Clomid (Clomiphene): Uses, dosage, side effects, warnings & patient reviews

What is Clomid (Clomiphene Citrate)?

Clomid is an oral prescription fertility medication. Its active ingredient, clomiphene citrate, works by blocking estrogen receptors in the brain. This action tricks the body into believing estrogen levels are low, which stimulates the pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In women, these hormones are crucial for triggering ovulation.

It is important to understand that Clomid is a treatment for infertility caused by anovulation (lack of ovulation), not a cure for all types of infertility. A thorough medical evaluation is necessary to determine the underlying cause.

Clomid is a branded medication. As with many drugs, generic versions containing clomiphene are available and are equally effective. For more information on this, see our guide on generic medicines.

Primary and Off-Label Uses

• For Women: The primary FDA-approved use is the treatment of ovulatory dysfunction in women who wish to become pregnant.
• For Men: Clomid is used off-label to treat hypogonadism (low testosterone) and certain male infertility issues by stimulating the body’s own hormone production.

How to Take Clomid

Clomid must be taken exactly as prescribed by your doctor, as the regimen varies significantly between women and men and depends on individual response.

For Women (Ovulation Induction)

Treatment typically starts on the fifth day of the menstrual cycle (the first day of menstrual bleeding is counted as day 1). The usual starting clomid dosage is 50 mg (one clomid 50mg tablet) taken once daily for 5 consecutive days.

Your doctor will monitor your response via ultrasound or blood tests and may adjust the dose in subsequent cycles if ovulation does not occur. Do not take Clomid for more than the prescribed number of cycles.

For Men (Off-Label Use)

When prescribed for male hypogonadism or infertility, the dosage and schedule are different and must be strictly individualized. It often involves lower doses taken every other day or on a specific weekly schedule. Never self-prescribe Clomid for male hormone optimization.

Important General Guidelines

• Timing: Take the tablet at the same time each day, with or without food.
• Duration: Never exceed the prescribed dose or duration of treatment. Long-term use in women is not recommended due to increased risks.
• Pregnancy Test: Women must have a negative pregnancy test before starting each cycle of Clomid. The medication is contraindicated during pregnancy.

Side Effects of Clomid

Clomid affects hormone levels, which can lead to a range of side effects. It is helpful to understand the spectrum of possible side effects.

What is Clomid Used For?

Clomid has distinct, well-defined uses in women and men, all centered around modulating reproductive hormones.

Primary Use: Female Infertility (Ovulation Induction)

Clomid for pregnancy is specifically aimed at helping women who do not ovulate regularly (anovulation) or who have irregular ovulation (oligo-ovulation) to conceive. It is a first-line treatment for conditions like Polycystic Ovary Syndrome (PCOS). It is crucial to remember that Clomid only helps with ovulation; it does not fix other potential causes of infertility like blocked fallopian tubes or male factor issues.

Off-Label Use: Male Hypogonadism and Infertility

While not its primary indication, clomid for men is prescribed by specialists. It can be used to stimulate the pituitary gland to increase production of hormones that signal the testes to produce more testosterone and improve sperm production. This can be a treatment for some men with hypogonadotropic hypogonadism. It’s important to note that low testosterone can be linked to other symptoms like low libido; for related issues, see information on erectile dysfunction symptoms.

Important Limitations

• Not for Undiagnosed Infertility: Clomid should only be used after a doctor has confirmed anovulation as the cause.
• Not a Hormone Replacement: It does not contain hormones; it stimulates the body to produce its own.
• Not for Long-Term Use: Treatment is typically limited to 3-6 ovulatory cycles due to diminishing success rates and increasing risks.

Important Safety Concerns and Considerations

Ovarian Hyperstimulation Syndrome (OHSS)

This is a potentially serious complication where the ovaries become swollen and painful. It is more common with injectable fertility drugs but can occur with Clomid, especially at higher doses or in women with PCOS. Symptoms include severe pelvic pain, rapid weight gain, abdominal swelling, nausea, and shortness of breath. Severe OHSS requires immediate medical attention.

Multiple Gestation (Twins, Triplets, etc.)

Clomid significantly increases the chance of multiple births (approximately 5-10% risk, mostly twins). Multiple pregnancies carry higher risks for both the mother (pre-eclampsia, gestational diabetes) and the babies (prematurity, low birth weight). This possibility should be discussed before starting treatment. If successful, parents may find our guide to kids’ medicine helpful in the future.

Visual Disturbances

As noted in the side effects, Clomid can cause dose-related visual symptoms like blurring, scotomata (spots), and photophobia. These are usually reversible upon discontinuation but warrant immediate cessation of the drug and medical evaluation. They pose a significant risk for activities like driving.

Impact on the Endometrium

Long-term or high-dose use of Clomid may have an anti-estrogenic effect on the lining of the uterus (endometrium), potentially making it thinner and less receptive to embryo implantation. This is one reason treatment is limited to a few cycles.

Psychological and Emotional Effects

The hormonal fluctuations induced by Clomid, combined with the stress of infertility treatment, can lead to significant mood swings, irritability, anxiety, or depressive symptoms. It is important to monitor emotional well-being and seek support if needed. For information on managing mood, see our guide to mental health support.

Critical Warnings for Clomid Use

Ovarian Enlargement and Cyst Formation

Clomid can cause pre-existing ovarian cysts to enlarge and may promote the formation of new functional cysts. A pelvic examination is recommended before starting and during treatment to assess ovarian size. The drug should not be used in patients with ovarian cysts not related to polycystic ovary syndrome.

Liver Disease and Abnormal Liver Function

Patients with liver disease or a history of liver impairment should use Clomid with extreme caution, as the drug is metabolized by the liver. Discontinuation is necessary if jaundice or other signs of liver dysfunction appear.

Uterine Fibroids

Clomid may cause the enlargement of pre-existing uterine fibroids. Patients with this condition should be monitored closely during therapy.

Risk of Ectopic Pregnancy

While Clomid does not cause ectopic pregnancy, the overall increased chance of pregnancy while on the drug includes a proportional increase in the risk of ectopic (tubal) pregnancy. Any severe one-sided abdominal pain during early pregnancy requires urgent evaluation.

Limitation of Therapy

Due to concerns about long-term safety (including a potential increased risk of ovarian tumors with prolonged use) and decreasing efficacy, treatment with Clomid should be limited. The manufacturer recommends that therapy not exceed a total of 6 cycles per patient.

Clomid Dosage Information

Dosage is highly individualized and must be determined by a fertility specialist or endocrinologist. The following table outlines standard approaches.

Important Administration Notes

• Monitoring: Women undergoing treatment require monitoring (via blood tests and/or ultrasound) to confirm ovulation, adjust dosage, and check for ovarian overresponse.
• Duration: Do not take Clomid for more than the prescribed number of days per cycle. Long-term continuous use is dangerous.
• Maximum Cycles: As per the warning, therapy should not exceed 6 total ovulatory cycles due to diminishing returns and safety concerns.

Drug Interactions with Clomid

Clomid has few clinically significant drug interactions, but a complete medication review with your doctor is still essential.

Note: Always provide your doctor with a full list of all prescription, over-the-counter, and herbal products you are using.

Additional Information

Historical Note

Clomiphene citrate was first synthesized in 1956 and was approved by the FDA for use in women in 1967. It revolutionized the treatment of anovulatory infertility, offering a simple, oral alternative to the more complex hormonal treatments available at the time. It remains a first-line therapy over half a century later.

Reporting Side Effects

If you experience a side effect, report it to your prescribing doctor. You can also report adverse drug events directly to the U.S. FDA via MedWatch or to your national health authority. Reporting helps improve overall drug safety knowledge.

References and Medical Sources

The information on this page is compiled from reputable medical sources and prescribing information.

1. U.S. Food and Drug Administration (FDA). Clomid (clomiphene citrate) Tablets Prescribing Information. [Revised 2012]. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/016131s026lbl.pdf
2. American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstetrics & Gynecology. 2018.
3. MedlinePlus. Clomiphene. U.S. National Library of Medicine; [Updated 2022]. https://medlineplus.gov/druginfo/meds/a682704.html
4. Drugs.com. Clomiphene Professional Monograph. Drugs.com; [Updated 2024]. https://www.drugs.com/monograph/clomiphene.html

Disclaimer: The information on this site is provided for informational purposes only and is not medical advice. It does not replace professional medical consultation, diagnosis, or treatment. Do not self-medicate based on the information presented on this site. Always consult with a doctor or other qualified healthcare professional before making any decisions about your health.