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Period Blood Colors and Textures: What Determines Them?

Written by Elizabeth Buescher, Gynecologist

Normally, around 35-50ml of scarlet or brown blood, possibly with clots, is discharged during a single menstrual cycle. As a rule, it is the volume of blood loss that determines the period blood colors and textures. Causes of heavy periods are almost always pathological. Scanty periods can be determined by two physiological causes, namely perimenopause and intake of oral contraceptives and at least 5 pathological factors. A timely visit to a gynecologist can help in finding out the underlying cause of the pathology.

Maturation of the ovum, its emergence from the follicle, preparation of endometrial lining to possible pregnancy, as well as its rejection in case conception does not take place – follow one after another throughout the menstrual cycle. Consequently, menstruation is the process of exfoliated mucous membrane’s detachment, which is discharged along with blood from the vessels, affected in the process of rejection.

On average, during each cycle a woman loses 35-50ml of red or brown blood, sometimes with clots. Discharge of more than 80ml of blood or necessity to change pads every 60 minutes point to excessively intense bleeding, and are referred to as menorrhagia. Alternatively, scanty periods are defined by the terms “hypomenorrhea”.

Bright red color of menstrual blood in case of menorrhagia

When there is too much of discharged blood, it does not have time to coagulate; therefore, it acquires a bright red color. Any clots that can be observed in it are either endometrial particles or, for example, elements of the disrupted ovum. It is generally believed that a woman may experience over dozen of such micro-abortions, not even being aware of her pregnancy since regulation of this process takes place on the genetic level.

Profuse bleeding in case of actual interruption of pregnancy/miscarriage (in this context it does not matter whether it is the case with normal or ectopic pregnancy or a hydatidiform mole) is characterized by disturbed well-being and acute pain with possible loss of consciousness.

Apart from miscarriage, there are also at least 6 factors that can provoke menorrhagia:

1. Dysfunctional uterine bleeding

DUB is a term, used to denote pathological periods, occurring after several anovulatory cycles in succession. The fact is that in certain stages of their lives (during the establishment of the cycle or in the postmenopausal period) women experience hormonal alterations – growth of endometrium along with insufficient secretion of estrogen and absence of ovulation.

Consequently, the envisioned rejection of the mucous membrane fails to take place. It continues growing in the next cycle until the separation of the useless endometrial lining is syndicated. At that, the exfoliated membrane can be rather massive – the more extensive it is, the more intense compensating period will be. In order to correct DUB doctors usually recommend intake of hormonal contraceptives.

2. Adenomyosis

This is a nonmalignant endometrial pathology, which involves growth of the endometrium into the myometrium (muscular layer). It can be accompanied by endometriosis (pathological proliferation of the endometrium).

Adenomyosis occurs under the impact of aggressively high level of estrogen and is more common in parous women. Apart from massive bleeding, symptoms of this disease include:

  • Highly painful periods;
  • Bloody discharge between periods;
  • Signs of pressure upon organs, adjacent to the uterus, due to the enlargement of the latter (disturbed urination and defecation).

Eradication of the uterus is indicated in case of poor response of adenomyosis to hormonal therapy.

3. Uterine fibroid

Uterine fibroid is another nonmalignant pathology, which is characterized by menorrhagia, suppression of other organs, adjacent to the uterus, pelvic pain, and infertility. This disease is also associated with a high level of estrogen in the blood.

Treatment of fibroids can be either medicinal or surgical.

4. Hyperplasia and endometrial cancer

The main symptoms of endometrial cancer or precancer include irregular uterine bleeding, including profuse menstrual bleeding and postmenopausal bloody discharge. Risk factors of endometrial dystrophia include:

  • Frequent cases of anovulation;
  • Early start of periods;
  • Few child deliveries;
  • Late menopause;
  • Obesity;
  • Diabetes mellitus;
  • High PAG;
  • Breast or ovarian cancer as the case with the patient herself or endometrial cancer in one of her relatives.

Intake of oral contraceptives throughout no less than a year is practiced as a preventive measure against endometrial cancer. The treatment should be performed by a gynecologist-oncologist, based on the stage and the level of advancement of the disease.

5. Precancer and cervical cancer

Classical symptoms of cervical pathologies are profuse menstrual, breakthrough and postcoital bleeding.

It is established that women, infected with human papillomavirus, are most exposed to cervical cancer. Besides, the following conditions require special awareness:

  • Early start of sexual life;
  • Unscrupulous sexual relationships without the use of preservatives;
  • Past history of sexually transmitted diseases (including HIV);
  • Smoking.

The volume of treatment (chemical, radial or surgical) is determined by the specialist, with regard to the peculiarities of each individual case.

6. Blood coagulation disorder

This condition, including, such that results from the intake of certain drugs intensifies bleeding due to blood thinning.

Dark brown and black color of period blood – hypomenorrhea

In the case of scanty periods, menstrual blood has time to coagulate, when it is yet in the cervix, on its way to the vagina. Therefore, it becomes dark and periods may appear in the form of brown spots on the underwear.

Normally, there are only two conditions that can be accompanied by minimal menstrual bleeding, and those are pre menopause, which is actually the decline of female reproductive function and intake of hormonal contraceptives, deliberately provoking anovulation.

Pathological causes:

1. Congenial uterine and cervical malformations

They determine two mechanisms of the development of hypomenorrhea:

  • Due to endometrial inadequacy along with structural deficiencies;
  • Due to obstruction or partial blockage of the cervix, creating an obstacle to the outflow of normal periods;

2. Adhesive changes

Pathogenesis of bleeding remains the same as in the first-mentioned case. The difference is only in etiology – acquired uterine and/or cervical traumas. Past history of endometriosis or inflammatory complication of any surgical manipulation can serve the ground for the formation of adhesions.

3. Polycystic ovarian syndrome

This hormonal dysfunction is characterized by disturbance of the menstrual cycle, infertility, obesity, prediabetes, etc. In some cases, it responds to oral contraceptives.

4. Rapid decrease of body mass, severe stress and moving to a new climatic zone

These three factors are able to provoke hormonal imbalance and cause a delay of periods or scanty menstrual bleeding throughout multiple cycles in a row.

5. Hypothyroidism

Insufficiency of thyroid hormones can also cause a decrease in period blood since the mentioned hormones are vital for the secretion of the hypothalamic- pituitary system.

Thus, it becomes obvious that period blood colors and textures may be significantly variable, depending on the age of the woman, her general health, physiological situation, weight and a number of other factors. Red, brown, and even black color of discharge constitute variants of the norm. At the same time, they may be indicative of a certain pathology. Therefore, in case of any concerns regarding the way the period blood looks, one should consult a specialist and dispel all doubts.