Clomid, the brand name of the generic drug Clomiphene, may be prescribed if you have been having difficulty ovulating or getting pregnant on your own. It works by inducing ovulation and thereby increasing your chances of getting pregnant.
Clomid is a prescription drug that should only be taken under the guidance of a medical professional. Certain medical conditions may prohibit the use of Clomid.
Clomid works by tricking the brain into thinking that your estrogen levels are unusually low. Since estrogen levels appear to be low, your body thinks there are no growing follicles; and responds by releasing hormone that signals your pituitary gland to produce more FSH (follicle stimulating hormone) and LH (Luteinizing hormone). The higher levels of FSH stimulate the ovaries, and the higher levels of LH eventually trigger ovulation.
As the follicles on the ovaries grow, they release estrogen. The increase in estrogen signals the brain to slow down the production of FSH, which in turn slows down the stimulation of the ovaries.
How to take Clomid?
If periods are regular
- On the third day of your cycle (The first day is the day you have a menstrual flow, and not just light spotting) start Clomid at 50mg (one Tablet) per day for five days
- You should be having sex every other day starting from day 10 till day 16 of your cycle
- Have a blood test on day 21 of the cycle. This test is called Day 21 Progesterone. You will be given the request form for the blood test.
- One week after this test you should telephone my office for the result of your blood test.
- If the result of your blood test shows that you are not ovulating (have not released an egg) then wait for your next period.
- If you did have your period, restart taking the Clomid, this time using 100mg (two tablets) instead of 50mg for five days. If you are still not ovulating after taking 100mg of Clomid then repeat, this time taking 150 mg (three tablets) for 5 days.
- If your next period has not arrived within 40 days, take a pregnancy test
- If the pregnancy test is negative and you did not have a period, you may use Provera tablets to start your period
- If your Day 21 Progesterone blood test confirms ovulation, however, you did not fall pregnant, then carry on with the same dose of Clomid for up to 6 cycles.
If periods are infrequent or irregular
- Have a pregnancy test if you have not had a period in the last 40 – 45 days
- If the pregnancy test is negative you can start Provera tablets, 10mg twice daily for five days. This is to stimulate a period so that you can start to take Clomid.
- The bleeding should start five to ten days after the end of taking the Provera
- If you do not bleed, repeat the pregnancy test. If negative, take the Provera tablets again at 10mg twice daily for five days.
- If you still do not bleed then book an appointment to return see me.
Clomid should not be used for more than six cycles in your life due to the slightly increased risk of ovarian cancer if used for more than 12 cycles.
You should ideally take the Clomid at the same time every day, and some say that taking the pill before bed can help you sleep through some of the side effects. Some do better if they take the pill in the morning. If you have another Clomid cycle, you can try taking it at a different time of the day, but don’t change the time of day once you start the cycle.
You won’t ovulate on the five days you’re actually taking Clomid, but with your first dose, Clomid begins a chain reaction that will eventually lead to ovulation.
Ovulation typically occurs 5 – 10 days after taking the last Clomid pill. So if you took Clomid on days 3 to 7 of your cycle, you are most likely to ovulate between days 10 and 16. Ovulation can, however, occur even later than 10 days after your last Clomid pill, so it’s something to keep in mind.
Even though you take Clomid for only five days, the chain reaction that starts with your first pill continues throughout the month. This is one reason why you may continue to experience some side effects days after you take your last dose.
Progesterone is a hormone that rises after ovulation, and testing for it can confirm whether or not Clomid triggered ovulation. Another reason for testing progesterone levels is to ensure levels aren’t too low. If they are, your doctor may order a progesterone vaginal suppository as a supplement.
Beyond day 21 Progesterone testing for ovulation or ovulation predictor kit so you can time intercourse for your most fertile days, most gynaecologists don’t closely monitor Clomid treatment cycles, but many reproductive endocrinologists and fertility doctors do monitor Clomid cycles for two primary reasons:
- Keep an eye on how many follicles grow, so they can cancel the cycle if more than two (or more than one) appear
- Time a trigger shot (explained in the next step) or an IUI – interuterine insemination
Mild, in the form of abdominal discomfort, feeling sick, breast tenderness, headaches and dizziness
Severe, in the form of ovarian hyper-stimulation where the ovaries become enlarged and you feel unwell or are getting visual disturbances. If this happens, stop the drug immediately and contact either myself or Accident & Emergency of your nearest hospital.
Please note that Clomid is a fertility medication. One important side effect is the possibility of multiple births. The probability of having twins while taking this medication is 7% (meaning 7 out of 100 women taking Clomid will get pregnant with twins). The chance of having more than twins is rare.
Ovarian hyper-stimulation syndrome (OHSS) can only occur after ovulation has taken place.
Mild symptoms include:
- Mild pain or discomfort in the abdomen
- Mild weight gain
- Mild nausea
More serious symptoms include:
- Rapid weight gain, more than 4.5 kg in 3 to 5 days.
- Severe abdominal pain
- Severe bloating
- Severe nausea (so much that you can’t keep down any food or fluids)
- Trouble with urinating
- Shortness of breath
- Rapid heartbeat
These symptoms are self-limiting and here are some things you can do at home to feel better:
- Take over-the-counter pain relievers, such as Paracetamol.
- Don’t overexert yourself; take it easy while you recover.
- While you shouldn’t overexert yourself, you should maintain some light activity.
- Total bed rest can increase the risk of some complications.
- Put your feet up. This can help your body get rid of the extra fluid.
- Sex should be avoided until you feel better. Sexual activity may increase your discomfort, and in the worst case scenarios, may cause ovarian cysts to leak or rupture.
- Don’t drink alcohol or caffeinated drinks (coffee, colas or caffeinated energy drinks).
- Do drink plenty of fluids, around 10 to 12 glasses a day. Drinks with electrolytes, such as Gatorade, are a good choice.
If your symptoms get worse, you should definitely seek medical attention by contacting myself, your GP or nearest emergency department.
In rare cases, you may need to be hospitalized. Hospitalization may include receiving fluids intravenously (through an IV), and they may remove some of the excess fluids in your belly via a needle. You may also be kept in the hospital for careful monitoring until your symptoms lessen.
Usually, symptoms will decrease and go away once you get your period. If you get pregnant, though, your symptoms may be prolonged, and it may take several weeks to feel completely better. Pregnancy can also make the symptoms worse.
Your queries are best answered over the phone, our friendly reception staff would be happy to assist you with your enquiry, contact us on +02 8824 4998