You and Your Luteal Phase
Guest post by Kate Davies
Many of my fertility patients come to me with concerns about their menstrual cycle and whether it is normal. The most frequent problem I see is with the luteal phase of the cycle.
The luteal phase (LP) is the post ovulatory phase of your cycle which lasts until menstruation. This is when fertilization and implantation occur. It is essential that the length and quality of the LP is sufficient enough to support an implanting pregnancy, ideally being 10 days or longer in length. In general, a normal LP is between 10-16 days. A short LP can cause complications in trying to conceive, and women who regularly have a short LP may suffer from Luteal Phase Defect (LPD).
Symptoms of LPD can be:
- A short menstrual cycle
- Low progesterone levels
- A disruption in Basal Body Temperature (BBT) readings post ovulation
If you are concerned that your LP is short or think you may have LPD, you should discuss this with your doctor. It is important to mention that although the diagnosis of LPD has been described convincingly in the research setting, it remains a controversial clinical entity (Bukulmez and Arici 2004, Shivapathasundram et al. 2010). As a result of the uncertainties that surround the diagnosis of LPD, medical treatment is controversial and may not be offered by your doctor.
What Causes Shortened LP?
Low progesterone levels is a common cause of a shortened LP. Good progesterone levels are crucial to support an implanting pregnancy, and low levels can be the cause of infertility or recurrent early miscarriage. It is therefore important to consult your doctor if you suspect that this may be causing you a problem, as there may be other causes for progesterone deficiency such as thyroid disorders or Polycystic Ovarian Syndrome (PCOS).
Symptoms can include:
- breast tenderness
- loss of libido
- headaches that are associated with your menstrual cycle
- weight gain
- irregular bleeding
- I recommend that you start fertility charting to assess your hormonal health and look closely at your LP. Find out exactly how long your LP is and how often it is less than 10 days. Observe your temperature for an indication on how healthy your progesterone levels are. Your temperature is a direct indication as to what is happening with your progesterone levels. For example, after ovulation your temperature should stay raised and above the pre-ovulatory temperatures. In general, your temperature will stay raised through the LP, dropping only the day before or the day that your next bleed starts. If your temperature drops early, this can indicate low progesterone levels.
- Ensure an adequate supply of Vitamin C in your diet – Research shows vitamin C improves hormone levels and increases fertility in some women with LPD. Foods rich in vitamin C include: papaya, bell peppers, broccoli, sprouts, strawberry and oranges.
- Essential fatty acids – these are vital for balanced hormone production. Many women are low in omega 3. Foods rich in essential fatty acids are walnuts, salmon, sardines and scallops.
- Green leafy vegetables– Green vegetables are rich in vitamin B complex and are necessary for good hormonal balance.
- Reduce stress
- Increase a low body weight
- Cut down on excessive exercise
- Consider taking magnesium, vitamin E and evening primrose supplements.
- For PCOS Inositol supplementation will help regulate a menstrual cycle.
- Vitex (Chasteberry)
Research has shown this herb to effectively lengthen the LP. It helps the body to increase its own production of luteinizing hormone (promoting ovulation) boosting progesterone levels during the LP of the cycle. Consult a qualified herbalist if you are considering this treatment.
- Women with LPD have significantly lower levels of antioxidants. Make antioxidants part of your every day foods by enjoying blackberries, blueberries, garlic, kale, strawberries, sprouts, plums, broccoli and red peppers.
- Acupuncture– Randomized controlled trials in China have demonstrated benefits to the menstrual cycle and fertility (Song 2008), however caution is needed when interpreting these studies as they may not be of high quality. In the West, there is a paucity of evidence for the benefits of acupuncture on the menstrual cycle and fertility (Balen et al. 2016) and it is clear that further research is needed. However, a recent study by Stener-Victorin et al. (2016) identified a decrease in circulating androgens in women with PCOS which in turn would improve cycle regularity and the luteal phase. If you are considering acupuncture to help with cycle regulation and your luteal phase, find an acupuncturist who specializes in fertility.
Balen, A.H., Morley, L.C., Misso, M., Franks, S., Legro, R.S., Wijeyaratne, C.N., Stener-Victorin, E., Fauser, B.C.J.M., Norman, R.J. and Teede, H. (2016) ‘The management of anovulatory infertility in women with polycystic ovary syndrome: An analysis of the evidence to support the development of global WHO guidance’, Human Reproduction Update, 22(6), pp. 687–708. doi: 10.1093/humupd/dmw025.
Bukulmez, O. and Arici, A. (2004) ‘Luteal phase defect: Myth or reality’, Obstetrics and Gynecology Clinics of North America, 31(4), pp. 727–744. doi: 10.1016/j.ogc.2004.08.007.
Shivapathasundram, G., Kwik, M. and Chapman, M. (2010) ‘Luteal phase defect: Part of the infertility zeitgeist or relic from the past?’, Human Fertility, 14(1), pp. 60–63. doi: 10.3109/14647273.2010.528504.
Stener-Victorin, E., Maliqueo, M., Soligo, M., Protto, V., Manni, L., Jerlhag, E., Kokosar, M., Sazonova, A., Behre, C.J., Lind, M., Ohlsson, C., Højlund, K. and Benrick, A. (2016) ‘Changes in HbA1c and circulating and adipose tissue androgen levels in overweight-obese women with polycystic ovary syndrome in response to electroacupuncture’, Obesity Science & Practice, 2(4), pp. 426–435. doi: 10.1002/osp4.78.
Kate Davies is a fertility practitioner, fertility coach and columnist. Kate works with women wishing to optimise their ability to conceive naturally and coaches women going through a difficult fertility journey.
Kate is a registered nurse specialist and worked for over 20 years in the UK’s National Health Service as a specialist nurse in Gynaecology, Sexual and contraceptive health and fertility. Four years ago Kate, frustrated with the lack of support and high quality advice for women who were struggling to conceive, founded her private practice ‘Your Fertility Journey’. Shortly after this, she trained as a fertility coach to offer her patients much needed emotional support as well as medical advice. Kate now has a thriving practice and consults women nationally and internationally via the wonders of Skype.
Kate has a special interest in PCOS and over the years has worked with 100’s of women who suffer with this debilitating condition. To enhance her practice, Kate has recently undertaken specialist training to enable her to offer women both the specialist advice and emotional support they desperately need.
Kate loves her job and her best days are when one of her lovely ladies calls her to say she is pregnant. Often she is the second person to know – what a privilege! Kate is very proud of the Facebook Support Group she founded over two years ago. This group, full of inspirational ladies going through all sorts of fertility journeys, gives ladies a safe place in which to ask advice, find support and get virtual hugs.
As well as her natural fertility and coaching services, Kate is also passionate about Natural Contraception and teaches women internationally on how to use this effective, safe and natural method of contraception.
Facebook Support Group: https://www.facebook.com/groups/Yourfertilitysupportgroup/