Q. Is it normal to pass a fist-sized clot while on birth control pills?

Answered by
Dr. R Balakrishnan Menon
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 22, 2017 and last reviewed on: Aug 19, 2019

Hi doctor,

I have been cycling on birth control pills for about four months. My gynecologist told me that if I experience spotting, I should stop taking the pills for three or four days to let everything come out, and then start back again. I experienced some pretty heavy spotting. So, I decided to do this. I am on my third day of not taking the pill and for the past couple of days, I have experienced what seems to be a period.

There was some brownish-red discharge and little cramps. But, today my cramps were unbearable and, I just passed a clot the size of my fist. Is this normal for someone who has not had a period in four months? What should I do to fix this? I planned on taking the pill again tomorrow as it is the fourth day. I had always had a heavy period previous to taking the pill but, never experienced too bad a cramps nor passed a clot that big. Please let me know if you can help. Thank you.

Dr. R Balakrishnan Menon

Infertility Obstetrics And Gynaecology


Welcome to icliniq.com.

How are you doing?

Do not worry. What you are having is the expulsion of the thick endometrium lining of the uterus. As days have passed without the shedding of the lining, the thickness of the endometrium has been increasing, which has to fall off one day. When you take the birth control pills, this thickness will not only slowly increase but, it also loses the water content in it. This makes the lining dark red or brown colored, fleshy, and it will come out in the shape of the uterine cavity en mass. As your cervix is still narrow (it dilates only after a vaginal delivery), the expulsion will be painful. It will not trouble you anymore as the thickness would have come out completely.You can take any of the painkillers, and that would be more than enough.

I would always advise you to have a period, once a month and never delay it by more than 45 days. In that case, the thickness will be lesser, and so will the bleeding and the pain. So, I suggest you have the birth control pills cyclically, I mean, without break for 21 days. Then depending on which birth pill you are using, either stop the pills for seven days or continue with the dummy or inactive pills.

During these seven days, you will have your periods. But, irrespective of whether you have periods or not, start the next packet from the eighth day. Keep taking it cyclically this way and your periods will never be a problem. Until the age of 21 years, the hormonal axis between your brain, pituitary, and ovary is not mature. So, your cycles will not be perfect. Once this axis is matured, you will have no problems.

Hope I have clarified your query. Do write back. All the best.

For more information consult an obstetrician and gynaecologist online -->https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

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