What are these big clots during my period?

Here's what defuses half the fear. A clot is mostly coagulated blood, with a little lining, not a piece of an organ falling out ^[2].

During your period, your uterus runs a system that keeps blood liquid as it flows out. It's called fibrinolysis: an enzyme, plasmin, constantly dissolves fibrin so the blood doesn't gel ^[2]. On a light day, it keeps up easily.

When flow gets heavy and fast, that system is overwhelmed. Blood pools faster than it can be dissolved, so it gels in place and forms the solid lump you see ^[2].

Here's the reassuring, counter-intuitive part: a clot isn't a sign of a clotting disorder, it's closer to the opposite ^[4]. What matters isn't the clot itself, it's how much blood you're losing.

You bled regularly for thirty years, and now everything shifts. It's not your imagination, and it isn't random. As menopause approaches, your ovaries stop ovulating every cycle ^[5].

Ovulation is what triggers progesterone, the hormone that balances estrogen and organizes the shedding of the uterine lining (the endometrium). Without ovulation, that progesterone is missing, and estrogen works unchecked ^[3].

The result: the lining thickens without control, then sheds all at once, heavily and irregularly. More tissue to pass means more blood, so bigger clots ^[3].

Other common causes amplify flow at this age: fibroids (benign muscle growths in the uterine wall) and polyps. Usually benign, they still deserve to be identified. That's why heavy bleeding after 45 warrants an evaluation ^[1].

Here's the concrete reference you want. Picture a 2-euro coin (about 2.5 cm) as your benchmark.

What's banal during a heavy flow:

• clots smaller than a 2-euro coin,
• mostly on your heaviest days, often in the morning,
• occasional, without soaking through your protection ^[7].

What's worth raising with your doctor:

• clots bigger than a 2-euro coin,
• coming back cycle after cycle,
• with a flow that floods: changing protection every hour, leaking overnight or through clothes ^[1].

It's the combination of size, frequency and flooding that counts, not one isolated big clot. This coin size is a landmark to picture things, not a formal clinical cutoff, since guidelines rely on how heavy the flow is ^[1].

Add a signal that's easy to miss: fatigue. Breathlessness on the stairs, pale skin, a racing heart... you may be losing enough blood to drain your iron stores ^[8].

You don't have to wait passively for menopause. Because clots come mostly from heavy flow, whatever reduces the flow reduces the clots. These are options to discuss with your doctor.

• Tranexamic acid (Exacyl): a non-hormonal tablet, taken only on your heavy days. It cuts blood loss by 40 to 50% ^[10]. It stays contraindicated if you have a history of thrombosis (a clot in a vein).
• NSAIDs (ibuprofen, mefenamic acid): they lower flow by around 20 to 40%, and ease period pain ^[11].
• The hormonal IUD (a levonorgestrel intrauterine system): the first-line treatment for heavy periods. It thins the lining and reduces flow by 70 to 95% ^[1][12].

Add oral progestogens to steady erratic cycles ^[3], and iron if a blood test confirms anaemia ^[9].

One last lever: log what you notice. Clot size (using the 2-euro coin), how often you change protection, your fatigue. This objective data helps your doctor act fast and order a blood test or a pelvic ultrasound (a painless scan that looks at the uterus) at the right time ^[4].