Luteal Phase Defect: The Short Luteal Phase Problem

Luteal Phase Defect Or The Short Luteal Phase

The Luteal phase defect ( LPD) is a controversial and often misunderstood.

Its significance has emerged from its supposed relation to
miscarriages and infertility. It is relatively common, easy to diagnose
and even treat.

I will consider in what LPD is, how common it is, its causes and its diagnosis and treatment.

What Is LPD?

The Luteal Phase Defect is an abnormal menstrual cycle with a luteal
phase shorter than normal. It is usually the result of insufficient
progesterone production or action which results in poor development of
the uterine lining needed to sustain a pregnancy.

It is also called Insufficient Luteal Phase.

How Common Is LPD?

Luteal phase defects have been identified in about 3 to 4% of women with infertility, and up to 5% in women with miscarriages.

However,
it has also been identified in a higher percentage of otherwise healthy
women, as high as 30%. This is one of the reasons why it is a
controversial condition, because some experts wonder if it really plays
any role in miscarriages or infertility given its higher occurrence in
healthy women.

The Normal Luteal Phase

The luteal phase of the menstrual cycle is the time between ovulation
and the beginning of menstrual bleeding. Normally, the length of the
luteal phase is 12-16 days. Women with luteal phase defect may have a
phase of 10 days or less.

Using fertility charting, each woman can be able to measure the length of her luteal phase.

Symptoms

The major symptom of LPD is a short luteal phase. This will be manifested as a short ovulation cycle or cycles which are irregular.

Risk factors that should alert any woman to this possibility include,

  • unexplained infertility
  • Repeated miscarriages

Causes

The common factor is defect in the production of progesterone or its
action. There are 3 major causes identified which may occur in
combination.

  1. Poor follicle production This occurs during the follicular phase
    of the cycle. Poor follicle production in the ovaries results in a poor
    corpus luteum which in turn produces insufficient progesterone.
    Deficiency in progesterone causes the endometrial lining to develop
    poorly and therefore unable to allow for implantation of the early
    pregnancy or its subsequent development.
  2. Premature failure of the corpus luteum
    The follicular phase may result in a normal corpus luteum initially
    which ultimately fails to last for its normal lifespan. The placenta
    fully takes over from the corpus luteum in a normal pregnancy at about
    3-4 months of pregnancy. If the corpus luteum fails before this time,
    there will be a miscarriage.
  3. Failure of the uterine lining to respond to progesterone. In this situation, there are normal levels of progesterone but the cells of the uterine lining fail to respond appropriately.

Diagnosis

Once LPD is suspected, the diagnosis must be confirmed by laboratory
tests and the precise cause determined.The doctor my require the
determination of the luteal phase length if there are no charts already taken by the woman. However, you need not wait to have one before seeking medical care.

Tests that can be used include

  1. Measurement of progesterone levels on the 7th day after ovulation. Levels less that 10ng/ml is considered diagnostic of LPD.
  2. Endometrial biopsies.
    The lining of the uterus is scrapped and examined for the effects of
    progesterone. This is now used for selected cases since progesterone
    levels are usually sufficient for most women.
  3. Other tests.
    Once the diagnosis is certain, it is also important to determine the
    precise cause of the LPD. Treatment is dependent on the precise cause.
    Ultrasound of the pelvis determines development of the follicles.
    Estradiol levels in blood may also be requested in some cases.

Luteal Phase Defect Treatment

LPD is treated by your doctor.

Treatment depends on the precise cause found if any was found. Drug options include

  • Progesterone supplementation during the luteal phase. It may be given as an injection or gel/cream.
  • Clomiphene. a drug that stimulates follicle development when he case warrants.

Return From Luteal Phase Defect To Luteal Phase

Return From Luteal Phase Defect To Ovulation cycle


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