Luteal Phase Defect

A fairly common problem among women with fertility problems, luteal phase defect (LPD) can impact your fertility by preventing implantation and cause early miscarriages.

What Is It?
During a normal menstrual cycle, the luteal phase will begin after ovulation and last until your period starts. It is during this time that the corpus luteum releases progesterone, getting the endometrial lining ready for implantation. However, women who are affected by LPD are either unable to produce enough progesterone during the luteal phase or the endometrium does not respond appropriately to the progesterone stimulation. The end result is that the endometrial lining is not sufficiently prepared for implantation.

It is difficult to pinpoint one specific cause of LPD. There are many different factors that can affect your menstrual cycle and any one of these can affect the production of progesterone during the luteal phase. For a rare few women, though, LPD will be caused by thyroid problems or hyperprolactinemia. Hyperprolactinemia occurs when there are abnormally high levels of prolactin, the hormone responsible for milk production, in a woman’s system.

Symptoms of Luteal Phase Defect
For many women, the subtle signs of LPD will go unnoticed until they experience problems trying to conceive. The majority of women with LPD will have the appearance of a normal menstrual cycle because of their regular periods. A few women may experience frequent but light periods. Women who are actively trying to get pregnant may notice the symptoms a bit sooner.

Since progesterone raises the body’s basal temperature, during the luteal phase, a woman’s basal body temperature is normally elevated. However, women who are charting their basal body temperature may notice that their temperature does not stay elevated during the luteal phase. Women who are charting their ovulation will likely find that their periods occur sooner than the average 14 days after ovulation.

Diagnoses and Treatment
An endometrial biopsy is the most accurate and detailed method of diagnosing LPD. The biopsy is usually done about one to two days before a woman expects her period. At the laboratory, the technician evaluates and dates the endometrial lining sample. If the date given by the technician is in line with the actual cycle date, then a woman is thought to be "in phase" or having a normal menstrual cycle.

When there is a difference of more than two days between the laboratory date and a woman’s cycle, then she is considered to be "out of phase." An "out of phase" diagnosis is indicative of LPD. However, a woman must have two "out of phase" biopsy results before a positive diagnosis of LPD can be made. Further testing can determine the cause, whether it is a lack of progesterone production or a poor response by the endometrial lining to progesterone stimulant.

Treating LPD is usually fairly simple. Depending on what is causing LPD, the appropriate hormonal drugs will be prescribed. Luckily for women with LPD, fertility problems quickly cease with the proper treatment.


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