Too much uterus lining shed during periods

In Short

You have detailed your problem which is mainly about painful heavy period and what you feel is "excessive shedding" of the uterine endometrium. There is nothing for you to worry about excessive endometrium being shed. It may feel that way but there is nothing untoward that has happened.

In terms of seeing strips or flakes of endometrium that doesn’t normally happen because the blood and the endometrium gets digested by the fibrinolytic and other protein digesting enzymes that are released locally. It is for that reason, menstrual blood, unlike blood drawn in a syringe from a vein, does not clot.

The pain that you suffer during menses is often due to the expansive rhythmic contractions of the uterus. If the endometrium and blood are totally digested by the enzymes, it is easier to expel the thick syrupy fluid. However if there are endometrial bits undissolved and blood clot that have overwhelmed the fibrinoytic capacity of the uterus, the contractions are more severe as the expulsion process is more intense.

But do visit your gynaecologist as your history is not very comprehensive.

Details

If I explained to you the general principles of what goes into making periods heavy and painful, it may help. Besides I can sense an undertone of concern that by “shedding more of the endometrium” you feel you may have problems in future as a consequence. On that count I can reassure you there is nothing to worry.

Basics first. Menstruation happens simply to enable a new lining of the womb, freshly laid to welcome an embryo developed from an ovum in the new cycle. That making of an egg is inter-twined with making of hormones, menstruation is an inevitable cycle should there not be the fertilized embryo which implants successfully.

The process of menstruation is triggered by the declining hormones (progesterone and estrogen) from the corpus luteum of the ovary .This corpus luteum (formed as a result of ovulation) would need to be supported by the pregnancy hormone hCG by the 20-21st day of a 28 days cycle. If the hCG is not there in the blood, the corpus luteum starts dying and as a result levels of both Estrogen (E) and Progesterone (P) hormones in the blood start falling. In the preceding 20 odd days the rising levels of E followed by P from the 14th day has made the endometrium thick and its basal layers to contain a lot of blood vessels. The entire structure (endometrium + blood vessels) need the hormones (E + P) to survive and when those hormones reduce; the blood vessels constrict and bleed to shed of the endometrial lining.

All of the endometrium will shed in a normal menstruation and the basal layer remains to re grow a new endometrial lining in the following cycle. So to address your question, what needs to be shed in the menstrual period, gets shed every month. If the cycle is regular, every month there is nothing left to shed after the menstrual period. However, if the ovulation hasn’t happened then there is no progesterone hormone and the growth of the endometrium is not uniform and subsequent loss of endometrial lining can be irregular and uneven but that is another scenario altogether.