One of the biggest issues for most women with PCOS is an inability to get pregnant. PCOS comes with highly irregular periods and an inability to release an egg regularly. Clomid is a drug recommended by doctors in an effort to help them get pregnant. The drug is believed to stimulate ovaries to release an egg. Treatment with clomid is complex in that it has to be perfectly timed. Women undergoing clomid treatment have the best chances of becoming pregnant in the first three months of treatment. Later on, since clomid has anti-estrogenic effects, chances of getting pregnant come down. While success rates of getting pregnant with clomid are apparently good, clomid does have side effects that should be understood.
Clomid And PCOS: How Does The Drug Help in Increasing Fertility?
Clomiphene citrate, the active chemical in clomid, is responsible for its fertility-inducing action. The chemical tricks the brain into believing that levels of circulating estrogen are low. Clomiphene has a structure similar to estrogen. This allows it to bind to estrogen receptors throughout the reproductive system. This binding does not allow the correct interpretation of actual levels of estrogen by the brain. This makes the brain “think” that estrogen levels are low. Reduced estrogen levels stimulate the brain into increasing the production and secretion of follicle stimulating hormone (FSH). As the name suggests, this hormone drives enhanced ovarian activity. The levels of FSH rise (for 5 days till the medicine is taken, as part of a typical treatment cycle) and then fall. This tide of rising FSH triggers ovulation.
Common Clomid Side Effects
Some women may experience the following symptoms while on clomid treatment:
- Mood swings
- Visual disturbances (like blurred vision)
- Nausea and vomiting
- Flushing or “hot flashes”
- Tenderness in the breasts
- Abdominal or pelvic pain (due to enlargement of ovaries)
One of the more severe clomid side effects is abnormal vaginal bleeding and severe mood swings and irritability. Clomid also causes thinning of the walls of the uterus and reduced secretion of cervical mucus. The cervix produces copious amounts of mucus, a clear, watery substance that helps the sperms to swim up to meet up with an egg. If mucus production is impaired, sperms will easily die in an otherwise “hostile” environment. Reduced mucus production reduces fertility. But, if you are undergoing clomid treatment, you are likely using artificial insemination rather than relying on good old sex. So the problem of reduced cervical mucus production is taken care of.
A rare side effect of clomid use is ovarian hyperstimulation syndrome (OHSS) which causes symptoms like:
- Enlargement of ovaries
- Decreased urination
- Severe gastrointestinal distress
- Swelling in the abdomen
- Shortness of breath
- Pain, redness and swelling in the legs
- Sudden weight gain
- Chest pain
- Buildup of fluid between the inner and outer coverings of the lungs
If you are allergic to clomid, you might develop allergic symptoms like rash, itching, dizziness, swelling on the face, tongue or throat and trouble breathing.
Call your doctor immediately if you experience any of the above side effects.
It is found that clomid may increase the chances of multiple births (7% twins and 0.5% triplets). This is probably the only “side effect” that is desirable!
Popular Brands of Clomiphene
The most popular and recognized brand name is Clomid. Other brands include:
- Clomiphene Citrate Actavis, etc.
How to Take Clomid?
There is a specific treatment protocol that you will need to follow for clomid and PCOS. This is, of course, designed by your doctor, but let’s understand the basics of the protocol.
- “Day 1” is established as the first day of menstrual bleeding. The bleeding could be spontaneous (as is usually the case with women with PCOS), or it could be induced by drugs like progestin.
- Once the menses have passed, clomid is started early in the menstrual cycle. It is taken for 5 consecutive days at a dosage of 50 mg (one tablet) daily, taken orally. You can take the tablet at any time of the day.
- Usually women ovulate 8 to 10 days after completing a 5-day course of clomid. But this can vary between women. Some of them may ovulate even two to three weeks after the last clomid tablet was taken.
- If a woman fails to ovulate at the initial dosage of 50 mg daily, the doctor may increase the dosage to 100 mg or even to 150 mg a day.
- If there is no ovulation even at a dosage of 150 mg per day, your doctor may move on to other therapies.
Can You Reduce Clomid Side Effects?
There are certain drugs like antidepressants and acetaminophen that your doctor might prescribe you to reduce the severity of certain side effects of clomid. You can talk to your doctor about using the lowest possible dosage of clomid, as the severity of side effects is dose-dependent. Typically, the side effects of clomid vanish once you have stopped taking the treatment, so usually you will have a healthy pregnancy.
Is Clomid Safe in the Long Term?
If there is a history of autism in your family, you should talk to your doctor about the possible risks of using fertility drugs. Although more studies are needed, there is some evidence that women who take fertility drugs for a long time may give birth to a child with autism.
Safety and Precautions for Using Clomid
Tell your doctor if you are allergic to clomiphene or have any other allergies. You should not take clomid treatment if you have certain health conditions like:
- Abnormal vaginal bleeding
- Liver disease
- Uncontrolled problems of the thyroid or adrenal glands
- Tumor in the brain (pituitary tumor)
Since this drug can cause dizziness and vision changes, do not operate heavy machinery or drive while you are undergoing treatment with clomid. Since this drug is used to get you pregnant, you have to stop taking it when you do get pregnant. You should NOT take this medicine if you are pregnant, because it can harm the child.
Does Clomid Interact With Other Drugs?
Clomid is known to interact with a drug called bexarotene that is used to treat a type of skin cancer. Using bexarotene together with clomid may increase your risks of pancreatitis (inflammation of the pancreas). Another drug that clomid interacts with is ospemifene. This drug is used in women to relieve pain during sexual intercourse due to menopause. When used together, they may increase the risks of blood clots, stroke and some cancers.
Dietary Considerations While Taking Clomid
Avoid herbs like
- Black haw
- False unicorn root
- Agave root
- Black cohosh root
- Licorice and
- Raspberry leaves
Avoid eating raw meat as it may increase the risks of bacterial infections and intoxications. Similarly, avoid canned and prepackaged foods. Avoid fishes like swordfish, mackerel and tile fish due to their high mercury content. Mercury can lead to developmental problems in the child.
It is also advisable to stay away from
- Soy products
- Artificial sweeteners
- Sesame seeds
- Soft cheeses and
- Peppermint tea
Also, avoid eating papaya and pineapple. If you must, eat small portions as these fruits may cause uterine contractions and miscarriage.
Storage and Disposal of Clomid
Store the medicine in a clean, dry and tightly closed container. Keep it away from humidity, excess light and heat. Do not refrigerate.
Always store medicines away from young children and pets. Unused and expired medicines should be disposed of in ways that they do not get consumed by pets, children and other people. Never flush the medicines. If you are not sure about the disposal of the medicine, take it back to your pharmacist.
Clomid For PCOS: The Final Verdict
Clomid has been around for close to five decades and has helped millions of women get pregnant. Clomid has also found to be extremely successful in getting women with PCOS pregnant. It is also the least expensive of all fertility treatments currently available. While the chances of experiencing side effects are low, they can be troublesome and in some cases pretty serious.
Not every woman with PCOS might be the perfect candidate for clomid therapy. Clomid also increases the chances of multiple pregnancies. While this may be perceived as an unexpected benefit, it can actually be tough for both the mother and children. Reproductive specialists and Ob-Gyns have to understand the underlying factors for the infertility of the woman and take the appropriate decisions to start any therapy for improving fertility.