It is important for women trying to have a baby or those who may plan pregnancy in the future, to be aware of all the factors affecting female fertility. Although the advent of IVF and infertility procedures has made treatment of infertility issues possible, women must take care of certain early alarming signs of infertility. Women having short menstrual cycle are at an elevated risk of Luteal Phase Defect. It is mentioned that women whose menses are shorter than 21 days may suffer from luteal phase defect or short follicular phase. The luteal phase is the second part of a woman’s menstrual cycle, which takes place post ovulation. The estimated time between ovulation and the beginning of periods should be 12 to 14 days. If the duration is shorter than this, this means the corpus luteum is not producing enough hormone progesterone to maintain the uterine lining of the uterus. Even if an egg is fertilized and becomes an embryo, a pregnancy cannot be sustained as there is no support for the embryo to get successfully implanted in the uterus. There are many medical and natural therapies today which are proved to be helpful for women for leading into a happy and healthy life in terms of fertility.
This article contains detailed information about the following aspects of Luteal Phase Defect:
- What is a Luteal Phase Defect (LPD)?
- Relationship between Luteal Phase Defect and progesterone hormone
- What is the role of Luteal Phase Defect (LPD) in pregnancy?
- What is the significance of Luteal Phase Defect in miscarriage?
- What are the causes of Luteal Phase Defect?
- Symptoms of Luteal Phase Defect
- What is the diagnosis of Luteal Phase Defect (LPD)?
- What is Luteal phase insufficiency and Short Luteal Phase?
- What is the treatment of Luteal Phase Defect?
- What are the natural therapies to treat Luteal Phase Defect?
- Frequently Asked Questions about Luteal Phase Defect
What is a Luteal Phase Defect (LPD)?
Luteal Phase Defect (LPD) is a condition wherein the endometrial or uterine lining doesn’t grow in the required manner each month. Due to this improper growth of the endometrial lining, it becomes difficult for a woman to achieve pregnancy or to remain pregnant to full term. The luteal phase is one of the four main phases of a woman’s menstruation cycle. It takes place after ovulation (when a woman’s ovaries release an egg) and before the period starts. During this time, the uterine lining normally gets thicker in order to prepare the uterus for a healthy pregnancy. The luteal phase is considered as the latter phase of a woman’s monthly cycle. This phase takes place with the formation of the corpus luteum and ends in either pregnancy or luteolysis.
This phase begins after ovulation, which lasts about 14 days (unless fertilization occurs) and ends just before the menses of the woman. In this phase, the ruptured follicle gets closed after releasing the egg and a structure called a ‘corpus luteum’ is formed. Corpus luteum is responsible for producing increasing quantities of the hormone progesterone, along with small amounts of estrogen. A defective corpus luteum in the secretion of progesterone hormone turns out to be a major cause of female factor infertility or early spontaneous miscarriage. Progesterone is considered as the primary hormone associated with luteal phase stage in women. One of the main functions of progesterone hormone in a woman is to help support and guide a developing embryo in the pregnant woman.
Relationship between Luteal Phase Defect (LPD) and Progesterone Hormone:
Progesterone hormone is significantly higher during the luteal phase than other phases of a menstrual cycle. The combination of these hormones helps in maintaining the thickened uterine lining, waiting for a fertilized egg to implant in the uterus. When a fertilized egg implants in the lining of the uterus, it produces hormones, which are essential to maintain the corpus luteum. This includes hormone Human Chorionic Gonadotropin (HCG), which is detected in a urine test for pregnancy. The corpus luteum keeps producing the increased levels of progesterone hormone that are required to maintain the thickened endometrial lining. When pregnancy doesn’t take place, this corpus luteum becomes shriveled and dies. This usually happens around day 22 in an average 28-day menstrual cycle. The drop in progesterone hormone levels makes the lining of the uterus to fall away in case of absence of pregnancy. This is known as menstruation. This cycle repeats on a monthly basis in a non-pregnant woman and ceases in a pregnant woman during the pregnancy period.
Luteal Phase Defect (LPD) Chart:
Women open up a lot of possibilities for themselves by recording their daily fertility related signs. Fertility charting is proved to be a useful method for women to assist them in achieving or prevent pregnancy. Fertility charting can answer important queries about the luteal phase, thyroid function, ovulation, and cycle health. Women can get a detailed image of their reproductive health by recording their cervical fluid viscosity, waking body temperature, and other useful data on a regular basis. It is so far the best tracking activities for women to live a healthier and happier life. Fertility charting involves learning to consider the short window of time when a woman is actually fertile. A reasonable number of women still believe that they are fertile throughout their menstrual cycle, while the truth is that there is only a 5-7 day window each cycle when a woman is actually fertile. Fertility charting can prove to be highly useful to protect and prevent pregnancy. Even as a contraceptive method, fertility charting has proved to have an appreciating 100 percent efficacy rate. Along with luteal phase defect, fertility charting can also help couples in identifying the right time for them to have sex in order to increase their chances of getting pregnant without putting a lot of efforts. Signs on the fertility charts that can indicate a luteal phase defect and low progesterone include the following:
- A short luteal phase of fewer than 10 days in length: It is sometimes told that a luteal phase under 11 days in length proves to be challenging for women with such condition.
- Premenstrual spotting during the luteal phase of the menstrual cycle, particularly if it begins less than 10 days after ovulation
- A non-existent temperature rise or a low-temperature rise in the presence of a positive progesterone blood test can be alarming
- Unstable temperatures during the luteal phase in the woman
- An early drop or delayed rise in temperatures after ovulation
Role of Luteal Phase Defect (LPD) in Pregnancy:
It has been reported that over 6 to 10 percent of women are experiencing luteal phase defect. It is being concluded in current infertility scenarios in general population that if women who have been trying to get pregnant without success and with no obvious cause identified, they may be suffering from a condition known as ‘luteal phase defect’. Luteal phase defect can have serious outcomes on pregnancy as the condition is difficult to diagnose without fertility charting. In addition, Luteal Phase Defect (LPD) is usually not detected during standard fertility investigation in a woman. The good news is that these types of defects can be identified with the help of fertility charting. Once the condition and cause have been diagnosed, there are numerous therapies, which can be used to treat the problems associated with Luteal Phase Defect (LPD).
Significance of Luteal Phase Defect (LPD) in Miscarriages:
Luteal Phase Defect (LPD) or deficiency refers to a problem with the luteal phase. In this condition, the endometrial lining of the uterus is not optimally prepared for successful implantation of a fertilized egg. LPD is considered as a theoretical cause of miscarriage and infertility in women. The idea underlying luteal phase defect is that if the uterus is not fully receptive of pregnancy, then either a woman will not conceive at all or the pregnancy will not implant properly. This will ultimately lead to miscarriage. Luteal phase defect can also be a significant cause of repeated miscarriages. It is when women have low levels of progesterone hormone over a series of menstrual cycles.
Causes of Luteal Phase Defect (LPD):
A luteal phase defect can happen to a woman if her ovaries don’t release enough progesterone hormones or if the endometrial lining doesn’t respond to the hormonal levels in the body. The condition has connections to many health problems, including conditions like:
- Anorexia Nervosa: It is an eating disorder characterized by difficulties maintaining the desired body weight, stature, height or age in growing children. A distorted body image is also observed in many cases. People or children experiencing anorexia restrict the types of food they eat and the number of calories intake. Some people experiencing anorexia eat large amounts of food at once and then purge when they are not able to digest it.
- Endometriosis: Endometriosis is a medical condition affecting women wherein, tissues responsible for making up the uterine lining starts to grow outside the uterus. Symptoms of endometriosis include painful periods, pain in the lower abdomen, painful sexual intercourse and of course, presence of infertility issues.
- Extreme workout routine/exercise: Strenuous exercise or workout can impair ovulation in women. Too much exercise can lead to a luteal phase defect in some of the women. A shorter luteal phase can affect a woman in achieving pregnancy in certain specific ways.
- Hyperprolactinemia: Hyperprolactinemia is a medical condition wherein a person has higher-than-normal levels of prolactin hormone in the blood. The main function of prolactin hormone is stimulating breast milk production after delivery. Sporadic luteal-phase hyperprolactinemia is a relatively common phenomenon with progesterone hormone deficiency.
- Obesity: Studies have shown that the length of periods and the luteal phase is possibly affected in obese and overweight women. This clearly indicates that increased weight also impacts the overall weight of a woman.
- Polycystic Ovary Syndrome (PCOS):Certain hormone imbalance like Polycystic Ovarian Syndrome (PCOS) can lead to a longer luteal phase than the desired time frame.
- Thyroid disorders: Thyroid disorders can affect fertility in several ways resulting in luteal phase defect, anovulatory cycles, sex hormone imbalances, and high prolactin (PRL) levels.
Many times, treating these conditions can help women correct their luteal phase defect.
Symptoms of Luteal Phase Defect (LPD):
There are several factors which can lead to a Luteal Phase Defect (LPD). The most common factor is considered to be low progesterone hormone levels. Progesterone hormone is an important hormone required for preserving the endometrial lining and pregnancy during the first trimester of the pregnancy. In cases where a woman’s progesterone hormone production does not reach the optimal level during the first trimester, the chances of occurrence of luteal phase defect are increased. When a woman has a luteal phase defect, she may notice conditions such as:
- More frequent periods
- Spotting between periods
- Trouble getting pregnant
Diagnosis of Luteal Phase Defect (LPD):
An endometrial biopsy can help in detecting a luteal phase defect. For those who are concerned by a short luteal phase, a simple blood test to check Progesterone hormone levels can help them understand what is happening with their body. A pelvic ultrasound can also help IVF specialist measure the thickness of the uterine lining in the concerned woman. Depending on the diagnosis, the infertility specialist may suggest the best treatment plan for increasing progesterone levels.
Diagnostic Criterion for Luteal Phase Defect (LPD):
Diagnostic tests for Luteal Phase Defect (LPD) are influenced by and are based on certain physiologic observations. These observations are explained below:
- The response of the endometrium is a reflection of the luteal-phase progesterone and estrogen and follicular-phase estrogen
- When implantation takes place, secretion of progesterone hormone by corpus luteum relies on increasing human chorionic gonadotropin hormone levels
- Failure of hCG hormone levels to increase directly leads to the failure of corpus luteum and a decrease in progesterone hormone levels
- Progesterone hormone is secreted in pulses
- The length of the normal luteal phase is relatively fixed at 12-14 days
- The levels of progesterone hormone peak in non-pregnancy cycles over 6-8 days after ovulation
Luteal Phase Insufficiency:
Luteal phase insufficiency is one of the major reasons for implantation failure and has been responsible for spontaneous miscarriage and unsuccessful or failed In Vitro Fertilization treatment. Luteal phase defect is typically observed in women with polycystic ovaries, prolactin disorder, and thyroid problems. Low progesterone environment is created iatrogenically following the interventions in assisted reproduction. Use of Gonadotrophin-releasing hormone analogs to prevent the LH surge and aspiration of granulosa cells during the oocyte retrieval may impair the ability of corpus luteum to produce progesterone. Luteal phase insufficiency usually takes place due to inadequate production of progesterone. Progesterone is critical for the secretory transformation of the uterine lining, which permits implantation as well as maintenance of early pregnancy.
A short luteal phase length can have a significant negative impact on natural fertility levels of a woman. A shortened luteal phase is often considered as a clinical manifestation of luteal phase defect. A luteal phase defect often results in dysfunctional endometrial lining development during the narrow interval. It usually happens when an embryo is present in the uterine cavity and is capable of implantation. In such cases, women with typical signs of a Luteal Phase Defect, like a shortened luteal phase, may experience a failure of implantation or maintenance of pregnancy.
Treatment of Luteal Phase Defect (LPD):
The cause of the luteal insufficiency can be the failure of maternal recognition of pregnancy. Supplementation with exogenous progestins can successfully help in maintaining the pregnancy in the absence of endogenous progesterone. There are three methods of therapy commonly used for treating Luteal Phase Defect. However, a highly-qualified fertility doctor will be the one best to guide which treatment option is right for particular health and medical condition. The most common way to treat luteal phase defects is to give the woman extra progesterone. Progesterone supplementation can effectively help in preventing the loss of pregnancy when given to women having a luteal phase defect. Usually, progesterone supplementation is begun three days following ovulation. It is therefore important to accurately document the day of ovulation, as starting progesterone too soon may increase the risk of tubal pregnancy in the respective patient. It is common for women to use urinary ovulation predictor kits to determine the day of ovulation. As the Luteinizing Hormone (LH) surge typically comes before ovulation by 18-30 hours, progesterone supplementation is begun four days after the initial detection of the LH surge. Correcting a luteal phase defect can often be comparatively simple, though it may take a little time for a woman’s menstrual cycle to normalize and for fertility to be restored. The three methods which are used to treat luteal phase defect are:
- Clomiphene citrate or human Menopausal Gonadotropin (hMG) for stimulating follicular growth. It helps in triggering the ovaries to make more follicles, which are responsible for releasing eggs. hCG hormones help in starting ovulation and increasing the production of progesterone.
- Supplemental hCG for improving corpus luteum secretion of the hormone progesterone
- Additional progesterone hormone after ovulation given by injection, orally or with the assistance of vaginal suppositories or gel is used in most of the cases
Fertility charting can help in determining the length of a luteal phase and can determine if a woman has low progesterone levels in her body. Luteal phase defect is projected to affect over 3-4 percent of women who have ‘unexplained infertility’. Estimates of up to 63 percent chances have been projected for women who repeatedly miscarry and 6-10 percent chances of miscarriage are present for women who are diagnosed as fertile or do not possess any kind of infertile issues. Progesterone hormone is responsible for the increase in basal body temperature after ovulation. Therefore, if the basal body temperature does not remain increased for a minimum of 12 days, a woman may have a luteal phase defect.
Natural therapies to treat Luteal Phase Defect (LPD):
Low progesterone levels and luteal phase defect can be treated effectively with a variety of methods which include natural therapies. The natural therapies may include modification of routine diet, herbs, progesterone cream, and supplements.
- Chasteberry (Vitex)
Chasteberry, which is a fruit of the chaste tree, is used as a dietary supplement for infertility, menstrual problems, menopause symptoms, and other medical conditions related to females. Research study has shown that this fruit has also been used to treat reproductive disorders with effective and proven results.
- Vitamin B6:
The vitamin B6 supplement has benefited a lot of women to have a lengthened luteal phase in case of the presence of possible abnormalities. Vitamin B6 has a hormonal balancing effect on a woman’s body. Vitamin B6 can be found in salmon, turkey, tuna, bananas, liver, and green veggies. Women should consult their doctors before consuming this supplement in their routine diet.
- Green leafy vegetables:
Green vegetables are rich in B vitamins, which are essential for proper hormonal balance in every woman’s body.
- Vitamin C:
It has been reported in several research studies that vitamin C helps in improving hormone levels. It also helps in increasing fertility levels in some women with luteal phase defect. Foods which are rich in vitamin C are broccoli, papaya, bell peppers, strawberries, Brussels sprouts, and oranges.
- Progesterone Cream:
One of the most common medical treatments for the treatment of luteal phase defect is to use progesterone cream. It helps in lengthening the luteal phase. Progesterone cream is available at the medical stores, but they need to be applied only after consulting with the concerned gynecologist. The cream should be used twice a day in the areas such as the inner thigh, inner arm, or neck after the occurrence of ovulation. This helps in fetching the desired results following the completion of the treatment.
Studies have revealed that women who had luteal phase defect have significantly lower levels of antioxidants than healthy women. Oxidizing free radicals are now considered to be a major reason for around 40 percent of sperm damage. Women should make antioxidants a vital part of their everyday diet regime by enjoying blueberries, blackberries, garlic, kale, strawberries, sprouts, broccoli, plums, and red peppers.
- Alternative therapies:
Alternative therapies also prove to be beneficial for patients who are looking for a solution for Luteal Phase Defect (LPD). Acupuncture therapy has been scientifically proven for regulating the monthly cycle of a woman. Acupuncture is highly beneficial particularly in lengthening the luteal phase. Women can hire an acupuncturist who specializes in helping patients with infertility issues. For this type of treatments, most acupuncturists recommend weekly sessions of acupuncture.
- Medical treatment:
There are many medical treatments available to help women with luteal phase defect. For those who are considering medical treatments as an option, should take the opportunity to discuss the possible treatments with their fertility doctor.
Frequently Asked Questions about Luteal Phase Defect (LPD):
Q. How is Luteal Phase Defect (LPD) diagnosed?
Luteal phase defect can be diagnosed in an endometrial biopsy. Women, who are concerned by a short luteal phase, can get a simple blood test done to check Progesterone levels. A pelvic ultrasound can also assist in measuring the thickness of the uterine lining in the concerned woman.
Q. Is there anything a woman can take or do to help lengthen a short luteal phase?
Depending on the diagnosis, the infertility specialist may suggest a treatment plan to increase progesterone levels in women. Certain lifestyle changes and dietary habits can help women in lengthening the luteal phase during their non-pregnant stages of life.
Q. What can be the reason for low progesterone production?
There are a few reasons a woman might not be able to produce enough progesterone, particularly if she suffers from any of the following:
- Polycystic Ovarian Syndrome (PCOS)
- Thyroid disorders
- Obesity or Anorexia
For those who are unable to conceive or experiencing recurrent miscarriage due to a short luteal phase can be distressing and discouraging. It’s important that patients don’t ignore fertility related issues. The sooner they seek help from a specialized doctor to diagnose the underlying cause for a particular condition, the sooner they will be able to receive treatment and have a healthy pregnancy. The best way for a woman to find out about the length and quality of the luteal phase is to start tracking and charting her menstrual cycles. It is advisable to keep a record of 2-3 consecutive menstrual cycles in order to have a better understanding of the menstrual cycle and luteal phase.
SOURCES AND REFERENCES:
- Luteal Phase | Wikipedia En.wikipedia.org, 14 June 2019
- Progesterone Fertility Guide | Natural Fertility Info Natural-fertility-info.com, 14 June 2019
- Menstrual Cycle | Better Health Betterhealth.vic.gov.au, 14 June 2019
- Anorexia Nervosa | NEDA Feeding Hope Nationaleatingdisorders.org, 14 June 2019
- What Is Anorexia | Beat Eating Disorder Beateatingdisorders.org.uk, 14 June 2019