Hi XXXXXXX

Thanks for the query.

Do you have fever, weakness, lethargy, breathing difficulty, sleepiness during the day and difficult to focus in work ?

Does your sanitary napkin pad get soaked with menses blood ?

Any lower abdominal or back pain ?

Do you have any burning sensation on passing urine ?

Since you are passing clots it indicates that you are possibly bleeding heavier than before. Heavy bleeding organizes to form clots. Other possibility could be infection which can also form brownish clot like structures but since it is dark blood it goes in favor of heavier bleeding.

Normally bleeding should occur on an average of 28 days apart, less than 50ml in total and no clots, for a period of 3-5 days. In your case, it only appears to be heavier bleeding volume.

If you are having increased weakness, difficulty to focus at work, increased sleepiness during the day you could be anemic due to loss of more blood in menses.

This kind of heavy bleeding could be due to hormonal disturbances, endometriosis, fibroid etc. It needs a thorough investigation by your Gynecologist.

Kindly consult a Gynecologist, get an ultrasound of your uterus, fallopian tubes to look for possible fibroid or endometriosis and also to rule out other pathology which can cause this problem. Endometrial thickness also needs to be measured in ultrasound to find if any hormonal disturbance is making the inner layer of uterus thick and thus more bleeding.

Blood tests like Hemoglobin, RBC Count, RBC indices, Total and differential leukocyte count, Platelet count, need to be done as well to look for anemia and related conditions.

Your Gynecologist may prescribe Combined oral contraceptive pills or Progesterone pills which will help to reduce the volume of excessive bleeding. Also if you are anemic, you may be prescribed iron tablets to bring back your hemoglobin and RBC count to normal in case they are low.

Eat a diet XXXXXXX in fresh fruits and XXXXXXX leafy vegetables Also consume moderately nuts, legumes, egg, chicken, lean meat. They will help improve hemoglobin levels as they are iron XXXXXXX food. Drink 1-2 litres of water daily.

Kindly follow above mentioned instructions and follow up with me on your progress.

Kindly do answer my queries as well.

I hope I have answered your query. I will be available to answer your follow up queries.

Wishing good health.

Regards,

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Hi XXXXXXX

Thanks for the reply.

The clots indicate heavier bleeding taking places, as it contains more endometrial tissue as well. This increased bleeding gets organised to clots so it may not appear to you like increased volume of blood.

Normally menstrual blood does not clot because there are anti-clotting substances present in menstrual fluid.

Sometimes when there is excess bleeding, it is much more than the amount of anti-clotting substances in the fluid which upsets the balance and can hence form clots.

Once you get your ultrasound to find endometrial thickness, ovarian pictures to look for any pathology, one cannot comment on fertility. Patients of endometriosis can have fertility problems but you do not experience severe menstrual cramping pain as seen in endometriosis.

The pain in the legs can be associated with menstrual cramps of could be due to low blood supply due to increased bleeding. This needs to be confirmed with above mentioned blood tests.

Kindly proceed one step at a time. Get the baseline investigations done and once everything becomes clear about this problem your fertility issues can be addressed immediately if needed.

Not to worry. In most conditions a hormonal disturbance can cause the same. Even thyroid hormones may need to be evaluated besides the reproductive hormones. This can be treated and you will get relief.

I hope I have answered your query. Kindly do follow up with me regarding your progress and I shall d my best to help and guide you.

Wishing good health.

Regards,

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Thanks XXXXXXX and GOOD LUCK !!!!

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