Clomiphene citrate, widely known by its brand name Clomid, is a first-line oral medication primarily prescribed for the treatment of ovulatory dysfunction in women who wish to become pregnant. As a selective estrogen receptor modulator (SERM), it represents a cornerstone of fertility therapy, offering a non-invasive and highly effective approach to stimulating follicular development and triggering ovulation. Its long-standing history in reproductive endocrinology is backed by extensive clinical research, making it a trusted initial intervention for anovulatory conditions such as Polycystic Ovary Syndrome (PCOS). This guide provides a comprehensive, expert-level overview of Clomid, detailing its mechanism, appropriate use, and essential safety information for patients and healthcare providers.

Features

• Active ingredient: Clomiphene Citrate
• Administration: Oral tablet
• Available strengths: 50 mg
• Therapeutic class: Selective Estrogen Receptor Modulator (SERM)
• Prescription status: Requires a physician’s prescription
• Typical treatment duration: 5-day course per menstrual cycle

Benefits

• Effectively induces ovulation in women with anovulatory disorders, significantly increasing the chances of conception.
• Provides a non-invasive, oral treatment option compared to injectable fertility medications.
• Features a well-established safety profile with decades of clinical use and research.
• Allows for cycle monitoring and timing of intercourse or intrauterine insemination (IUI).
• Cost-effective first-line treatment for many causes of female infertility.
• Can be used in certain cases of unexplained infertility or luteal phase defect under specialist guidance.

Common use

Clomid is predominantly prescribed for the induction of ovulation in women who do not ovulate regularly or at all—a condition known as anovulation. It is most commonly indicated for patients diagnosed with Polycystic Ovary Syndrome (PCOS), which is a leading cause of anovulatory infertility. It may also be used off-label in cases of unexplained infertility or to correct a luteal phase defect. Treatment is typically initiated early in the menstrual cycle (days 3-5 or 5-9) and is almost always accompanied by monitoring via transvaginal ultrasounds and/or blood tests to track follicular growth and prevent complications like ovarian hyperstimulation syndrome (OHSS) or multiple gestation pregnancies.

Dosage and direction

The standard initial dose of Clomid is 50 mg (one tablet) daily for five days, beginning on day 3, 4, or 5 of the menstrual cycle (with day 1 being the first day of menstrual bleeding). Treatment should only be initiated under the supervision of a reproductive endocrinologist or gynecologist. If ovulation does not occur at the 50 mg dose, the dosage may be increased in subsequent cycles to 100 mg daily for five days. Doses exceeding 100 mg per day are not recommended due to an increased risk of side effects without a substantial improvement in efficacy. The maximum recommended duration of use is 3-6 ovulatory cycles. It is critical to follow the prescribed schedule exactly and to undergo cycle monitoring as directed by a physician.

Precautions

Prior to initiating Clomid therapy, a thorough fertility evaluation must be conducted to rule out other causes of infertility, such as tubal blockage or male factor infertility. Patients should be informed of the risk of multiple pregnancies (approximately 5-8% risk, mostly twins) and ovarian hyperstimulation syndrome (OHSS). Liver function should be assessed, as pre-existing liver disease is a contraindication. Visual disturbances, though rare, require immediate discontinuation and ophthalmologic evaluation. Long-term use (more than 12 cycles) may be associated with an increased risk of borderline ovarian tumors and is not advised. Patients with uterine fibroids may experience enlargement of fibroids during treatment.

Contraindications

Clomid is contraindicated in patients with:

• Pregnancy
• Liver disease or history of liver impairment
• Abnormal uterine bleeding of undetermined origin
• Ovarian cysts not related to polycystic ovary syndrome
• Uncontrolled thyroid or adrenal dysfunction
• Hypersensitivity to clomiphene citrate or any component of the formulation
• Organic intracranial lesions, such as pituitary tumors

Possible side effect

While many patients tolerate Clomid well, some may experience side effects, which are often dose-dependent. Common side effects include:

• Vasomotor flushes (“hot flashes”)
• Abdominal discomfort or bloating
• Breast tenderness
• Nausea and vomiting
• Headache
• Visual disturbances (blurred vision, spots, or flashes), which are reversible upon discontinuation but warrant immediate medical attention
• Mood swings
• Less commonly, ovarian hyperstimulation syndrome (OHSS), characterized by rapid weight gain, abdominal pain, nausea, and shortness of breath, requires urgent medical care.

Drug interaction

Clomid may interact with several medications, potentially altering its efficacy or increasing the risk of adverse effects. Notable interactions include:

• Danazol: May diminish the therapeutic effect of Clomid.
• Tamoxifen: Concomitant use is not recommended due to similar mechanisms of action.
• Thyroid hormones: Dosage adjustments may be necessary.
• Warfarin: Clomiphene may potentiate the anticoagulant effect, requiring closer monitoring of INR. Patients must provide their physician with a complete list of all medications, including over-the-counter drugs and supplements, before starting treatment.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. However, if it is almost time for the next dose, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended. Consistent daily dosing is crucial for the medication’s effectiveness in stimulating ovulation. Patients should contact their healthcare provider for specific guidance if a dose is missed.

Overdose

Symptoms of a Clomid overdose are not well-documented but may include an exacerbation of known side effects, such as severe nausea, vomiting, vasomotor flushes, and visual disturbances. There is no specific antidote for clomiphene citrate overdose. Treatment is supportive and symptomatic. In cases of suspected overdose, immediate medical attention should be sought, and the patient should be managed based on their clinical presentation. Gastric lavage or activated charcoal may be considered if ingestion was recent.

Storage

Clomid tablets should be stored at room temperature (20°C to 25°C or 68°F to 77°F), in a tightly closed container, and protected from light and moisture. Keep the medication out of reach of children and pets. Do not store in bathrooms or other areas prone to dampness. Properly discard any unused medication after the treatment cycle or upon expiration, following local guidelines for medication disposal.

Disclaimer

This information is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The use of Clomid must be supervised by a qualified healthcare professional familiar with the patient’s medical history.

Reviews

“After struggling with PCOS and irregular cycles for years, Clomid was our first step. With careful monitoring, we conceived our first child on the second cycle at the 50mg dose. The hot flashes were noticeable but manageable.” – Sarah T., 32 “As a reproductive endocrinologist, I have prescribed Clomid for decades. It remains a powerful and reliable tool for ovulation induction when used appropriately with cycle monitoring. Patient education on the risks of multiples and OHSS is paramount.” – Dr. Evan R., MD “The 100mg dose successfully induced ovulation for us after the lower dose didn’t work. We are now expecting twins. We were fully aware of the risk and are thrilled, but it’s a important outcome to be prepared for.” – Mark and Jessica L. “I experienced some blurry vision during my third cycle, which resolved after stopping the medication. My doctor took it very seriously and we moved to a different treatment plan. It’s crucial to report any visual changes immediately.” – Priya W., 29