I have polycystic ovaries and am currently taking Clomid in the hope of becoming pregnant. It is my first month on the drug, and I have been experiencing side effects. I have hot flashes and bad mood changes, and I find it difficult to sleep. Is there anything that I can do to minimize the side effects but still carry on taking Clomid? Also, should Clomid make my periods regular? I am five days late, and I am unsure as to when I should be taking my second month's dose.

Jane

Clomiphene is a potent anti-estrogen that tricks the brain into thinking that your ovary is "slacking off." The result is that the brain releases more of the hormones LH and FSH to stimulate the ovary to develop egg-containing follicles. The side effects you experienced are not uncommon and relate to your body's need for estrogen. Unfortunately, anything done to minimize these side effects will diminish clomiphene's effectiveness at restoring normal ovulation.

Without careful monitoring of your cycle, you may miss the benefits from this medication. Many physicians take a hand's-off approach. They don't check the ovaries to rule out ovarian enlargement before the start of the cycle; nor do they monitor your progress with ultrasound. If you do not ovulate, these physicians will simply give you medicine to bring on your period and increase the dose the following month.

Unfortunately, many women treated this way develop painful ovarian enlargement and, in my opinion, waste a lot of time. Active monitoring of clomiphene therapy involves conducting a baseline ultrasound at the start of each cycle and withholding the medication if your ovaries are enlarged. LH and FSH levels are checked on day 9 of the first cycle. On or about the 12th day, you begin urine LH testing to pick up signs of ovulation. If no surge in LH levels is seen by the 16th day, an ultrasound is again performed to determine the exact source of the problem. If the problem is failure to grow follicles, a higher clomiphene dose can be use the next cycle. If a follicle grew but did not release a mature egg, you can have an hCG injection to release the egg (if the follicle is over 18mm in size and the uterine lining is 7mm or greater).