Luteal phase defect occurs when the uterine lining does not thicken or grow enough to support a pregnancy. For women who have difficulty conceiving or carrying a pregnancy to full term, one possible cause is luteal phase defect. This condition impedes the growth of the uterine lining, which is necessary for embryo implantation and fetal development. The good news is that luteal phase defect can be easily recognized and treated through lifestyle changes and hormonal treatments.
Luteal Phase and Female Fertility
The luteal phase is a natural stage in the menstrual cycle of women. It occurs right after ovulation, which is when the egg is released, and before menstruation begins. The duration of this phase is usually between 12 and 16 days. If a woman has a 28-day menstrual cycle, the luteal phase will typically start around day 15. However, menstrual cycles can vary slightly among women.
Some may have a short luteal phase, meaning menstruation begins within 10 days after ovulation, while others have a long luteal phase, delaying menstruation until 17 days or more after ovulation.
The purpose of this menstrual stage is to prepare a woman’s body in case pregnancy occurs. During the luteal phase, the ovaries produce the hormone progesterone, which helps thicken the uterine lining so that a fertilized egg can implant. If no egg is fertilized, the woman will not become pregnant, and progesterone levels will decrease. Subsequently, the uterine lining will shed and exit the body as menstrual blood.
Tanya Ferly tentang Promil?
Some signs that a woman is in the luteal phase include:
Breast tenderness
Mood changes
Bloating
Acne
Feeling hungrier or less hungry than usual
Thick vaginal discharge
If the luteal phase shortens to 10 days or less, meaning the ovaries do not produce enough progesterone, or if the uterine lining does not respond well to this hormone, the uterine lining will not grow optimally each month. This condition is known as a luteal phase defect. It is associated with impaired endometrial receptivity, which can hinder embryo implantation and increase the risk of miscarriage.
Symptoms of Luteal Phase Defect
Most women with a luteal phase defect are unaware of the condition until they experience difficulty conceiving or have a miscarriage. Other symptoms of a luteal phase defect include:
Spotting or bleeding between menstrual cycles.
A slow rise in basal body temperature.
More frequent menstruation or shorter intervals between menstrual cycles (<21 days).
Women who monitor ovulation may notice a shortened luteal phase, meaning the time from ovulation to menstruation is 10 days or less.
Causes of Luteal Phase Defect
A woman may experience a shortened luteal phase when her body does not produce enough progesterone. The following health conditions can increase the risk of a luteal phase defect:
Psychological stress
Eating disorders like anorexia or bulimia
An underactive thyroid (hypothyroidism) or overactive thyroid (hyperthyroidism)
Endometriosis
Excessive physical activity or exercise
Hyperprolactinemia (excess production of the hormone responsible for milk production)
Obesity
Drastic weight loss
Polycystic ovary syndrome (PCOS)
Pituitary gland abnormalities that affect reproductive hormone production
Age and aging
Despite this extensive list of causes, many women with a luteal phase defect can still conceive normally and carry a pregnancy to full term.
Diagnosis of Luteal Phase Defect
Currently, there is no single test or specific criteria to diagnose luteal phase defect. If there is suspicion, a doctor may recommend blood tests to check the levels of the following hormones:
Follicle-stimulating hormone (FSH): This hormone is released by the pituitary gland in the brain and is responsible for stimulating the development and maturation of ovarian follicles each month. The egg, which is released during ovulation, is contained within these follicles.
Progesterone: This hormone is primarily responsible for thickening the uterine lining after ovulation. It is produced by the corpus luteum, a temporary gland that forms after ovulation. The corpus luteum develops in the ovary, specifically in the follicle that has matured and released its egg.
Estrogen: This hormone is produced by developing follicles and causes the uterine lining to thicken before ovulation.
Luteinizing hormone (LH): Like FSH, this hormone is produced by the pituitary gland. An increase in LH levels in the blood triggers ovarian follicles to ovulate.
In addition to hormone testing, the doctor may perform an ultrasound of the reproductive organs to measure the thickness of the uterine lining. This parameter can reflect low progesterone levels or inadequate hormone activity in the woman’s body.
Treatment of Luteal Phase Defect
The approach to managing this condition depends on the woman’s overall health and whether she desires to conceive. Treatment also aims to address the underlying issues causing the luteal phase defect.
Women who do not wish to become pregnant do not require any treatment. However, if the goal is to achieve pregnancy, luteal phase defect is generally treated with the following medications:
Clomiphene citrate or letrozole: These medications stimulate the ovaries to develop more follicles, which release mature eggs.
Human chorionic gonadotropin (HCG): This hormone helps initiate ovulation and increases progesterone production.
Progesterone supplementation: This can be administered orally, by injection, or as vaginal suppositories. These medications are used after ovulation to help thicken the uterine lining, thereby allowing normal implantation to occur. However, there is no evidence that using them during pregnancy can prevent miscarriage.
Additionally, lifestyle changes such as reducing stress or achieving a healthy weight can have a positive effect. If there is an underlying condition affecting the woman’s luteal phase, treating that condition can often improve the luteal phase defect.
Is IVF Required for Luteal Phase Defect Cases?
IVF is not always necessary for women with luteal phase defect. However, if a woman becomes pregnant without assisted reproductive technology, there is no evidence that correcting the luteal phase defect will increase the chances of a successful pregnancy.
If a woman has difficulty conceiving or experiences recurrent miscarriages, the doctor will help find the best approach based on her specific condition.
Conclusion
A luteal phase defect should be considered if a couple is having trouble conceiving or experiencing unexplained miscarriages. Although this condition has not been proven to be a direct cause of infertility, it is undeniable that normal progesterone levels are necessary to establish and maintain a pregnancy.
If you are trying to conceive and tests show that your body is not producing or utilizing progesterone properly, discuss with your doctor what might be causing this and what methods can help correct it.
This article has been medically reviewed by Dr. Fiona Amelia, MPH
Source:
American Society for Reproductive Medicine. Diagnosis and treatment of luteal phase deficiency: a committee opinion. URL: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/clinical-relevance-of-luteal-phase-deficiency.pdf.
Crawford NM, Pritchard DA, Herring AH, Steiner AZ. Prospective evaluation of luteal phase length and natural fertility. Fertility and sterility. 2017 Mar 1;107(3):749-55.
Resolve: The National Infertility Association. Luteal phase defect. URL: https://resolve.org/learn/infertility-101/underlying-causes/luteal-phase-defect.
After graduating from the Faculty of Medicine, University of Indonesia, dr. Fiona served as a Non-Permanent Employee (PTT) doctor from the Indonesian Ministry of Health in a remote village in Luwuk-Banggai Regency, Central Sulawesi. This experience led her to continue her master's degree in International Health at Gadjah Mada University, Yogyakarta.
