increased blood loss.

The disease occurs due to hormonal imbalances. Proliferation occurs at the site of damage to uterine tissue during childbirth and surgery, after infectious and inflammatory processes.

Polyps and cysts in the endometrium

They arise as a result of its improper development. Polyps are easily injured, especially when the endometrium is detached during menstruation. This leads to increased bleeding and the appearance of blood lumps in the discharge.

Uterine fibroids. Malignant tumors

A benign tumor arises in the wall of the uterus and grows towards the uterine cavity, grows in the thickness of the muscle tissue or extends to the outer lining. The uterus stretches, blood circulation and endometrial development are disrupted. In this case, menstruation is irregular, heavy, with dark mucous fibers and lumps.

Irreversible tissue destruction in malignant tumors causes heavy bleeding and large dense clots.

Video: Reasons for heavy periods

Examination of a woman to determine the causes of the pathology

If a woman has signs of abnormal menstruation, then first of all, blood clotting is examined and the hemoglobin content is determined in order to determine the degree of anemia. The content of leukocytes can be used to determine the presence or absence of an inflammatory process.

A blood test is performed for hormones and antibodies to infectious agents. If cancer is suspected, an analysis is done for tumor markers.

An ultrasound of the pelvic organs is required. The study allows you to determine the presence of neoplasms and endometrial hyperplasia, to see deviations in the structure and location of the internal genital organs.

To examine the cavity and cervix, an optical device, a hysteroscope, is used, which allows you to examine suspicious areas with special lighting and magnified images.

Tissue biopsy and diagnostic curettage make it possible to accurately determine the nature of the tumors.

Video: Hormone examination for menstrual irregularities

From about 12 years of age, every girl experiences menstrual bleeding every month. By the nature and regularity of these discharges, one can judge the woman’s health status and any possible pathologies. It often happens that menstruation comes in clots. Why does this happen and is this a reason for an unscheduled consultation with a gynecologist?

What is menstrual flow?

Throughout a woman's entire menstrual cycle, the lining of the uterus prepares for the possibility of pregnancy. In order for the fetus to be securely attached to it, its walls constantly thicken. If the conception of a child does not occur, the next period begins, during which not only menstrual blood, but also the rejected endometrial layer comes out of the woman’s body. After the end of the monthly discharge, the endometrial layer will begin to grow again in anticipation of fertilization.

Typically, the blood released during the “red days of the calendar” has clearly defined characteristics: a bright scarlet color, a rather unpleasant specific odor and low coagulability. On average, discharge lasts about 4 days, and during this time no more than 250 ml of blood leaves the female body. The nature of menstruation can differ significantly in the first and last days. At first they are scarlet in color and high intensity, and after the third day they become less abundant and acquire a brown or dark red hue.

Causes of clots during menstruation

For what reasons does blood clot, why do menstruation also clot? The most common are the following.

Endometriosis, or pathological proliferation of endometrial tissue. Absolutely all women of childbearing age can be susceptible to this disease. But in most cases it affects girls who have repeatedly had abortions and curettage. Usually this condition is accompanied by severe pain, heavy menstruation and spotting before and after it.

Sometimes the first periods after childbirth begin in a similar way. This pathology can be caused by the fact that particles of the placenta remain in the uterus. In advanced cases, curettage may be required.
Immediately after the curettage procedure (for example, during a frozen pregnancy), notches may form on the uterine mucosa. Blood sometimes gets into such holes, which coagulates and is released along with menstruation in the form of clots.
When female hormonal levels are disrupted, namely the ratio of estrogen and progesterone, in some cases the blood clotting function is enhanced - this leads to the formation of clots.
Uterine fibroids are a benign neoplasm that changes the nature and process of menstruation.
If there is an intrauterine device, particles of the fertilized egg may come out in the form of clots.
Finally, a change in the nature of menstruation and the formation of blood clots can be triggered by low hemoglobin, an excess of B vitamins, abuse of alcoholic beverages and nicotine, as well as psycho-emotional instability and regular stress.

Should I see a doctor if my periods come with clots?

As a rule, women do not go to the gynecologist if they notice blood clots during menstruation.

Indeed, this is often a variant of the norm and does not require a medical examination.

At the same time, in some situations it is necessary to consult a doctor as soon as possible in order to determine why your periods are coming with clots and to rule out the presence of serious diseases. The following symptoms may be the reason for an unscheduled visit to the doctor:

heavy bleeding with clots when the pad gets wet in less than 2 hours;
sudden change in the nature of menstrual flow;
severe sharp pain in the abdomen;
heavy periods with clots lasting more than 7 days;
presence of clots larger than 5 centimeters;
irritability, nervousness, feelings of depression and constant fatigue, poor health in general.

Treatment of pathological clots during menstruation

In order to get rid of clots caused by any pathologies, it is necessary to first determine the cause. If you consult a doctor in a timely manner, an ultrasound diagnosis of the pelvic organs will be prescribed. This research method will be able to determine the presence or absence of the main cause of clots during menstruation - endometriosis. Hormonal drugs can be used to treat it. However, in most cases, only a drastic measure - surgery - helps to completely get rid of this problem. In addition, the doctor may perform an MRI of the urogenital system to rule out the presence of any neoplasms.

Also, in case of complaints about the appearance of clots in the menstrual flow, a blood test for male and female sex hormones is almost always prescribed, as well as a general blood test, which can be used to determine the level of hemoglobin. Depending on the detected cause, appropriate medications are prescribed to normalize hormonal levels or increase iron levels in the blood. Finally, along with complex treatment of the disease that has caused changes in the nature of menstruation, ascorutin or calcium gluconate is very often prescribed.

If your periods come in clots, this is equally likely to be normal and a sign that requires medical intervention. It all depends on how typical this phenomenon is for a particular woman and whether it provokes serious blood loss in her. In addition, you need to be attentive to your well-being during menstruation and quickly respond to obvious deviations from the usual course of events.