A luteal phase defect is a disruption of the menstrual cycle when the lining of the uterus doesn’t develop properly, making it difficult to get pregnant or to sustain and grow a pregnancy.
Most women don’t like to hear they have a ‘defect,’ and even some doctors don’t think a luteal phase defect or LPD is a real diagnosis but rather an indication of another reproductive problem.
The luteal phase is the fourth phase of the menstrual cycle, usually lasting 12-14 days. The other three phases are menstruation, the follicular phase, and ovulation.
Menstrual cycle overview
The menstrual cycle is a complex process where organs, glands, and hormones interact with each other in a biofeedback system. Your period generally lasts 28 days but can be shorter or longer as well as vary from month to month.
It starts on the first day of bleeding and ends the day before your next cycle begins.
- The menstruation phase starts on day one and is the elimination of the lining of the uterus, which takes three days to a week. Your body knows when to begin menstruating as estrogen and progesterone levels fall. You may feel depressed or irritable because of this.
- The follicular phase starts on the first day of your period and ends at ovulation, at around day 14 of a 28-day cycle. The pituitary gland releases follicle stimulating hormone (FSH), which stimulates the ovaries to produce a dominant follicle containing a mature egg. While the dominant follicle grows it releases the hormone estrogen which stimulates the lining of the uterus to thicken with glands and blood flow in preparation for a possible pregnancy.
- Ovulation takes place approximately two weeks before menstruation. Your body releases several hormones, including estrogen, gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH) and FSH. Rising levels of LH trigger ovulation, causing the egg leave the ovary and move to the fallopian tube to look for sperm if they are present. Fertilization of the egg happens in the fallopian tube after which the fertilized egg now called an embryo will travel down the tube to the uterus to look for a place to implant and grow.
- The luteal phase is the last stage of the cycle when progesterone levels are at their highest and, on average, lasts 14 days. FSH and LH cause the remaining parts of the dominant follicle to transform into the corpus luteum, which produces progesterone. Progesterone readies the uterus for implantation and pregnancy. The death of the corpus luteum triggers an increase in FSH and a drop in estrogen and progesterone, which starts a new follicle recruitment as well as menstruation and the start of a new cycle.
The riddle of the luteal phase defect
A luteal phase defect occurs when this phase is shorter than usual (less than 12 days), and progesterone levels are low. These conditions cause an abnormality in endometrial development, which is needed to receive a fertilized embryo for implantation. Symptoms could include more frequent periods, spotting between periods, and miscarriages.
There is no definitive diagnostic test for an LPD, however your doctor may perform several endometrial biopsies before your period (though some physicians feel biopsies are ‘old school’ tests), an ultrasound to measure the thickness of the lining of your uterus and blood hormone tests.
Treatment for a luteal phase defect can include taking medications like Clomid to promote follicular recruitment, hCG (human chorionic gonadotropin) to start ovulation and make progesterone, and progesterone supplementation to encourage the lining of your uterus to grow until pregnancy is well established.
Not all fertility specialists feel LPD is an actual condition versus a symptom of other disorders such as endometriosis, polycystic ovary syndrome, thyroid issues, or anorexia or even excessive exercise.
If you suspect you might have problems with this phase of your cycle, you can discuss treatment options with one of the specialists at HRC Fertility.
References:
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menstrual-cycle
https://www.webmd.com/infertility-and-reproduction/guide/luteal-phase-defect#1
https://www.womenshealth.gov/menstrual-cycle/your-menstrual-cycle
https://en.wikipedia.org/wiki/Luteal_phase
https://resolve.org/infertility-101/medical-conditions/luteal-phase-defect/
https://www.healthline.com/health/pregnancy/short-luteal-phase#diagnosis