Ovulation is when a woman is most fertile and her egg is ready for fertilisation by the sperm. A woman typically ovulates around day 14 of her menstrual cycle. Day 1 is the day she starts her menstrual period. Around day 14, the egg begins to descend the fallopian tube and is ready to meet the sperm for fertilisation. For some women, this ovulation does not happen on time. The use of Letrozole can help induce ovulation and help women track their ovulation more effectively.
Letrozole is a medication predominantly used in breast cancer treatment. It aids in stopping or slowing the growth of breast cancer cells by decreasing estrogen production in the body. Over time, doctors began using this medication in various other health issues that involved hormones.
Doctors have been using Letrozole to help induce ovulation for more than twenty years. They first started using this medication for women suffering from PCOS. It helped induce ovulation, which enabled doctors and women to track ovulation for either natural conception or fertility treatments.
Letrozole, being a non-steroidal oral medication, became more popular for ovulation induction in anovulatory women and for follicle growth in ovulating women. This tablet is also used in IVF, IUI, and ICSI treatments along with other medicines. Letrozole may be used in fertility preservation protocols for women undergoing certain cancer treatments.
Letrozole can be used separately or in combination with other fertility drugs. It is usually prescribed for a 5-day cycle starting around day 3-7 of the menstrual cycle. At this time, the follicles in the ovaries are about 6-8 mm. This follicle will have high levels of androgen receptors and will work well with the Letrozole to induce ovulation.
Letrozole has a short half-life, which means it affects embryo implantation but does not significantly change endometrial thickness, but creates a hormonal environment that is more favourable for embryo implantation. Taking the tablet around the same time every day for five continuous days can increase its effectiveness.
Here is a clear explanation of what precisely happens once you start taking Letrozole –
● You usually take one Letrozole tablet a day for 5 days, commonly starting on day 3 of your period, and ending on day 7.
● Letrozole blocks an enzyme called aromatase and reduces estrogen production in the body.
● By lowering estrogen, Letrozole increases androgen levels in the ovaries, which helps follicles grow.
● The low levels of estrogen will stimulate the pituitary gland to produce more FSH (Follicle Stimulating Hormone). LH (Luteinizing Hormone) may also rise, depending on the timing.
● The increase in FSH and LH will stimulate follicle development and its maturation, increasing the chances of ovulation.
● As the eggs in the follicle mature due to the increase in hormones, the egg is released around the expected time.
● Your doctor may ask you to undergo a scan around day 7 - 10 to monitor the ovaries and follicle development.
● A blood test is taken on day 21 of the menstrual cycle to check progesterone levels and confirm ovulation. If progesterone or ovulation is inadequate, the doctor may adjust the treatment for the next menstrual cycle.
● If you miss your period, a blood test is done to check for pregnancy.
Using Letrozole for fertility issues can have the following advantages:
● It induces ovulation, thus increasing your chances of natural conception.
● It aims at developing a single follicle, thus reducing the chances of multiple pregnancies, like with other fertility treatments.
● Ovulation starts 5-10 days after the Letrozole course, thus making it easier to track ovulation.
● It does not adversely affect cervical mucus or the uterine lining.
Letrozole, when compared to other fertility drugs, has fewer side effects. Some common side effects you may experience due to these tablets are:
● It reduces the estrogen levels, which can interfere with hormone balance and cause mood swings, hot flashes, fatigue, dizziness, etc.
● Taking Letrozole when already pregnant can negatively impact the baby.
● There is a very slight risk of congenital abnormalities for the baby if conception happens while on Letrozole.
● It can have a temporary impact on liver function.
● Letrozole may not be effective for women with regular ovulation but suffering from other unexplained fertility issues.
● Letrozole may also cause bloating, blurred vision, sleep disturbances, stomach upsets, spotting, and pain in the breasts.
Letrozole is an aromatase inhibitor that blocks the conversion of androgens into estrogen. As a result, the estrogen levels decrease and impact the hormonal balance. Many doctors opt for this medication over other ovulation induction medications due to the low side effects. However, the following precautions need to be taken to reduce the side effects:
● Take Letrozole only if your doctor prescribes it, and always follow the recommended dosage. Avoid self-medication.
● Do not take Letrozole if you are already pregnant. This medicine is meant to induce ovulation, not to support a pregnancy. If you think you might be pregnant, wait until you confirm with a test before taking the tablet, as it can harm the developing baby.
● Letrozole may interact with other medicines that affect hormone levels. So, it is essential to inform your doctor if you are taking any hormone-related medications.
● If you are suffering from high blood pressure or are taking any medications for the same, ensure you inform your doctor about the same. Letrozole may increase blood pressure for some or interact with blood pressure medications.
● Discuss your concerns about the side effects of Letrozole on you and the baby with your doctor. Do not try to alter the dosage or treatment plan without consulting your doctor.
Letrozole is a safe medication when taken as prescribed. Contact your doctor in the following cases:
● If temporary side effects like hot flashes, breast pain, vomiting, nausea, and headaches do not go away.
● Chest pain, shortness of breath, a sudden increase in heartbeat, dizziness, or fainting.
● Allergic reactions like hives, itching, swelling of the face or parts of the face, or breathing difficulty.
● Signs of blood clots like redness in the limbs, throbbing pain, swelling, warmth, or coughing up blood.
● Pain in the upper right abdomen, yellowing of the skin or eyes (jaundice), or flu-like symptoms.
Letrozole is predominantly a drug used for breast cancer as it controls the secretion of estrogen in the body. In recent years, doctors have been using this medication to help induce ovulation as well. The medication was banned earlier due to the side effects, but studies showed that Letrozole does not increase any risks to the mother or the baby when compared to similar medications. Taking Letrozole under a doctor’s guidance can help induce ovulation in women who have anovulatory infertility.
