Clomiphene (also known by the brand name Clomid) is a medication that is dispensed at the local pharmacy for fertility. This medication is a first-line agent (meaning it is often the first fertility medication utilized), but many women have questions regarding how their bodies will react and adjust to this medication.
As a pharmacist, I've received a variety of questions on this medication. Common questions include which side effects are normal versus which side effects should warrant a call to the patient's doctor, or how to manage some of the side effects experienced. This article explores the background of clomiphene, how women may feel while taking clomiphene, and what to do for certain side effects.
Clomiphene is a medication that is taken orally (by mouth) in tablet form used for treatment of infertility. This medication stimulates ovulation by working in the hypothalamus of the brain. The hypothalamus is important to hormone regulation. A hormone called follicle stimulating hormone (FSH) is released which results in ovulation.
Individual Body Genetics and Clomiphene
When speaking about side effects, it is important that not all individuals will have the same experience taking a drug. This is because individual genetics and DNA impacts how each person reacts to medication. Clomiphene may work well for one individual and not so well for another. One woman may have success and get pregnant their first month on clomiphene and another woman may not. There are many factors that determine the success of clomiphene, and some of that is due to the individual woman’s body chemistry. Certain women will process the clomiphene differently or their body’s hormones will react differently to this medication than others.
Physical Side Effects of Clomiphene
Clomiphene can cause a variety of side effects. Some women may have no side effects while other women display side effects that result in needing to stop the medication. Normal side effects that some women may encounter include:
- Breakthrough bleeding or spotting
- Breast tenderness and/or pain
- Flushing (this is a warm or tingly feeling)
- Blurry vision
- Hot flashes
Typically, the side effects are mild and will stop once the clomiphene is stopped. Only about 10% of women will have any side effects with this medication. However, with clomiphene use, encountering these side effects can be troublesome.
There has been discussion regarding clomiphene causing decreased cervical mucus. This can troublesome as cervical mucus is important to contraception.
Managing the Physical Side Effects of Clomiphene
Tylenol (acetaminophen) can be taken for headaches or breast pain/tenderness. Motrin or Advil (ibuprofen) use isn’t recommended during pregnancy or with clomiphene use, and long tern use of ibuprofen can actually reduce ovulation.
Rolaids or Tums along with Mylanta is appropriate for nausea and vomiting if needed. Pepto-Bismol products should be avoided as these products have an ingredient similar to aspirin that can cause effects like ibuprofen as mentioned above.
Other side effects such as blurry vision may just need to be tolerated until the medication is stopped. Less common side effects, if encountered, can still be normal. However, if any side effect is extremely troublesome or concerning, the patient should always check with her doctor to see if she needs to be examined.
Emotional Impact Associated With Clomiphene Usage
Perhaps the most difficult side effect to manage are the additional emotions often associated with clomiphene. A user of fertility medication is already dealing with the emotional impact of infertility, and adding the additional emotional side effects associate with clomiphene usage can prove difficult to handle.
This is especially true as women can feel mood swings during the entire cycle when taking clomiphene. Even though clomiphene is only taken for five days, the medication is designed to work for the entire month of the cycle in order to increase ovulation. This means that women can experience side effects throughout the entire month of the cycle, not just the five days while taking the medication, as the user may expect.
Up to 25% of women report emotional side effects (mood swings) while taking clomiphene. It is possible that the emotional impact of taking the medication proves too great, requiring the treatment to be discontinued.
Mood swings also have the potential to impact intimacy between a woman taking clomiphene and her partner. Painful or tender breasts can further contribute to the issue. These obstacles are best addressed through honest communication and an understanding that the side effects are temporary.
When to Seek Help Regarding Clomiphene Use
A pharmacist can be contacted for advice as to which over the counter medications can be taken for side effects such as mentioned above, or for advice treating a cold or flu while on clomiphene.
Severe side effects should be reported to a doctor or even 911 may need to be called. Any type of allergic reaction (difficulty breathing, swollen throat or mouth), or passing out should be considered an emergency situation. If any side effect becomes unbearable or is bothersome, a doctor should be contacted.
It is important to note the difference between side effects and areas of potential concern. For example, some spotting or bleeding is normal, but heavy vaginal bleeding is not normal. Blurry vision is common, but other vision problems are not. If there is any doubt, a contact a doctor to determine if the side effect is normal.
Serious Side Effects of Clomiphene Use
Clomiphene can cause a condition called ovarian hyperstimulation syndrome (OHSS). This is a serious condition in which a doctor should be contacted immediately. OHSS is typically mild, but severe cases can lead to severe illness or death. In OHSS, a woman’s ovaries become swollen and painful. Symptoms of OHSS include:
- Vision problems (other than minor blurry vision), such as increased light sensitivity and presence of flashes or floaters
- Vaginal bleeding that is considered heavy
- Swelling, pain, or pressure in the pelvic area
- Excessive nausea or vomiting
- Excessive weight gain
Other Risks Associated With Clomiphene Use
As with any medication, there are risks associated with clomiphene use including:
- Allergic reactions can occur with any medication, so if difficulty breathing, passing out, or tightness in throat occurs, 911 should be called immediately.
- Using clomiphene for longer than three cycles can increase the risk of an ovarian tumor.
- Additionally, use of clomiphene can increase the chance of a multiple pregnancy, such as triplets or twins, due to increased ovulation.
- Clomiphene should never be used if there is a chance of an existing pregnancy due to the risk to the developing fetus.
Clomiphene generally has minimal side effects, and most go away shortly after stopping treatment. Any women should discuss the potential positive results of using clomiphene with their doctor and weigh against any potential risks before beginning use.
As with any medication, all women should discuss any other current health concerns and medications (both prescription and over the counter) before beginning treatment with clomiphene for the safest result and highest chance of pregnancy.