Menstrual Cycles and Anticoagulants: What’s Normal?

If you are a woman, one of the first questions you might have after starting blood thinners may be, “Should my menstrual cycle be this heavy while taking anticoagulants?” It was one of the first things I worried about after I was discharged from the hospital on low molecular weight heparin blood thinning injections several years ago. I worried – a lot – and wondered if it would be a major issue for me, especially since I had already struggled with uncomfortable periods for as long as I could remember. My periods were a little heavier, but nothing that made me worry, or think something was wrong. I had more frequent and slightly heavier periods for several months, but eventually my cycle returned to what was normal for me. Once I transitioned successfully to the oral anticoagulant warfarin, my periods stayed the same. A little unpredictable, but mostly manageable. They were occasionally longer or heavier, or I would occasionally have two shorter cycles in a month, but nothing was overly concerning for me or my doctors.

About five years after my blood clot, I had a period that was not normal for me. It arrived at the regular time, but it started out a lot heavier than usual. My first thought was, “Good. I’ll get it all out of the way in a day or two. I began to grow more and more concerned as the third day of my cycle arrived, and the bleeding worsened. By that time, I was going through a 10-hour pad in less than hour, and I was soaking through my clothes. It was a weekend – which is when all of my issues seem to happen, blood clots included – and I thought, “Since it’s my period, I’ll wait until Monday and call my gynecologist.”

It got worse as the weekend went on, so I called my gynecologist’s office. Most gynecologists have an on-call physician for pregnant patients who go into labor and delivery, so I was relieved to hear a messaging service answer where I could leave my number and have an on-call physician call me back. A doctor at from my gynecologist’s office called me back in about 10 minutes and asked me what was going on, so I explained my situation. The doctor was alarmed, even though I was very clear that I was taking the blood thinner warfarin. He instructed me to go immediately to the emergency room, which I did, now completely panicked about my situation.

At the hospital, I saw a number of doctors who ran and performed numerous tests to determine whether I was bleeding internally from my abdomen or from my uterus. After several hours, and a lot of uncomfortable evaluations, it was determined that I had uncontrolled uterine bleeding. In my case, it was a period that wasn’t stopping. The cause was an INR level that was way too high, which I did not know about. I needed a reversal treatment (oral vitamin K in this situation), to help bring my INR back into a safe range. I am very fortunate that I did not need a blood transfusion or need to be admitted. The ER staff told me repeatedly that it was very good I came in when I did, instead of waiting until Monday, because the bleeding may not have stopped on its own.

It took several weeks of medication adjustments, blood draws, and ultimately bridging with injections to stabilize my INR. While it was a very scary experience for me – and one that has also taken me some time to think about sharing here – it is an experience that I take very seriously. I learned a lot about my body and what not to assume. If I ever have bleeding like that again, I will not assume it is my period, because I know now that something could be seriously wrong.

If you have heavy periods on blood thinners, at least have one conversation with your doctor, before ending up in a situation that requires emergency room visits and emergency interventions to resolve.

FAQ: What You Need to Know About Periods and Blood Thinners

Below is a list of frequently asked questions about menstrual cycles and blood thinners. These are questions that I have asked myself, and that I hear a lot. What is the bottom line? If you have a heavy period on blood thinners, please talk to your doctor.

Q: Since I am on blood thinners, I can expect a heavier period, right?

A: Like so many things when dealing with blood clots and blood clot recovery, it depends on the individual situation. Not every woman has a heavy cycle on blood thinners, so if you do, you need to discuss it with your doctor to find out if it is normal or not. A possible side effect of the newer oral anticoagulants are heavier periods, so if you take those medications, talk to your doctor about your concerns and what to expect. It is important to make sure nothing else is wrong, or going on, as well as to find a solution for managing heavy periods.

Q: What kind of doctor should I discuss my heavy periods with?

A: It is probably best to involve two doctors, or specialists, in your care when discussing your menstrual cycle: The doctor who prescribes your anticoagulant (for me it is my hematologist) and your gynecologist. If you do not have a gynecologist, you can find one with this search tool: The American College of Obstetricians and Gynecologists.

Q: My doctor(s) said to expect heavier bleeding on blood thinners, so do I need to worry if I am bleeding a lot?

A: Don’t assume heavy bleeding is normal, especially since it could be dangerous and have dangerous consequences, such as blood loss or anemia. If you have heavy bleeding, you need to go to the emergency room, or hospital, to be evaluated. The U.S. Centers for Disease Control and Prevention (CDC) defines heavy bleeding as: 1) needing to change your pad or tampon after less than two hours, or 2) you pass clots the size of a quarter or larger. Read more about heavy periods, also known as menorrhagia, from the CDC: Heavy Menstrual Bleeding.

Q: During that time of the month, can I just skip taking my blood thinners?

A: No, not without speaking to your doctor. Heavy periods are usually not a reason to stop taking your blood thinner. Stopping your medication – even for a day or two – could be dangerous and result in a repeat clotting event. Not taking medication as prescribed is the most common cause of blood clot recurrence. Please do not ever stop your blood thinner without consulting with your doctor first. While some women may be given instructions to reduce or stop their blood thinner during the heaviest days of their menstrual cycles, this direction must only be given my the advice of a medical professional.

Q: Birth control helped with my periods, and now I can’t take it because of blood clots. What options do I have?

A: Birth control with estrogen is a risk factor for blood clots, and many women are advised to stop taking birth control with estrogen after a blood clot. However, many women have options without estrogen for birth control that may also help with heavy periods, especially if they are continuing to take an anticoagulant. More information about these options can be found here: Birth Control and Blood Clots. Other options to help manage a heavy period may include: pads or tampons, menstrual underwear or menstrual cups. We’re all different, and what works for one woman may not be an option for the next woman. Some women may, along with their physician, consider various surgical procedures to help address significant menstrual bleeding, such as a endometrial ablation or hysterectomy.

It can be difficult to manage a heavy menstrual cycle on anticoagulants, and for many women, it can be uncomfortable to talk about, but it is really important. Not only can an unusually heavy cycle be dangerous to your health, it can be damaging for your self-esteem. It can even effect work and social commitments. If you are experiencing a heavy period while taking anticoagulants, talk to your doctor about your concerns, and your options.

There is hope for healing and you are not alone,


Reader Writes In: Journal your thoughts, or share in the comments below. Have you experienced heavier periods since starting anticoagulants?


Read More: Women’s Issues and Blood Clots


Bye Bye Bad Periods…Hello DivaCup!

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{Disclosure: I was given a DivaCup Model 2 to review in order to write this post. I was not paid for my review, or endorsement, of this product, nor was I asked to write a positive review. The thoughts and opinions expressed here are my own.}

I have always had a hard time with my periods, even before I was diagnosed with a clotting disorder, antiphospholipid syndrome, in 2012. My menstrual cycle has always been heavy, painful, sudden to start, irregular and generally wreaks havoc on my emotions. If I could bury myself in a dirt hole for the duration of my cycle, I would, gladly to spare myself and others the misery of my company. Since my diagnosis, my periods have only gotten worse and while I do have months that are uneventful, my body seems to make up for it the next time with a period like no other.

Throughout the pre-blood clot years of my menstrual cycle, I almost exclusively wore pads (Always, extra long, overnight, jumbo pack) and I continued wearing pads after my blood clot.

My Problem

In the initial months (read first year) of my recovery from DVT and PE, I found that my menstrual cycle was nearly unmanageable in terms of flow. I rarely left the house during my period and if I did, I went armed with a stack of pads (which I changed hourly). I planned out where I was going to go and when I was going to use the restroom. I couldn’t be gone for very long, and I certainly couldn’t do anything spontaneous like drive to another store or friend’s house because I was uncertain of how long it might take. I wore dark pants, multiple pairs of panties and cursed my light car interior. I didn’t sit on anyone’s furniture, as a matter of fact, sometimes I didn’t sit at all for fear of leak.

Flash forward to now, three years after my clotting incident, and my periods are still really heavy, can happen out of nowhere, with no pre-symptoms, and last for an extended period of time. Sometimes, I get a day or two of relief and then it starts all over again. Just when I think it is under control – I tried to wear a tampon at a festival this summer – I am back to running for the car so I can rush home and take care of the leak (by staying in my bed for the next four days). The emotional turmoil and anxiety I feel during my cycle every month is in part due to the fear I have of leaking at work, a friend or relative’s house or anywhere that is not my own room – and even that can result in a fit of tears and anger. It’s miserable, I’m miserable and desperate for relief. 

My Solution 

First and foremost, I was in constant communication with not only my hematologist, but my OBGYN too about my flow and frequency of periods. My OBGYN told me that remaining on warfarin and progestin-only birth control and aspirin will continue to contribute to a heavy flow. He ensured nothing else was going on (i.e. cervical cancer, a miscarriage, etc.) and informed me that my options for controlling the flow included a contraceptive implant, which is not an option I am comfortable with personally. So, after ruling out any medical concerns, I began my search for something to offer the relief I so desperately sought.

What I found is the DivaCup. And the DivaCup is a reusable, bell-shaped menstrual cup that is worn internally (yes, in your vagina), collecting rather than absorbing your menstrual flow. It lasts for 10-12 hours before it needs emptied, is comfortable, holds my entire flow in a day (no, I’m not kidding either), and is cheaper and healthier than traditional menstrual products like pads and tampons. Wait, wait, it’s gross, right? Hear me out before you make a determination about how sanitary it is and enter to win your own DivaCup to try for yourself.

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The Basics

The DivaCup costs around $40 and you can find it online or now at CVS. It is not disposable and you should only need to replace it about once a year, or when it is best as determined by you. It offers 10-12 hour leak-free protection and is made of health-grade silicone. It really holds my entire flow, and I actually found thorough the measurements on the side of the cup that I was not bleeding as much as I thought I was. It comes in two sizes, 1 if you are under 30 and have not had a vaginal delivery or C-Section and 2 if you are over 30 and/or have delivered a child(ren) vaginally or via C-Section. You wear it when you use the restroom, but not during sexual intercourse and it is not a contraceptive device. You wash it using a mild, unscented soap, or the DivaWash, which I prefer to use. Read more details about the DivaCup basics.

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The Pros

I have not leaked at all while wearing the DivaCup, not once, not for the entire 11 or so hours I wore it during heavy flow. The first time I tried the DivaCup I wore it on the heaviest day of my menstrual flow and I was really worried about it, but I did not have any leaks. That to me is worth the entire product. Toward the end of the day, I will say I felt the DivaCup slide down slightly, but it did not leak or spill and I adjusted it upon emptying it. Most people empty it 2-3 times a day, but you may need to empty your DivaCup more often depending on your flow. The great thing about is it is much easier to monitor your menstruation cycle. I don’t have to worry about carrying a bag of pads with me anymore, the DivaCup comes with a discreet cloth bag that I store it in after cleaning and generally I carry it in my cosmetic bags in case of emergency or a sudden start. It’s always available and I’m no longer running to the store at midnight or on my lunch break, praying I make it there and back in time. I save money using the DivaCup (an average of $100-$150 a year) and I am healthier. The last thing I need is a possible health complication, for example, from the ingredients found in tampons.

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The DivaCup has given me back a piece of my self-esteem and self-confidence when it comes to my menstrual cycle. I no longer worry about leaks, stains, unsanitary messes and where will be the next time I need to change my feminine product because the DivaCup holds my entire flow in a day. My periods have become more manageable because they are not managing me for once! I feel like a new woman using the DivaCup.    

The Cons

Wearing a cup is different from wearing a pad or a tampon and it took me a few tries to be able to insert it correctly (although, with practice, it is not too much different from a tampon and I struggled with that at first too). I suggest either wearing a pad with it at first to ensure you have it inserted correctly or wear it in a place (like home) where you know you can handle it right away if you feel a leak. For me, it is very easy to tell if I have the DivaCup placed incorrectly because, much like a tampon, I can feel it. Most of the incorrect positioning comes from pushing it up into the vaginal canal, instead of back, towards the tailbone. You can find great instructions on how to insert it here and the Diva Team is more than happy to help with questions, should you have any. At $50-$55 for the cup and the wash (or about $40 for the cup), it can be expensive to get started, but remember, you are saving money in the long run. Most ladies I have spoken to are most worried about emptying the cup, but when you remove it by pulling is straight down, the contents do not spill out and are easily disposed of in the toilet (then wash the DivaCup in the sink with the DivaWash or mild, unscented soap). The inconvenient part is it is not practical to empty it in a public restroom so I make sure I do that somewhere where I feel comfortable, like my house. To me, it is more sanitary than removing a pad (where the contents are already outside of your body) or a tampon (where there is no container at all). I actually feel cleaner using the DivaCup.

Just For You

Connect with The DivaCup on Facebook, Twitter and Instagram and through their website for great ideas, tips, information, and chances to win a DivaCup.

You can order your own DivaCup through my Amazon Influencer Shop.

There is hope for healing and you are not alone,

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