Heavy bleeding with clots — what could be the reason?

Heavy periods with clots — the current term is heavy menstrual bleeding, replacing the older word menorrhagia — most commonly result from fibroids, endometrial polyps, adenomyosis, a bleeding or clotting disorder, or hormonal imbalance causing the lining to build up and shed erratically. Clinically, heavy menstrual bleeding is defined by its effect on you rather than by a measured volume: bleeding heavy enough to interfere with your physical, social or emotional quality of life. Practical signs include soaking through a pad or tampon in under two hours, passing clots larger than a 10-rupee coin, needing double protection, or bleeding through to clothing or bedding. Seek care the same day if you are soaking through a pad every hour for two or more hours in a row, feel faint or breathless, or your heart is racing — that level of bleeding needs urgent assessment. Otherwise, please see a gynaecologist without long delay. Heavy periods are a common cause of iron deficiency anaemia, which develops gradually and is often missed. Expect a pelvic ultrasound, a full blood count with ferritin, thyroid function, and a clotting screen if you have bled heavily since your very first period.