When should I take clomiphene (clomiphene citrate) for ovulatory dysfunction?

When to Take Clomiphene Citrate for Ovulatory Dysfunction

Start clomiphene citrate 50 mg daily for 5 days beginning on cycle day 3-7 (typically day 5) after either spontaneous menses or progestin-induced withdrawal bleeding. 1

Timing Protocol

• Begin treatment on day 5 of your menstrual cycle (counting the first day of bleeding as day 1), though starting anywhere between days 3-7 is acceptable 1
• If you have amenorrhea (no periods), you must first undergo progestin withdrawal to induce a bleed before starting clomiphene 1, 2
• Take the medication for 5 consecutive days only, not continuously throughout the cycle 3, 1

Dosing Strategy

Always start with the lowest effective dose of 50 mg daily to minimize risks of ovarian hyperstimulation and multiple pregnancy 3

• The 50 mg starting dose achieves similar efficacy to 100 mg with fewer side effects 4
• If you don't ovulate or have poor ovulatory response, your physician can increase the dose in subsequent cycles up to a maximum of 150 mg daily (still for only 5 days) 1, 2
• Approximately 80% of women with ovulatory dysfunction will ovulate on clomiphene, with 50% achieving pregnancy 3

Important Precautions Before Starting

You must meet these conditions before taking clomiphene 1:

• Not pregnant - pregnancy test required
• No ovarian cysts present (except in polycystic ovary syndrome)
• No abnormal vaginal bleeding - must be evaluated first to exclude cancer
• Normal liver function - clomiphene is contraindicated in liver disease 5
• Adequate estrogen levels - though reduced levels don't preclude treatment 1
• Pelvic examination completed before each treatment course 1

Treatment Duration Limits

• Do not continue beyond 6 total cycles (including 3 ovulatory cycles), as long-term cyclic therapy is not recommended 1
• Each cycle should be properly timed with ovulation monitoring using basal body temperature charts or other appropriate tests 1

Common Pitfall to Avoid

The major risk is multiple pregnancy, particularly higher-order multiples, which occurs due to multifollicular development 5, 6. Starting with 50 mg rather than 100 mg significantly reduces this risk while maintaining efficacy 3, 4.