Twice in recent times, I have been faced with the question of whether spotting during what should be a menstrual period is okay enough to start a fertility boosting medication.
And each time, my answers were, “What is a normal menstrual cycle for you, a full bleed or spotting?” And then, “Yes, that medication requires that you are entertaining the witch actively.” While these questions helped the ladies determine what to do, they also led to investigations, as they showed that there might be an issue with the luteal phase of one of the ladies.
First of all, her cycle is short, and her luteal phase was less than 10 days often times, since she started charting in May 2017. Ordinarily that was just a pattern that she thought was peculiar to her; having a longer follicular cycle than a luteal phase, with a menstrual cycle of only a few days, with more spotting than bleeding.
At least, until she had to take this fertility boosting drug and the issue of her perennial spotting came up again. Her doctor suggested that she take a day 21 test, as well as a scan to check the thickness of her endometrial lining. It provided some answers to the reasons she may still be TTC.
She has a very uncommon condition luteal phase defect. This condition is rarely diagnosed in women, but it happens to a good number of women all the time.
What is the Luteal phase first of all?
Before we go further, it is important that we know exactly what the luteal phase is, and what it is not,
The luteal phase begins during the second half of a woman’s menstrual cycle. Normally, it lasts between 12-14 days after ovulation.
The corpus luteum, which the luteal phase is named after, is formed right after ovulation and is responsible for producing progesterone.
During the luteal phase, the production of hormone such as progesterone and even estrogen, begin to increase as they are important to the preparation of the uterine lining for the implantation of the fertilised egg(s).
If there is no presence of a fertilized egg, or the hormones levels are not at optimal levels, then the menstrual cycle begins again.
The Luteal phase defect
Most experts agree that a luteal phase less than 12 days does not give the womb enough time to thicken sufficiently for fertilised embies, and therefore will cause a miscarriage even if implantation occurs.
Like earlier pointed out, the hormone progesterone is essential to implantation, and a successful pregnancy. When a short luteal phase occurs, the body doesn’t secrete enough progesterone, so the uterine lining doesn’t properly develop. This makes implantation impossible for a fertilized egg.
A short luteal phase can cause infertility. Even if a woman does become pregnant after ovulation, a short luteal phase can result in an early miscarriage.
To sustain a healthy pregnancy, the uterine lining must be thick enough for an embryo to attach itself and develop into a baby, and that is a condition that a short luteal phase makes nearly impossible.
Even though, there are still controversies about its impact on fertility, luteal phase defect is recognised by the Practice Committee of the American Society for Reproductive Medicine, and they agree that it is plausible that a short luteal phase could be a cause of infertility or pregnancy failure, given the importance of ovarian progesterone production to implantation of the embryo and early pregnancy.
Like I stated earlier, luteal phase defects are rare diagnosed. A recent study showed that only 3.5 percent of women who were evaluated for infertility were reported to have luteal phase defects.
The study discovered that it was more common in younger women (37% of menstrual cycles in women aged 18-20 years, as compared with only 9 percent of cycles in women aged 35-39 years, with temperature elevations lasting fewer than 10 days).
Different studies have shown that 15% of cycles of adult women had luteal phases shorter than 11 days, 3.2% of women in the multinational World Health Organisation study had luteal phases of less than 8 days.
According to Natural fertility, symptoms of Luteal Phase Defect include:
- A short menstrual cycle
- Low progesterone
- Disrupted basal body temperatures after ovulation
- Odd symptoms during luteal phase such as low back pain, bleeding and loose stools
If your charts consistently show a short luteal phase or other signs of a luteal phase defect, there is no need for panic, because the condition can be corrected in most cases.
The first and important thing to do is see your doctor or specialist, so that any medical conditions that might be causing the problem can be diagnosed.
After seeing the doctor, a treatment plan should be the next thing and this can be achieved with a mixture of prescription drugs, supplements and dietary or lifestyle changes. The correct treatment for you will depend on the likely cause of the luteal phase defect.
For example, if a short luteal phase results from extreme exercise or stress, then decreasing your activity level and learning stress management techniques can result in the return of a normal luteal phase.
It’s important to note, that while some supplements for treating luteal phase defect are backed by scientific research, others have not proven to be effective.
Apart from some supplements, your doctor may also recommend supplemental human chorionic gonadotropin (HCG), which is a pregnancy hormone. Taking this supplement can help your body secrete a higher level of the hormone progesterone.
You might also take additional progesterone supplements after ovulation, just to improve the levels of progesterone in your body.
With treatment done, there should be no reasons for conception not to happen, provided other underlying issues have been rectified.
Food for thought.
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