Description

Clomid (clomiphene)

Clomid contains clomiphene citrate, used to stimulate ovulation in women with anovulation due to polycystic ovary syndrome, altered luteal phase, oligomenorrhea, or secondary amenorrhea. It’s a selective estrogen receptor modulator — by blocking estrogen receptors at the hypothalamus, it interrupts the negative feedback that would normally suppress GnRH release. The result is increased FSH secretion from the pituitary, which drives follicular development and, if the cycle responds, ovulation. Available in 25 mg, 50 mg, and 100 mg tablets.

Dosing

Standard starting dose: 50 mg daily for five days, typically beginning on cycle day 3, 4, or 5. Ovulation generally occurs 5 to 10 days after the final tablet. If 50 mg produces no response, the dose is increased to 100 mg in the next cycle, and to a maximum of 150 mg if needed. Treatment should not exceed six cycles — if six cycles at appropriate doses fail to produce ovulation, alternative approaches should be considered. Clomiphene should not be taken if pregnancy cannot be confirmed absent (a positive test would be a reason to stop immediately).

Multiple pregnancy risk

Clomiphene increases the risk of multiple pregnancy. The majority of multiple pregnancies with clomiphene are twins, but higher-order multiples occur. This risk should be discussed before treatment begins. Ovarian monitoring by ultrasound during treatment helps identify excessive follicular response and guides decisions about proceeding in a given cycle.

Visual disturbances

Visual symptoms — blurred vision, spots or flashes, or other visual disturbances — require immediate cessation of clomiphene and prompt ophthalmological evaluation. These can become prolonged if treatment continues after symptoms appear.

Contraindications

Pregnancy and lactation. Significant liver function impairment. Menometrorrhagia (abnormal uterine bleeding should be evaluated before treatment). Known or suspected ovarian cysts not related to polycystic ovary syndrome. Hypersensitivity to clomiphene. Galactose intolerance or lactase deficiency (tablets contain lactose).

Ovarian hyperstimulation

Ovarian enlargement and discomfort are expected to some degree during follicular stimulation. Significant ovarian hyperstimulation syndrome (OHSS) — with abdominal pain, bloating, nausea, and in severe cases fluid accumulation — requires medical evaluation. If significant ovarian enlargement occurs, the next cycle’s dose should not be increased.

Side effects

Hot flushes, breast tenderness, nausea, headache, and abdominal bloating are the most commonly reported. Mood changes and fatigue occur in some women. Visual changes are less common but require immediate attention as noted above.