What Is Clomid?

Clomid (clomiphene citrate) is a pharmaceutical drug used to induce ovulation. It’s one of the most common fertility treatments in conventional reproductive medicine, often prescribed as a first-line treatment for intertility. Whether you’re of “advanced maternal age” (meaning above 35 years old), you have an ovulatory disorder such as hypothalamic amenorrhea or PCOS, or you simply have been trying to to conceive without luck, fertility specialists will likely prescribe Clomid for you. Its appeal is simple: force the body to ovulate. But that approach skips over the deeper question: Why isn’t ovulation happening in the first place? Answering that question is the key to finding a natural alternative to Clomid.

How Does Clomid Work?

Clomid binds to estrogen receptors in the brain—specifically, in the hypothalamus. It blocks the brain’s perception of estrogen, tricking it into thinking estrogen levels are low. The brain responds by producing more GnRH (gonadotropin-releasing hormone), which then stimulates the pituitary to release more FSH (follicle-stimulating hormone) and LH (luteinizing hormone). The result: follicle (egg) development and, ideally, realease of that egg for potential fertilization via ovulation.

It’s a pretty amazing system. But hijacking it with synthetic chemicals comes with risks: mood swings, hot flashes, ovarian cysts, thin uterine lining, and a higher rate of multiples. Not to mention, you might be uncomfortable with the thought of overriding your body’s own functionality. Is there a better way?

The Hormones Involved in the Clomid Pathway

To get pregnant without Clomid, it’s essential to understand how the body’s hormones work and what changes when Clomid enters the scene:

• Estrogen signals to the brain whether to stimulate or suppress reproductive activity.
• GnRH from the hypothalamus tells the pituitary to act.
• FSH promotes follicle (egg) development.
• LH triggers ovulation.

Clomid disrupts this communication loop to force ovulation. But instead of forcing, functional medicine offers options to support. And we do that using targeted, evidence-informed botanical tools that replicate the intended effects of Clomid—without its side effects.

Why Do Women Want a Natural Alternatives to Clomid?

Many of my patients seek functional medicine for natural alternatives to Clomid due to concerns about side effects, a preference for holistic approaches, or previous poor responses to the medication. Clomid, while effective for stimulating ovulation, can cause side effects such as mood swings, hot flashes, headaches, and thinning of the uterine lining, which may impact implantation. Individuals with conditions like PCOS often also worry that Clomid could further disrupt their hormonal environment, while others may have tried the drug without success and are exploring alternatives as a result. In some cases, natural approaches are also more accessible and affordable, particularly where fertility treatments are not covered by insurance.

Natural Alternatives to Clomid

In my pratice, I typically use the following three herbal strategies as natural Clomid alternatives. Sometimes, I prescribe these herbs truly as alternatives to Clomid but in other circumstances, I use them as part of a treatment plan designed to treat the root cause of hte health conditions that led to the Clomid prescription in the first place.

Black Cohosh as a Natural Clomid Alternative

Black cohosh (Actaea racemosa) acts as a natural alternative to Clomid by binding to estrogen receptors in the hypothalamus and pituitary, just like Clomid—but without chemically blunting the system. This herb increases FSH and LH levels, promoting ovulation naturally. Studies show black cohosh improves ovulation rates, especially when paired with lifestyle and nutrient interventions. It supports the body’s innate rhythm rather than overriding it. In other words, if the body is trying to ovulate on its own, black cohosh helps it along.

How to Use Black Cohosh as a Natural Alternative to Clomid: When I prescribe black cohosh to infertility patients in my practice as a natural alternative to Clomid, I recommend 250 mg twice daily during the follicular phase. (Need help identifying your follicular phase Read this.)

Salvia Miltiorrhiza as a Natural Clomid Alternative

Salvia miltiorrhiza (also known as the Chinese herb Dan Shen) acts as a natural Clomid alternative by stimulating the hypothalamus to produce GnRH. This drives the cascade of FSH and LH needed for ovulation. It also improves blood flow to the reproductive organs and supports endometrial health—critical for successful implantation. In functional medicine, we use Salvia to restore communication between the brain and ovaries, especially in women with irregular or absent cycles, such as in the case of hypothalamic amenorrhea or hypothalamic hypothyroidism.

How to Use Salvia (Dan Shen) as a Natural Alternative to Clomid: When I prescribe salvia to infertility patients in my practice as a natural Clomid alternative, I recommend 3-6 mL of tincture taken twice daily. Avoid taking in the second half of the luteal phase.

Maca (Lepidium meyenii) as a Natural Clomid Alternative

Maca works on both the brain and ovaries, providing a natural alternative to Clomid. It increases GnRH output and supports healthy estrogen receptor function, giving it a unique dual role. Unlike hormone replacements, maca acts as an adaptogen. It helps normalize the HPO (hypothalamic-pituitary-ovarian) axis, bringing balance whether estrogen is low or high. Research shows maca improves cycle regularity, egg quality, and libido—without disrupting hormonal feedback loops.

How to Use Maca as a Natural Alternative to Clomid: When I prescribe maca to infertility patients in my practice as a natural Clomid alternative, I recommend 500 mg Gelatinized Maca (Hypocotyl Concentrate) taken twice daily. Typically when prescribing maca, treatment plans involve its use in combination with other herbal strategies that target the root cause.

Root-Cause Medicine: The Key to Successful Conception

Whether you’re using Clomid or natural Clomid alternatives, the goal is the same: ovulation. But real, lasting fertility success comes when we ask why ovulation isn’t happening. Hormone imbalances are symptoms, not diagnoses. PCOS, hypothalamic amenorrhea, thyroid dysfunction, and chronic inflammation all disrupt fertility. Masking symptoms with a prescription skips the part where we solve the problem.

In functional medicine, we reverse infertility and offer alternatives to Clomid by restoring function. That means identifying and treating the root cause—whether it’s blood sugar dysregulation, nutrient deficiencies, poor gut health, or stress overload. Whether you’re using a pharmaceutical ovulation trigger or herbal support like black cohosh, salvia, or maca, your best chance of success lies in aligning with your body’s design.

Ovulation disorders don’t result from Clomid deficiency. Your body wants to conceive. When we remove the blocks and support the right pathways, fertility improves—naturally, predictably, and sustainably. That’s what I call real medicine. And that’s how we create not just pregnancies, but healthy mothers and babies.

If you need help unscrambling your hormones and understanding the root cause of infertility, check out The Hormone Hacker, a guidebook that helps you with exactly that. After all, guessing about your health won’t help you get pregnant.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Is There a Natural Clomid Alternative? appeared first on Dr. Alexandra MacKillop.

But, that doesn’t mean it’s impossible. Or even unlikely. Quite the opposite, actually.

One of my favorite parts of my job is seeing patients get better, but the icing on the cake is when they have a truly dramatic and objective improvement, such as getting pregnant and delivering a healthy baby after sometimes years of unsuccessfully trying to conceive. Sometimes my pregnant patients have been previously told by other providers, including fertility specialists, that they will never conceive naturally…

As a functional medicine doctor, I’ve had the privilege of seeing women and couples from all walks of life conceive successfully and finally fulfill their dream of become parents, or perhaps become parents a second or third time after things didn’t go as smoothly after the birth of their first child(ren). Yes, this includes couples over 40, too.

In the world of fertility, time is of the essence. In today’s day and age, couples are waiting longer to start trying in the first place and, if fertility problems pop up, it really can throw a wrench in a couple’s plans. For this reason, many OB/GYN offices refer patients out for fertility treatments if they don’t successfully conceive after just 6 months of trying. While many couples who don’t have fertility problems naturally conceive without a problem within a year of trying, the setback of an additional 6 months turns into sometimes additional years once the decision to start IVF (after IUI attempts) has been made and finances secured. At some point, they say, a woman just gets “too old.” Or, does she?

I won’t dispute that age is a factor when it comes to fertility. Obviously, natural conception is virtually impossible after menopause. But, menopause aside, 40 is not “too old” to get pregnant despite what many fertility specialists might say.

I’ve seen plenty of women, both patients and otherwise, conceive successfully well into their 40’s. The key difference between women who conceive easily and women who don’t comes down to understanding a few key things about fertility. Let’s dive in…

1. Egg quality isn’t just about age

A woman is born with all the eggs she will have in her lifetime, but not all those eggs are fully mature at the same time. Rather, the primordial, pre-eggs reside in ovaries and ultimately develop and differentiate into mature eggs or “oocytes” over the course of a couple menstrual cycles. This maturation process depends on nutritional quality, hormonal balance, and control of factors that can degrade the quality of the eggs, such as environmental toxins and yes, aging. But biological age and oocyte age are not the same thing. There’s no “hard and fast rule” for what is too old to conceive. I’ve had young women in their 20’s with poor egg quality that we’ve reversed through functional medicine as well as women in their 40’s who have had excellent egg quality. (We measure this with Anti-Mullerian Hormone, or AMH, on blood work.)

Egg quality can be improved, and there are many factors that can help slow down the processes of aging and poor egg quality. The most important factors to improve egg quality are lifestyle-related ones like:

• Stopping smoking
• Reducing or eliminating alcohol
• Sleeping at least 9 hours per night
• Exercising 5 or more days per week
• Eating enough calories and cabohydrates, but also maintaining an ideal body weight
• Controlling insulin resistance (look into a CGM to get a better idea of your body’s glucose control)
• Drinking clean water and avoiding endocrine toxins like plastics, parabens and phthalates
• Managing stress

Egg quality can also be dramatically improved with supplementation techniques like:

• Melatonin
• Zinc
• CoQ10
• Pycnogenol
• Pterostilbene
• NAD

These supplements generate energy for the cells (powering up mitochondria), reduce oxidative stress, scavenge free radicals and help slow down the aging process of cells. A little supplementation can go a very long way, and these are staples in my fertility arsenal for any patient over 40.

2. You need to know what diagnosis you’re working with

“Unexplained infertility” is not a diagnosis. It simply means that the doctors haven’t yet dug deep enough to find an answer and create a treatment plan to solve the problem.

Conditions like hypothalamic amenorrhea (HA) and polycystic ovarian syndrome (PCOS) are hallmark reasons for irregular ovulation and difficulty conceiving. Perimenopause may also cause less frequent ovulation and unpredictable periods, making family planning efforts more challenging. That being said, perimenopause at any age, including over 40, does not prohibit pregnancy. But irregular periods can easily be chalked up to “probably perimenopause” if a proper diagnosis isn’t made. This means you need thorough testing to identify problems like:

• Low FSH/LH, meaning the brain is not signaling to the ovaries to develop an egg, as is the case in hypothalamic amenorrhea (HA)
• Elevated androgen levels, possibly elevated LH despite normal FSH, as is often the case in polycystic ovarian syndrome (PCOS)
• High or unpredictable levels of estradiol, low progesterone, and elevated FSH, as is often the case in perimenopause

But that all isn’t even to mention the impact of thyroid disorders, including hashimoto’s, which often go undiagnosed.

To add more to the list, endometriosis is also a common culprit for fertility disorders, with its abnormal tissue growth and accompanying inflammation that can damage the ovaries. While harder to diagnose than conditions which show up on blood tests (endometriosis requires surgery to formally diagnose, though it may show signs on an MRI), there are still hopeful options, such as excision surgery, anti-inflammatory strategies and even platelet-rich plasma (PRP) injections which all provide next steps for women of any age dealing with infertility.

Tip: the first two cycles after endometriosis excision surgery are often considered the “most fertile” time for women struggling with fertility and endometriosis.

3. You need to know your cycle

Are you ovulating How do you know

If you can’t confidently answer both of those questions, you might be experiencing some important road blocks to fertility in your 40’s which can easily be overcome.

One of the major shortcomings of our sexual education practices in America is that we emphasize birth control and pregnancy prevention, but don’t much dive into how to actually help couples conceive when the time comes. As a result, many women have no idea when to time intimacy in order to facilitate a swift family planning process. (Not all days of the month are equally fertile!)

In fact, most women I’ve spoken to have never heard of the concept of a “most fertile day,” or don’t know what their cervical fluid means. Still more have never even heard of luteinizing hormone, much less learned how to identify its surge.

I recommend that all my patients track their cycles using basal body temperature, or a home fertility tracking strategy such as over-the-counter test strips for urinary LH, or a fertility monitor such as Inito to predict and confirm ovulation. If you know for sure when you’re ovulating, you can streamline your efforts for trying to conceive to max on O-2, which is two days prior to ovulation, the day you most typically will see a positive LH strip (AKA ovulation prediction test kit), experience peak production of egg white cervical mucus (ewcm) and be the most fertile. Sex on this day will result in an abundance of healthy sperm waiting in the fallopian tube for a healthy egg to be released.

4. You need to know your options

If you have tried all the things and are looking to fertility treatments as a next step, don’t forget that alternatives do exist. That’s my bread and butter in functional medicine, which is helping identify the root cause. But, sometimes you just need to make it happen. If you haven’t already, check out my blog post regarding natural alternatives to fertility drugs if you’re looking for ways to avoid Clomid, bromocriptine, letrozole, and other prescriptions.

If you’re over 40 and TTC, it’s not too late for you. There is hope and you have options!

Baby dust!

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Get Pregnant After 40 (Without Fertility Treatment) appeared first on Dr. Alexandra MacKillop.

“Okay, okay, hypothalamo-whatta-whatta?“

If that’s what you’re thinking, you’re in good company. The hypothalamic-pituitary-adrenal-thyroid-gonadal axis is quite the tongue twister. But don’t worry, it sounds more confusing and overwhelming than it is. In short, the HPATG-Axis is the system of hormone balance in our bodies. To understand how to balance hormones naturally, we need to first understand what hormone balance looks like through this great, big web of connections.

In a nutshell, the HPATG-Axis phrase refers to is the fact that a part of our brain called the hypothalamus communicates with our adrenal glands, thyroid, and ovaries (aka gonads) through a series of hormones produced by the pituitary gland (also located in our brain). In physiology, we often talk about those interactions separately, referring to them as the hypothalamic-pituitary-adrenal axis, or the hypothalamic-pituitary-thyroid axis. But in reality, they’re all connected, and this post will explain everything you ever wanted to know about how and why. (Okay, maybe not everything, but the basics…)

The HPATG Axis (AKA Endocrine Axis)

HPATG physiology can basically be summed up like this: the hypothalamus talks to our pituitary gland using hormonal signals, telling the pituitary gland when and how to stimulate our thyroid, our adrenal glands, and our ovaries. All of those glands send hormonal messages back to our brain with information about how much activity is going on, and whether or not there are any problems. In response, the brain tells the body to amp up activity in each of those sites, or tone it down. This is called a negative feedback loop.

When we face periods of stress (or rather, when we face too much stress for too long), our HPATG axis is completely intercepted. This is where we can run into imbalances in our thyroid hormones (such as hyperthyroidism or hypothyroidism), adrenal hormones (such as “adrenal fatigue”), or fertility problems, (such as hypothalamic amenorrhea). These problems can occur one at a time, or all at once, leading someone to feel really sick, and probably also really confused! Stress is a biggie when it comes to a properly functioning HPATG axis. In most cases, if you’re wondering how to balance hormones naturally, we need to start by addressing stress because stress is the single most powerful influence over the HPATG axis.

Stress and Stress Management

When we think about stress, we typically think about the psychological or emotional—deadlines at work, an overly packed schedule, a bad breakup, or a death in the family. But stress comes in many forms, and can even be triggered by good life events…

• Under eating (not enough calories or carbs)
• Nutritional deficiencies
• A significant/sudden change in diet/eating habits (especially yo-yo dieting)
• Over exercising (or a sudden change in the type of exercise)
• Lack of sleep or change in sleep schedule (i.e. night shift)
• Illness or injury (including surgery)
• Travel (even if it’s fun!)
• Moving
• Starting a new job or educational program
• Getting married
• Certain medications, or drug use
• Depression or anxiety
• Emotional distress (like the loss of a loved one)
• Psychological distress (like work deadlines or studying for exams)

Many of these things are normal parts of life, and when we are following a pattern of self care, our bodies are able to accommodate the stressors without falling into dysfunction. But when our self-care routine falls out of balance (or we begin struggling with disordered eating) we detract from the foundation of health. When that happens, everything else starts to crumble. One of my favorite ways to explain this relationship between stress and self-care is the bucket analogy:

Self-care fills our bucket, but stress drains our resources. When the bucket gets low, we start to notice symptoms of burnout. When the bucket gets empty, it leads to hormonal disaster, interrupting our whole HPATG axis at a biochemical level in our brains (big red stress arrow on the infographic at the top of this post). Ultimately, learning how to balance hormones naturally means learning how to identify and cope with the small, daily stressors in our lives.

Dysfunction, one axis at a time

The reason we often talk about the HPATG axis in terms of its separate components (HPA, HPT, HPG axes) is because unilateral dysfunction is common. For example, an autoimmune disease called Hashimoto’s Thyroiditis can lead to destruction of the tissue of the thyroid gland and subsequent hypothyroidism. When this happens, the thyroid loses its ability to produce thyroid hormone. When the pituitary gland realizes that thyroid hormone levels are so low, it amps up its secretion of thyroid-stimulating hormone in an attempt to tell the thyroid to do a better job. The problem is, the thyroid itself has been damaged—it can’t do its job until the autoimmune reaction is addressed. (Here’s where stress pops up again: if you’re wondering how to balance hormones naturally in terms of your thyroid hormones, you still need to pay attention to the stress piece because stress is one of the primary drivers of autoimmune disease.)

Low levels of thyroid hormone create a further stress response in the body, signaling back to the brain that something’s off. This consequently affects the signaling between the pituitary gland and the adrenals/ovaries as the body tries to balance things out. Low levels of thyroid hormone, for example, creates a dangerous environment for a growing baby, and so the reproductive system is one of the first to get shut down (via the HPATG axis). On the other hand, pregnancy causes the body to re-prioritize its hormonal resources. When a woman is pregnant, the body needs different levels of thyroid hormone, cortisol, and other hormones to carry the pregnancy to full-term. These body signals these changes through the same negative feedback loop. (All of this takes place without us ever having to think about it. You’ve got to admit, God’s design is pretty amazing!)

The HPATG Axis and Healthcare

When a patient complains of problems like fatigue, weight gain or weight loss, thinning hair, or irregular periods (just to name a few), the solution is never as simple as writing a prescription for birth control pills or Synthroid. There’s always more to the story, and that’s why its so important to identify the root cause of the problem when considering how to balance hormones naturally. In my practice, I do this primarily by talking with my patients in detail about their health history, and taking a closer look at the lab work. From a functional medicine perspective, it’s never safe to assume that the other components of the HPATG axis are functioning properly, even if we’ve already identified that one of them is out of sync. That’s why holistic healthcare means addressing the whole person, and not just using a symptom-by-symptom, band-aid approach.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Balance Hormones Naturally (Understanding the HPATG Axis) appeared first on Dr. Alexandra MacKillop.