Some time ago we already published an article named What Every Woman Should Know About Her Luteal Phase, where we described the luteal phase in a more general way. In this article, we go deeper into the topic.
Why Is Luteal Phase Defect Such A Big Deal Anyway?
Results in several scientific research show that luteal phase defect or LPD has been diagnosed in 3-20% of patients who are infertile and in 5-60% of patients experiencing recurrent pregnancy loss. Data also shows that 6-10% of women who are fertile demonstrate an inadequate luteal phase.
Many women will not realize they have a short luteal phase until they attempt to conceive. A short luteal phase is one major cause of fertility issues in women, and the primary symptom is trouble conceiving.
But first – let us discuss some basic terms, definitions and essentially talk about what is what.
The normal menstrual cycle can be divided into two phases: follicular and luteal, which are separated by ovulation and bookended by the first day of menstrual bleeding.
Or in plain words – the luteal phase of the menstrual cycle is the phase after ovulation and before the start of the period.
During this time, a woman’s body releases progesterone and thickens the lining of the uterus to prepare for pregnancy. (Further, in the article we will be talking a lot about this sex hormone.)
The follicular phase is dominated by the development of the preovulatory follicle, while the corpus luteum or luteal phase produces progesterone.
Without both phases working in series, natural reproduction is not possible!
Luteal phase defect was a condition first described in 1949 (Georgeanna Jones, MD, first described luteal phase deficiency) and despite the primary mention being almost 70 years ago, the understanding and research on this issue is still incomplete and it remains a controversial topic.
Some of the reasons behind the controversy are:
- Difficulty regarding diagnosis. (A definite way to test or confirm a luteal phase defect is yet to be found.)
- Cause and effect. (Low progesterone level doesn’t always cause infertility.)
- Uncertain treatment results. (It’s unclear if proposed treatments really improve fertility.)
The Length Of The Luteal Phase
Research indicates that the normal luteal phase length from ovulation to menses ranges from 11 to 17 days with most luteal phases lasting 12 to 14 days.
When the luteal phase lasts for 10 days or less, it is known as a short luteal phase or a luteal phase defect.
If your luteal phase is longer than 14 days, you may not be ovulating regularly. This could be because of Polycystic Ovarian Syndrome (or PCOS) or another issue that is causing anovulatory cycles.
The Symptoms Of Short Luteal Phase
There are several symptoms mentioned in the literature and faced by women that experienced them and wrote about them online. Some of them can include:
- spotting between periods,
- more frequent periods,
- trouble getting pregnant,
- early menstrual cycles,
Short Luteal Phase Causes
As said before, a short luteal phase can often be the result of the body not producing enough progesterone.
Though any woman may develop a short luteal phase, several health conditions may cause or are risk factors:
- anorexia (and milder forms of restrictive eating) or obesity,
- anxiety and panic attacks (Progesterone acts like a natural valium, it helps to keep us calm, so it makes sense that low progesterone may cause anxiety and even panic attacks.),
- excessive exercise,
- no ovulation (After ovulation, the follicle in the ovary produces progesterone. Ovulation is the catalyst for progesterone production so if you’re not ovulating regularly, there will be inadequate progesterone.),
- stress (When we are chronically stressed, our adrenal glands produce too much cortisol.),
- thyroid disorders (Underactive or overactive thyroid – you need a certain amount of thyroid hormone to make pregnenolone (the mother hormone to progesterone) which then makes progesterone.),
- endometriosis (Endometriosis affects an estimated 1 in 10 women during their reproductive years (ie. usually between the ages of 15 to 49), which is approximately 176 million women in the world),
- polycystic ovarian syndrome.
Despite the list above, the causes for short luteal phase don’t stop there. We can also mention:
- Poor Follicle Production
If the pituitary gland does not make enough FSH hormone during the first half of the menstrual cycle, then follicle production may be weak, which can cause a thin uterine lining and an early period. This will prohibit fertilization and implantation.
- Unresponsive endometrium
A luteal stage defect could happen when the endometrium doesn’t respond appropriately to progesterone. The endometrium fails to thicken due to its insensitivity to progesterone and pregnancy will not happen.
- The premature drop in progesterone
If progesterone levels drop too soon (within a few days of ovulation), the body will think that it is time to flush out the uterus and start all over again. This is common with short cycles of 21-24 days.
- Low luteinizing hormone
Luteinizing Hormone (LH, also known as lutropin and sometimes lutrophin) increases prior to ovulation occurring. It is this spike in LH which triggers ovulation to occur. LH is necessary to maintain luteal function for the second two weeks of the menstrual cycle. If pregnancy occurs, LH levels will decrease.
- Uterine lining failure
A fertilized egg needs a nourishing environment to grow into a fetus. (Which is the job of the uterus). If uterine lining is not thick enough, it can’t sustain this new life and a miscarriage may occur. Estrogen is the hormone which thickens the uterine lining in preparation for implantation and progesterone “ripens” the uterus preparing for implantation.
How Do You Uncover A Short Luteal Phase?
With medical testing. Having said that…
There is currently no convenient, accepted medical test available to diagnose a luteal phase defect or short luteal phase. However, your doctor may suspect it if you have a serum progesterone level of <30 nmol/L or < 10 ng/ml.
He will most likely perform is a blood test. The test will measure the levels of certain hormones in the body.
The hormones that the doctor will check levels for include:
- progesterone (causes the lining of the uterus to thicken),
- luteinizing hormone (starts ovulation),
- follicle-stimulating hormone (controls ovary function)
It’s important that the blood test is done approximately 7 days after ovulation (mid-luteal phase). Your day of ovulation can be worked out by charting your basal body temperature (or BBT).
A doctor may also request an ultrasound scan of the pelvis. A pelvic ultrasound may help your doctor measure the thickness of the lining of your uterus.
The sperm enters the egg and the conception occurs. Wrong! Pregnancy doesn’t begin until the embryo implants in the uterine lining. For implantation to happen, your body must be making enough progesterone in order to build up a thick lining.
Progesterone prepares the endometrium for implantation and maintenance of a pregnancy.
If pregnancy occurs, the production of progesterone continues for 7 weeks. Studies show that after 7 weeks, the placenta takes over this function. If pregnancy does not occur, menses begins with the demise of the corpus luteum.
The lack of progesterone (A common definition of an inadequate luteal function is progesterone levels that do not reach 16 nmol/liter for at least 5 days.) results in the uterus lining not being thick enough for a fertilized egg to implant or stay implanted.
What Are The Solutions For Luteal Phase Defect?
As I asked at the beginning of this article – how to evaluate treatment for a disease that cannot be correctly diagnosed?
The short answer is – you can’t. However, there is, fortunately, a longer answer to that.
There are 3 methods of therapy commonly used linked to treating luteal phase defect. Your doctor will be the one best to decide which treatment option is right for you:
- stimulate follicular growth (clomiphene citrate or human menopausal gonadotropins (hMG)),
- improve corpus luteum secretion of progesterone (supplemental hCG),
- additional progesterone after ovulation (by injection, orally or by vaginal suppositories).
You can change our lifestyle and diet for the better in order to lengthen our luteal cycle. You can keep away from alcohol, smoking, junk food, and carbonated drinks.
You can also try a number of natural remedies:
Oxidative damage may be a cause of luteal phase defect. Women who had luteal phase defect were found to have significantly lower levels of antioxidants than healthy women.
- Vitamin B6
Women have reported a lengthened luteal phase after supplementing with vitamin B6. This may have been caused by the hormonal balancing effect vitamin B6 has on the body. You can find it in tuna, bananas, turkey, salmon and many of the greens.
- Vitex (Chasteberry)
It helps the body to increase its own production of luteinizing hormone which in turns boosts progesterone levels during the luteal phase of the cycle.
- Cholesterol from eggs, coconut oil, and fat from organic and grass-fed animal products
Cholesterol is necessary for hormone production. Eat a diet that includes whole fat sourced from grass-fed animal products. Use foods like free-range/pastured eggs, butter from grass-fed milk, coconut oil, and grass-fed beef.
- Green leafy vegetables
Rich in B vitamins.
The list above is of course far from complete. You can also use Omega-3 fatty acids, vitamin C, progesterone cream, melatonin and many more.
Some Frequently Asked Questions About The Luteal Phase Defect
When doing research for the short luteal phase, I found a lot of related questions about the topic that women were asking. Some of them are stated below and I will try to answer to them as best as I can:
- How common is a short luteal phase?
- How can I increase the length of my luteal phase while I’m still breastfeeding?
- Is short luteal phase after miscarriage normal?
- Will Clomid fix a short luteal phase?
- Can you get pregnant with a short luteal phase?
- Can a progesterone cream be used for a short luteal phase?
- Can a short luteal phase correct itself?
- Short luteal phase and high estrogen
- Is short luteal phase a myth?
The short answer is not very. Some research states that only 3.5 percent of women who are evaluated for infertility are reported to have luteal phase defects.
I was surprised how often this question occurred. Why? Because there are quite a few women that want to get pregnant again, while still breastfeeding.
There are 2 main issues regarding this question. First, doctors usually give you an impossible choice, which is to choose between breastfeeding and trying to conceive again.
Another issue is that there are close to none studies actually been done on the topic – which is the best and safest way to increase the length of luteal phase while still breastfeeding?
There are often 2 solutions mentioned in the literature – vitamin supplement and Vitex.
It is recommended that you take anywhere between 50-100 mcg of vitamin B6, along with a B-complex (such as B100 or B50).
As far as the Vitex goes – women have mixed results. For some, it increased their milk supply and for others it reduced it.
My suggestion would be to go to your doctor first and insist on getting the solution for you.
Hormones are very tricky. Miscarriage can really mess your whole body. Human chorionic gonadotropin (hCG) that is usually mentioned within the topic is only one of the hormones that can play a vital role. And when your body goes through such a hormonal cocktail after a miscarriage – it can affect your luteal phase.
Research shows that there is no correlation between miscarriage and luteal phase length. For some it can be as normal as it was before, for some it can take several months to work itself out and for some, it can change in both ways – get shorter or longer.
Definitely, mention the concern to your doctor so they can do bloodwork throughout your cycle to see what your hormones are doing.
I think there is some need of explanation because of the way that the question is formed.
Clomid is an oral medication that can be used to jump-start ovulation.
It works by blocking estrogen receptors and tricking your body into producing more of the hormones that lead to stronger and better ovulation. When this happens, the hypothalamus is stimulated to release follicle stimulating hormone, and luteinizing hormone.
Clomid can be helpful for those trying to get pregnant who have any of the following problems: irregular ovulation, male factor fertility problems or unexplained infertility.
So, through inducing ovulation and preparing the uterine lining, it should, in theory, be easier for a woman to conceive and maintain a pregnancy. Most doctors recommend ultrasound surveillance when doing Clomid cycles.
A short luteal phase is one that lasts fewer 12 days. There are reports of women who got pregnant with the length of the luteal phase of 8 days or even less. So it is possible. However, those are the exceptions.
Some experts agree that a luteal phase less than 12 days does not give the uterus sufficient time to establish a necessary thickness of the lining for a growing fetus and therefore will cause a miscarriage even if fertilization has occurred.
Bottom line is that the lining of your uterus must get thick enough to prepare for a possible pregnancy.
Progesterone supplements or injections: If you are having low progesterone levels during your luteal phase, your doctor may prescribe either an oral progesterone supplement or have you come in for progesterone injections. Increased progesterone will help support the corpus luteum and lengthen your luteal phase.
Be careful though: Progesterone cream is not right for everyone and if not used in the right way might increase the risk of miscarriage, so be sure to consult with your doctor and don’t self-treat.
Although there are a lot of natural remedies out there, the reality is that luteal phases that are short, are unlikely to correct themselves naturally. (There are women though that had their luteal phase corrected by itself, for example after their first pregnancy.)
I would suggest for you to read 2 articles from Lara Briden, called The Ups and Downs of Estrogen. Part 1: Estrogen Deficiency and The Ups and Downs of Estrogen. Part 2: Estrogen Excess.
Bottom line: We don’t want too little, but we definitely don’t want it too much, because estrogen excess can cause heavy periods, breast pain, fibroids, and premenstrual irritability.
In my humble opinion no, ergo this article! But there is a lot of research to be done in this area.
I hope I presented the issue of the short luteal phase or luteal phase defect or luteal phase deficiency in a clear way. To summarize the article:
- Luteal phase defect is a controversial topic.
- There are a lot of things that can cause a short luteal phase.
- Warn your doctor, that a short luteal phase can be the issue of your infertility and she will conduct some test (If she is a good doctor, she will conduct the test without saying.).
- Progesterone, progesterone and progesterone!
- You can help yourself a lot by living healthy.
You can do something else to find by yourself the length of the luteal phase – chart your menstrual cycle! It is going to help you pin down the length of your luteal phase each cycle so that you can see if the changes you have implemented are working or not.
I believe I am not an isolated case so I would like to hear from you how you are dealing with the luteal phase defect.
I’d love to hear any thoughts at all on the topic.
Leave the comment below and let’s talk about it.
With love, Monika.
p.s. If you enjoyed this article, check my previous one, where I talked about Can I Have A Successful Career And Be A Hands-on Mom?
p.p.s. If you enjoyed this article, I’d be very grateful if you’d help it spread by emailing it to a friend or sharing it on Twitter or Facebook. Thank you!
About The Author
Monika Setinc is a mother, businesswoman and a Chief Engagement Officer with Kunapipi. She spends her free time with her little son.
References (a.k.a. some scientific material to read)
p.s. Some of the articles are behind the paywall if you are not subscribed to Science Direct.
- Mesen TB, Young SL. Progesterone and the Luteal Phase. A Requisite to Reproduction. Obstet Gynecol Clin North Am. 2015 Mar: 42 (1); 135 – 151
- Boutzios, G., Karalaki, M. & Zapanti, E. Common pathophysiological mechanisms involved in luteal phase deficiency and polycystic ovary syndrome. Impact on fertility. (2013) 43: 314.
- Dhont, Marc. Recurrent Miscarriage. Current Women’s Health Reports 2003, 3:361–366
- Steven L. Young and Bruce A. Lessey. Progesterone Function in Human Endometrium: Clinical Perspectives. Seminars in reproductive medicine/volume 28, number 1 2010.
- Tolga B.Mesen, Steven L.Young. Progesterone and the Luteal Phase: A Requisite to Reproduction. Obstetrics and Gynecology Clinics of North America, Volume 42, Issue 1, March 2015, Pages 135-151
- Orhan Bukulmez, Aydin Arici. Luteal phase defect: myth or reality. Obstetrics and Gynecology Clinics of North America, Volume 31, Issue 4, December 2004, Pages 727-744
- Natalie M.Crawford, David A.Pritchard, Amy H.Herring, Anne Z.Steiner. Prospective evaluation of luteal phase length and natural fertility. Fertility and Sterility, Volume 107, Issue 3, March 2017, Pages 749-755
- Juan A.Vanrell, Juan Balasch. Luteal phase defects in repeated abortion. International Journal of Gynecology & Obstetrics, Volume 24, Issue 2, April 1986, Pages 111-115.
- Linsey Stapley. Treatment of luteal phase defect by ovarian stimulation. Trends in Endocrinology & Metabolism, Volume 12, Issue 4, 1 May 2001, Page 146