Clomid and spotting

Clomid and spotting DEFAULT

It may be possible to ovulate without a period.

For many couples suffering from infertility, the treatment journey starts with Clomid (clomiphene). These fertility pills help to stimulate ovulation, and when used properly, are safe and effective as a first line treatment for many couples.

One of the more frustrating parts of about taking Clomid is having to wait for a menstrual period to start the medications.

Traditionally, Clomid is started on the 3rd or 5th day of the menstrual cycle, and it is not uncommon for doctors to proscribe progesterone-like medication to bring on the period before starting fertility drugs. If you are seeing an obgyn physician for your fertility treatment and your cycles are irregular, this is likely what will happen.

It turns out it is no longer necessary to have a period in order to start fertility drugs.

Fertility specialists have adopted this new way of thinking after a article came out a few years ago, suggesting the having a period is not necessary in order for fertility pills to be successful.  Not only that, but the chances for success may even be lower if medications are used to bring on the period. This is referred to as the "stair step protocol." So, what does this mean?

The stair step protocol means less time to make you ovulate and a shorter time to conception.

So, why does my doctor not use clomiphene that way?

Most obgyn doctors have been trained to use Clomid in the traditional way. Fertility specialists tend to be more current on the latest treatments and more likely to offer the stair step.

Can the stair step be used with other fertility drugs?

In our practice, we routinely use letrozole (Femara) in place of clomiphene with the stair step and it works just fine. Injectable fertility drugs can also be started without a period, but those treatment cycles are different.

Does this mean we can start clomiphene at any time?

No. Your doctor will need to determine that you are not pregnant and did not ovulate already before starting fertility drugs. Using these drugs as the wrong time of the cycle can cause more harm than good.


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Ovulation Induction – Clomid

Occasionally women need to have their ovulation induced when they are having problems conceiving. Clomid is a fertility medication, which induces ovulation. We usually start this medication at 50 mg. (one tablet) daily on days 5-9 of your menstrual cycle (please see instructions below). If the lower dosing fails to induce ovulation we may increase the dosage.

After clomid, one of three things may occur

Ovulation will be induced, but you will not get pregnant. In this case, you will have a period on days 27-30 of your cycle. Ovulation will be induced, and you will get pregnant. You will not have a period, and should visit our office for a pregnancy test. The dosage of clomid may fail to induce ovulation. In this case, you will not have a period, and will have a negative pregnancy test. We will most likely increase the dosage of the medication at this point. If your period does start, then repeat the cycle with clomid again. Mark the days on your calendar with the instructions below to ensure that you are following them correctly. If you have a period on days 27-30 after taking clomid, then the medicine is working correctly. You should continue taking the medication and have intercourse at the time of ovulation. If you fail to have a period, but your pregnancy test is negative, you are not pregnant. We will induce a period with medication. During your next cycle, we will increase the clomid to 100 mg. to be taken days 5-9 of your cycle. We will continue to increase the dose if you do not ovulate when taking the lower dosage.

Instructions for your calendar

When your period begins, mark this as “day 1″ on your calendar. Count and mark the number of days until “day 5″ and mark this on your calendar.

This is the day you will begin taking clomid. Take the medication on days 5, 6, 7, 8 and 9. You may then label the calendar on the days you may ovulate (most likely days 12-15). You should have intercourse at least on days 12, 14, and 16 of your cycle. Then count and label your calendar on “days 27-31.” This may be when your period begins again. If your cycle has not begun by “day 31″ please call our office.


Clomid is a fertility medication. One important side effect is the possibility of multiple births. The probability of having twins while taking this medication is 7% (meaning 7 out of 100 women taking clomid will get pregnant with twins). The chance of having more than twins is rare.

Answers to Viewers questions: Ovulation bleeding, Endometriosis \u0026 Uterine abnormalities

Wait for your period to begin. The first day of bleeding is “day 1 of your cycle.” If you typically spot for a few days before the bleeding begins, count the days of spotting as your period. The first day of any kind of bleeding constitutes day one of your cycle.

Call our office when your period begins for a “Clomid Check” appointment. If your period begins on the weekend, call our office on Monday. We will need to see you sometime between the 1st and 5th day of your cycle.

When you come into the office, we will perform a pelvic exam with or without an ultrasound. We want to exclude the possibility of your having an ovarian cyst of significant size that would cause us to wait a while prior to prescribing the clomid (Should you have a cyst on the ovary then we will wait one more month then reassess, as clomid may cause the cyst to greatly enlarge and burst).

After the exam, we will give you your prescription for Clomid. If you require multiple clomid tablets daily to produce ovulation, be sure to take tablets as a single daily dose, and not at separate times during the day. You will need to take the medication on 5 consecutive days, beginning on day 3 or 5 of your cycle (doesn’t matter which). For example: If you require 50mg Clomid, you will take one tablet once daily for 5 days. If you require 150mg Clomid, you will take three 50mg tablets together at once daily for 5 days.  Alternatively, we may prescribe a medication called Femara. It works very similarly to Clomid and may have an advantage in patients with polycystic ovarian syndrome. Two pills are taken together at once daily for five days.

Buy an ovulation predictor kit from a local pharmacy. You do not need a prescription for this. Follow the directions for use. Begin on day 11.

On the day that you have a positive result, keep in mind that you will ovulate in 24 to 36 hours. Intercourse should occur a short time before the 24 hour mark, as much as your schedule will permit. You would get 10 different recommendations regarding how many times to have intercourse and with what kind of interval in between if you asked 10 different physicians. Suffice it to say, the sperm live in the pelvis for up to 2 days, and the egg remains “fertilizable” for only about 12 – 24 hours. Therefore, the more sperm present waiting for the egg, the better.

To make sure that the dose of Clomid is the correct dose to produce ovulation, you will need to have your blood drawn on Day 21 of your cycle. This will be done each cycle until we have confirmed that the dose of clomid you are taking is the correct one. After we have established the correct dose, we will no longer need to check this. On Monday thru Thursday, you may have your blood drawn in our office. If Day 21 lands on a Friday or on the weekend or a holiday, you will need to have it drawn at a lab close to your home or at the hospital (make sure you have a request form from our office when you go to have it drawn).

If your period does not start on schedule (usually on Day 28), use a home pregnancy test and let us know… If your period begins, give us a call and we’ll start the process over again.


Spotting clomid and

Clomid (Clomiphene) Side Effects and Risks

Additional Risks

While side effects are usually physical or emotional discomforts experienced while taking a drug, a drug's risks are what may occur beyond what you feel. With that said, here are the possible risks to Clomid:

Twin or multiple pregnancy: The risk of getting pregnant with twins or more may be the most well-known side effect of clomiphene. Data from the National Birth Defects Prevention Study, 1997–2005, shows 11.7% of pregnancies were twin pregnancies and 1.1% were triplets or quadruplets.

To reduce the chances of having twins, your doctor should always start you on the lowest dose first, before trying higher doses.

Ovarian Hyperstimulation Syndrome (OHSS): Usually mild with clomiphene treatment, but in rare cases, the severe form can occur. Without treatment, severe OHSS can be life-threatening.

If you experience nausea, severe abdominal or pelvic pain, sudden weight gain, or severe bloating, contact your doctor immediately.

Irreversible vision disturbances: Extremely rare, only in those who continue treatment after vision disturbance began. In those who discontinued treatment, vision disturbance stopped after three days.

Ovarian cysts: 15.4% of women will develop an ovarian cyst during treatment. The cyst is typically benign (not cancer), and it should go away on its own not long after the treatment cycle is over. If the cyst does not go away, the doctor should follow up and reevaluate. In rare cases, it may require surgical intervention.

Ovarian cancer: Some studies have found an increased risk of ovarian cancer if clomiphene is taken for a year or longer. It's unclear if this is caused by clomiphene or infertility itself.

Clomid Side Effects - Is there anything you can do?

Instructions for the use of Clomid

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Clomid, the brand name of the generic drug Clomiphene, may be prescribed if you have been having difficulty ovulating or getting pregnant on your own. It works by inducing ovulation and thereby increasing your chances of getting pregnant.

Clomid is a prescription drug that should only be taken under the guidance of a medical professional. Certain medical conditions may prohibit the use of Clomid.

Clomid works by tricking the brain into thinking that your estrogen levels are unusually low. Since estrogen levels appear to be low, your body thinks there are no growing follicles; and responds by releasing hormone that signals your pituitary gland to produce more FSH (follicle stimulating hormone) and LH (Luteinizing hormone). The higher levels of FSH stimulate the ovaries, and the higher levels of LH eventually trigger ovulation.

As the follicles on the ovaries grow, they release estrogen. The increase in estrogen signals the brain to slow down the production of FSH, which in turn slows down the stimulation of the ovaries.

How to take Clomid?

If periods are regular

  •   On the third day of your cycle (The first day is the day you have a menstrual flow, and not just light spotting) start Clomid at 50mg (one Tablet) per day for five days
  • You should be having sex every other day starting from day 10 till day 16 of your cycle
  • Have a blood test on day 21 of the cycle. This test is called Day 21 Progesterone. You will be given the request form for the blood test.
  • One week after this test you should telephone my office for the result of your blood test.
  • If the result of your blood test shows that you are not ovulating (have not released an egg) then wait for your next period.
  •  If you did have your period, restart taking the Clomid, this time using 100mg (two tablets) instead of 50mg for five days. If you are still not ovulating after taking 100mg of Clomid then repeat, this time taking 150 mg (three tablets) for 5 days.
  •  If your next period has not arrived within 40 days, take a pregnancy test
  • If the pregnancy test is negative and you did not have a period, you may use Provera tablets to start your period
  • If your Day 21 Progesterone blood test confirms ovulation, however, you did not fall pregnant, then carry on with the same dose of Clomid for up to 6 cycles.

If periods are infrequent or irregular

  • Have a pregnancy test if you have not had a period in the last 40 – 45 days
  • If the pregnancy test is negative you can start Provera tablets, 10mg twice daily for five days. This is to stimulate a period so that you can start to take Clomid.
  • The bleeding should start five to ten days after the end of taking the Provera
  • If you do not bleed, repeat the pregnancy test. If negative, take the Provera tablets again at 10mg twice daily for five days.
  • If you still do not bleed then book an appointment to return see me.

Clomid should not be used for more than six cycles in your life due to the slightly increased risk of ovarian cancer if used for more than 12 cycles.

You should ideally take the Clomid at the same time every day, and some say that taking the pill before bed can help you sleep through some of the side effects. Some do better if they take the pill in the morning. If you have another Clomid cycle, you can try taking it at a different time of the day, but don’t change the time of day once you start the cycle.

You won’t ovulate on the five days you’re actually taking Clomid, but with your first dose, Clomid begins a chain reaction that will eventually lead to ovulation.

Ovulation typically occurs 5 – 10 days after taking the last Clomid pill. So if you took Clomid on days 3 to 7 of your cycle, you are most likely to ovulate between days 10 and 16. Ovulation can, however, occur even later than 10 days after your last Clomid pill, so it’s something to keep in mind.

Even though you take Clomid for only five days, the chain reaction that starts with your first pill continues throughout the month. This is one reason why you may continue to experience some side effects days after you take your last dose.

Progesterone is a hormone that rises after ovulation, and testing for it can confirm whether or not Clomid triggered ovulation. Another reason for testing progesterone levels is to ensure levels aren’t too low. If they are, your doctor may order a progesterone vaginal suppository as a supplement.

Beyond day 21 Progesterone testing for ovulation or ovulation predictor kit so you can time intercourse for your most fertile days, most gynaecologists don’t closely monitor Clomid treatment cycles, but many reproductive endocrinologists and fertility doctors do monitor Clomid cycles for two primary reasons:

  1. Keep an eye on how many follicles grow, so they can cancel the cycle if more than two (or more than one) appear
  2. Time a trigger shot (explained in the next step) or an IUI – interuterine insemination

Side effects

Mild, in the form of abdominal discomfort, feeling sick, breast tenderness, headaches and dizziness

Severe, in the form of ovarian hyper-stimulation where the ovaries become enlarged and you feel unwell or are getting visual disturbances. If this happens, stop the drug immediately and contact either myself or Accident & Emergency of your nearest hospital.

Please note that Clomid is a fertility medication. One important side effect is the possibility of multiple births. The probability of having twins while taking this medication is 7% (meaning 7 out of 100 women taking Clomid will get pregnant with twins). The chance of having more than twins is rare.

OHSS Symptoms

Ovarian hyper-stimulation syndrome (OHSS) can only occur after ovulation has taken place.

Mild symptoms include:

  • Bloating
  • Mild pain or discomfort in the abdomen
  • Mild weight gain
  • Mild nausea
  • Diarrhea

More serious symptoms include:

  • Rapid weight gain, more than 4.5 kg in 3 to 5 days.
  •  Severe abdominal pain
  •  Severe bloating
  •  Severe nausea (so much that you can’t keep down any food or fluids)
  •  Dizziness
  • Trouble with urinating
  • Shortness of breath
  • Rapid heartbeat

These symptoms are self-limiting and here are some things you can do at home to feel better:

  • Take over-the-counter pain relievers, such as Paracetamol.
  • Don’t overexert yourself; take it easy while you recover.
  • While you shouldn’t overexert yourself, you should maintain some light activity.
  • Total bed rest can increase the risk of some complications.
  • Put your feet up. This can help your body get rid of the extra fluid.
  • Sex should be avoided until you feel better. Sexual activity may increase your discomfort, and in the worst case scenarios, may cause ovarian cysts to leak or rupture.
  • Don’t drink alcohol or caffeinated drinks (coffee, colas or caffeinated energy drinks).
  • Do drink plenty of fluids, around 10 to 12 glasses a day. Drinks with electrolytes, such as Gatorade, are a good choice.

If your symptoms get worse, you should definitely seek medical attention by contacting myself, your GP or nearest emergency department.

In rare cases, you may need to be hospitalized. Hospitalization may include receiving fluids intravenously (through an IV), and they may remove some of the excess fluids in your belly via a needle. You may also be kept in the hospital for careful monitoring until your symptoms lessen.

Usually, symptoms will decrease and go away once you get your period. If you get pregnant, though, your symptoms may be prolonged, and it may take several weeks to feel completely better. Pregnancy can also make the symptoms worse.

Your queries are best answered over the phone, our friendly reception staff would be happy to assist you with your enquiry, contact us on +02 8824 4998

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