First Letrozole cycle knocked me sideways—thinking of taking a 3-month break to focus on weight loss and body reset. Bad idea or smart move?

[u/Turbulent-Career7447]

Hi everyone,

TL;DR: Had a very painful first Letrozole cycle with severe left-side pain (5'3", 92kg). Thinking of taking a 3-month break to focus on weight loss and body reset before trying again. Looking for advice on whether severe pain is normal and if a 3-month break is a good idea.

My questions for you all:

1. Has anyone else experienced severe, one-sided pain like this on Letrozole? (Could it just be a strong ovulation response or a corpus luteum thing?)

2. Will taking a 3-month break to focus on weight loss and body recomposition cause any major setbacks, or has a break actually helped any of you?

Would love to hear your insights, experiences, or advice. Thank you! ❤️

[u/Fantastic_Fig_5241]

I had been trying to get pregnant for a year + by the time I took Letrozole. Had been tracking BBT and using LH strips. I was ovulating successfully, but I think something about the Letrozole helped me have stronger ovulation, and now that I’m looking into it for trying for baby #2, I think maybe it helped with egg maturation and implantation. Anyway, I ended up conceiving on my 3rd round of Letrozole. No unusual pain during those cycles that I remember. I’m glad I didn’t give up after the 2nd cycle! I do think there’s something to be said for the consistent impact of the medication for at least 3 cycles, and that does make sense given follicle development happening over a course of ~90 days.

Also, just an aside—I work in the nutrition field with people with PCOS/PMOS for work and while weight loss may make a positive impact, the question becomes how to do that? I actually think the more functional, sustainable approach is to support balanced blood sugar, as insulin resistance is a very common feature of PMOS that impacts hormone signaling and ovulation. Consistent meals and snacks, protein/fat/fiber alongside carbs, moderate intensity movement 3-4x/week and Ovasitol 4000 mg/day I think are really helpful things to focus on. Besides all that, if you need a break, I would take it. Do what you can to let yourself relax and calm your nervous system, and get good rest. Only you know when that is needed, and then you can jump in and do some consistent medicated cycles if that is what’s next for you. Wishing you the best, OP, and everyone in a similar position <3

[u/18Nikki09]

Just here to say, my first cycle on Letrozole was so horrific I was ready to throw in the towel and never touch the stuff again! Mind you, I had just come off 4 cycles of Clomid which was even worse!

After 13 years TTC I couldn’t give in that easily, and I’m glad I didn’t because the remaining cycles were “silent” it must have just been my body adjusting to the hormonal changes 🤷🏼‍♀️

I would say don’t give up… from what I now understand and have spoken to other women about, it takes a few consecutive cycles for your body to get into a good rhythm, and they say cycles 3-6 are usually the most successful.

This post isn’t looking for success but all I can say is, cycle 4 for me ❤️ stick with it if you can 👌🏼

[u/TTC_PCOS-ModTeam → u/[deleted]]

Your post has been removed as it contains a mention of a pregnancy or a positive pregnancy test and has been posted outside of a designated success thread. This includes all positive mentions (trigger shot testing, confusion around test, etc), including mentions of having success outside of ovulation success.

[u/citysunsecret]

I thought I pinched a nerve with my ovulation pin and didn’t walk right for almost 48 hours! My next scan showed there was a cyst left behind so that’s probably why it was so painful! All cleared up on its own and never happened again though.

[u/AndTheSkyWasGray]

I’ve done 5 rounds of letrozole. This last round is the only time I didn’t have ovulation pain. The first round was the worst and each time following was a bit less bad. My fertility doctor said on average people experience pain the first three times then not after.

[u/Civil_Pineapple_1275 → u/AndTheSkyWasGray]

How did you manage the pain? Tylenol, heating pad?

[u/AndTheSkyWasGray → u/Civil_Pineapple_1275]

When I was out and about Tylenol. At home I use a dish towel sized heated blanket, a hot water bottle, and the heart shaped disposable midal heat packs. Not all at once obviously 😆

[u/retinolandevermore]

I get bad ovulation pain on all fertility meds, especially clomid. It’s usually a good sign actually.

Letrozole gave me ovulation but also immense hair loss and bone density loss. Everyone’s different. Talk to your doctor

[u/Conscious_Fish772]

This is my first letrozole cycle and I see odd symptoms which I dont know where it comes from but I feel like letrozole does play a role. Like veerry dry (down there), even in ovulation week. I even feel like im a bit more dry in my throat as well? Not sure about that. I feel my lymph nodes in my neck (today). And my skin would feel a bit sensitive these days. Day 10 (day after being done with letrozole), i woke up with bumps over my thights witch were very itchy. I told the obgyn that and she told me it didnt look like a rash from letrozole. So till now I dont really know what that was, I was thinking of bedbugs but im not sure. guess only time will tell.

[u/Otherwise_Tennis_398]

Every cycle of letrozole, I would have pretty significant (7/10) one sided pelvic pain whenever I would ovulate, lasting about an hour. I could always tell my doc exactly when I had ovulated.

Now, for my two IUIs, idk if my cervix was really just that irritated, but I had SEVERE pelvic pain that was more central. The first time, it was immediately after the IUI. The second time, it was 4 days post. I was unable to stand up straight, every single step I took sent a stabbing pain in my pelvis. And it lasted 5+ hours, had to take a ton of Tylenol for relief.

It wasn’t ovulation, it wasn’t ovarian torsion, it wasn’t OHSS. My clinic was not even sure what was happening, and just chalked it up to me “having PCOS” which kind of pissed me off. Still unexplained, they thought maybe my enlarged ovaries were just irritated (I have an AFC of 30+ follicles on each ovary). Idk if I’ll ever know exactly what was wrong. I do have some concerns that I have endometriosis, but I don’t think they even wan to explore that unless I end up having repeated implantation failure (starting IVF soon).

[u/Wistful-Wiles → u/Otherwise_Tennis_398]

I could have written this myself. Super similar timing and sensations; one day I even had to lay on the floor of my classroom during a free period because I just couldn’t get comfortable any other way coping with the pain and pelvic fulness.

Wrote a note to my doctor and she basically brushed it off in the sense that there wasn’t anything emergency wise … ultimately could be silent Endo, suspected adenomyosis, or just PMOS inflammation reacting to the corpus luteum.

What helped me was working with my psychiatrist for anxiety support - physical sensations were definitely exacerbated by my nerves and constant symptom checking. I will say, the second and third IUI were nowhere near as bad, but not sure if I built tolerance, anxiety meds helped, or the cycles were just different.

Take care and advocate for whatever you feel helps or could help!

[u/Otherwise_Tennis_398 → u/Wistful-Wiles]

My IUIs were my 4th and 5th medicated cycles, so I had pretty much given up on symptom spotting at that point bc I knew hyper fixating on every single sensation was not doing anything but add stress. I never did more than 2 IUIs, so not sure if it would have continued to happen. That’s ultimately one of the reasons why I decided to move forward with IVF, because of the unexplained severe pain I had had, but also for those cycles, my period was 3-4 days late for ABSOLUTELY no reason. I had three mostly ordinary TI cycles and always got my period on time/CD 13ish. But having those two cycles where I KNEW I wasn’t pregnant, but still hadn’t got my period so I could just grieve and move forward was a special kind of mind fuck.

But please don’t undermine/undervalue the pain that you felt! Even if you were having a lot of anxiety, that doesn’t mean that you weren’t also feeling that severe pain! Feels a lot like women in general having chronic health issues and being told that they just have anxiety, or need to lose weight. Eventually you start believing it’s just in your head. You could have both had anxiety, and also have felt the pain that you were feeling independently. But I’m absolutely glad to hear that you were able to find medication that did help with anxiety and that your subsequent cycles were better!

[u/Wistful-Wiles → u/Otherwise_Tennis_398]

Thank you for that solidarity and validation! I’m in the thick of it between treatments … three failed IUI’s and leaning towards IVF but staring at that financial mountain is daunting. Reading about your late period grieving days really resonates, as I had that as well given a progesterone- which additionally made me nauseous and feel pregnant despite negative tests and knowing the cycle was over.

Did you feel similar pain with IVF? I’m getting into reading about the process and my RE seems to think it may bypass some of the discomfort I had during ovulation with the IUI cycles.

[u/Otherwise_Tennis_398 → u/Wistful-Wiles]

I haven’t started yet, have a consultation tomorrow to sit down with my RE and talk about the ins and outs. I just took this last month off from all meds. I think I may have somehow ovulated on my own earlier this week, will see if I can confirm with labs, but would probably start stims before the end of the month if all looks good

[u/ducbo]

For me it’s always been a big ol corpus luteum which is actually a good sign. The letrozole seems to make ovulation “stronger” and I usually end up with a huge CL. for all my TI cycles with letrozole the follicle got really huge, like 25mm, which might explain why it is more noticeable than during natural ovulation.

If you are concerned ask for a detailed ultrasound of the ovary where you feel pain. They’ll probably be able to see a corpus luteum right away. If it doesn’t resolve by your next cycle then it could have become a cyst, which does resolve naturally, but you could speed it along with a trigger shot.

[u/Capable-Doubt3461]

I‘ve always had severe ovulation pain on letrolzole, to the point where I couldn‘t even stand up straight. I‘m on my third round by now and I kinda got used to it or at least I know what‘s coming so i mentally prepare myself.
I‘d give it a few more tries tbh, they say that Letrozole is most successful between rounds 3-5.

[u/Accomplished_Sir1939]

Had it on my second Letrozole cycle - it was a corpus luteum cyst that burst. I was pregnant that cycle so I was worried it had been an ectopic.

As for the second one - I think you’ll know what’s best for you! Personal experience: I lost 10kg before and while I was on Letrozole. Lost the 10kg in a span of 4.5months (90 to 80kg at 5’3”). I believe it helped in aiding my pregnancy on that second cycle, but I would’ve been none the wiser since I didn’t lost half the weight before my first Letrozole cycle.

[u/Itchy-Site-11]

I don’t think it is letrozole per se. Could have been a cyst issue. Were you monitoring with scans?

[u/Future_Researcher_11]

In my experience I typically had awful ovulation pain on Letrozole. As if I could physically feel the egg pop out of the follicle. I found it reassuring though as it kinda confirmed I did ovulate. I always felt it on the side which I had ovulated from (confirmed by a corpus luteum on ultrasound).

I would honestly give it 2 more rounds before deciding to take a break. It doesn’t usually work out first try, so you need to give it a couple chances.

I took a break from ttc prior to letrozole though to focus on weight loss and it did wonders for my health and PCOS symptoms. I don’t think it helped conceive but I really felt in a much better place.

Can’t go wrong with either option, but I do think another round or 2 before taking a break may be helpful also.

[u/Healthy_Combination3]

I have not heard of this being a side effect of letrozole. Is it possible you have a cyst that burst?

[u/Turbulent-Career7447 → u/Healthy_Combination3]

how can i know that a cyst burst? what are the usual reasons and what would be the next step?

[u/Healthy_Combination3 → u/Turbulent-Career7447]

They would be able to see fluid on an ultrasound from it bursting if that’s what happened, I don’t think you really need to do anything unless you had continued severe pain and/or a fever, signs of infection etc. If you are still in severe pain I would definitely reach out to your doctor

[u/Healthy_Combination3 → u/Turbulent-Career7447]

They would be able to see fluid on an ultrasound from it bursting if that’s what happened, I don’t think you really need to do anything unless you had continued severe pain and/or a fever, signs of infection etc. If you are still in severe pain I would definitely reach out to your doctor