Clomiphene And It’s Most Effective Uses
Clomiphene/clomifene Citrate, aka Clomid or Serophene, is taken in tablet form and primarily used to treat infertility in women by stimulating increases of hormones that support the growth and release of a mature egg – ovulation. Additionally, it can be used in both men and women for other conditions. In the case that the patient cannot make eggs properly, as a consequence of primary pituitary or ovarian failure, the medication is not appropriate.
Clomid in Australia is classed as an “estrogen agonist-antagonist – antiestrogen” and a “selective estrogen receptor modulator (SERM)“. It is a non-steroidal that causes hormone release by the pituitary gland. Acting at the level of the hypothalamus, hypothalamic estrogen receptors are effectively depleted, inhibiting estrogenic negative feedback. With a half-life of about 5 days, clomiphene is excreted primarily through feces and to a lesser extent urine, and may take up to 6 weeks post discontinuation to be completely eliminated from the body. Pharmacologic composition: 38% zuclomiphene, 62% enclomiphene. Clomiphene is most successful in treating:
- Polycystic ovary syndrome – a medical condition that prevents natural ovulation
- Amenorrhea-galactorrhea syndrome
- Psychogenic amenorrhea
- Post oral contraceptive amenorrhea
- Other secondary cases of amenorrhea
Estrogen level checks and pelvic examinations will be taken at the beginning of each treatment cycle. Dosing for infertility treatment (tablet form) is generally started on the fifth day of a menstrual cycle, taken for five days at 50 mg doses. Doses may be taken right away for those without menstrual cycles, with dosage increases when pregnancy does not occur after the first course: the maximum dose being 250 mg after several increases, but no more than four ovulatory cycles (3-6 treatment cycles). Subsequent courses can start as early as 30 days after the previous course; it is most common for ovulation to occur within the first 5 to 10 days of the first course, however.
Starting a cycle
Optimizing the potential for clomiphene to facilitate pregnancy requires transparency from the patient as well as planning, and regular tests/instruction from the doctor, including daily temperature readings (in the morning). Communication is key. During the menstrual cycle, ovulation prediction test kits can be provided and analyzed by the doctor, who looks at luteinizing hormone (LH) concentrations in the blood and urine. LH controls ovulation, so when a sudden rise in LH is detected in the middle of the menstrual cycle ovulation will likely occur within about 30 hours.
During this window a woman has the best chance of becoming pregnant, so intercourse should occur within 24 hours of LH surge detection.
Generally, Clomid is well tolerated with predominantly mild side effects. The most common profiles, with some incidence percentages, include worsening or origination of the following:
- 13.6%+ : Ovarian enlargement
- 10.4% : Hot flashes, breast tenderness
- 1%-10% : Stomach upset, bloating, abdominal swelling, abnormal uterine bleeding, menorrhagia
- 1%-10% : Blurred vision, photo-sensitivity (among other vision changes), headaches, dizziness
- Yellow eyes or skin, hives
- Mood and/or mental changes
- Eye Pain
- Rapid weight gain
- Nausea/vomiting, diarrhea
- Breathing problems
- Decreased urination
- Chest pain, irregular heartbeat
- Rash, bleeding
A thorough medical history should be openly discussed/disclosed with a doctor prior to taking clomiphene. The medication gonadorelin may interact with the medication, and it is wise to disclose usage of simple over the counter supplements, herbals and vitamins. The following would preclude clomiphene as a treatment method:
- ovarian cysts
- liver disease
- endometriosis or uterine fibroids
- thyroid or adrenal gland problems
- hyperlipidemia, high fats or triclycerides in the blood
- brain or pituitary tumors
- currently pregnant
- Ospemifene – may see an increase of toxicity levels and adverse effects
- High cholesterol foods
Studies on clomiphene use while breastfeeding are still inadequate, so this uncertainty must we weighed on a case by case basis. Clomid can slow breast milk production and pass into breast milk, posing a risk to a nursing baby. Although dosing for up to four cycles does occur, usage longer than three cycles might increase the risk of developing ovarian tumors. At high doses risk of developing a life threatening condition known as ovarian hyperstimulation syndrome (OHSS), causing potentially irreversible visual disturbances, increases. Probability of multiple births – twins, triplets – increases with fertility treatment, possibly associated with higher doses. These are riskier pregnancies that are best avoided.