Luteal Phase Deficiency

Luteal Phase Deficiency (LPD) is also called Luteal Phase Defect, but I don't particularly like to think of the human body as "defective" so I prefer deficiency.  LPD is a hormonal condition that involves deficiency of progesterone, which makes the luteal phase (the portion of the cycle after ovulation and before menstruation) a bit too short. This may contribute to low basal body temperatures during this phase, which can make implantation and pregnancy difficult. In fact, infertility and miscarriage are common symptoms of LPD and progesterone deficiency.

If this is the first time you're hearing about LPD, then you probably have a lot of questions. What causes it? How can you tell if you have it? And what can you do to treat it? Not to worry, I'm going to break it all down for you right now.

What exactly is LPD + how does it affects fertility

The luteal phase, which is the second half of the cycle between ovulation and menstruation (if you're not clear on the phases of the cycle brush up with: The 4 Phases of the Menstrual Cycle) is typically 12-16 days long. If the luteal phase is 10 days or shorter, then that's considered deficient.

If you have a short luteal phase and you're trying to get pregnant or are thinking of trying in the future, the luteal phase is when implantation happens and pregnancy becomes established. Believe it or not, implantation doesn't occur until 7-10 days after ovulation, so if the luteal phase ends before implantation is complete, it can prevent pregnancy from happening or contribute to early miscarriages.

The root of the issue is insufficient progesterone production. Normally the corpus luteum, which is a temporary structure formed in the ovary where the egg was released at ovulation, is what produces and releases progesterone for about 2 weeks after ovulation. If it can't do this it's typically because the ovaries aren't functioning properly. 

What causes it

LPD is linked to poor ovarian function. In most cases I see it develop as a result of age, so the older the person gets the shorter their luteal phase becomes. In other cases it can develop secondarily to another condition, such as thyroid imbalance, adrenal deficiency, or another endocrine imbalance. Some people are simply prone to LPD and have always been.

Signs + Symptoms

In order to evaluate yourself for LPD you need to chart your cycle and determine when you're ovulating, which I usually recommend doing this with ovulation predictor kits and/or basal body temperature charting. You have to know when you ovulate to actually be able to count the days of your luteal phase, you can't simply chart your cycle based on your last menstrual period.

If you have short cycles (your cycle is the length between periods, not he period itself,) that might be a clue that your luteal phase is short, especially cycles less than 24 days long. But this isn't always the case, I often see short cycles with normal length luteal phases, or normal to long cycles with short luteal phases, so you can't assume you do or do not have LPD based solely on your cycle length itself.

Spotting before your period, especially if it lasts for several days, may be an indication of low progesterone. And if you've ever taken your basal body temperature before and found you have chronically low temperatures, especially during the luteal phase, that is another classic sign of low progesterone.

Other common symptoms of low progesterone include: low energy, weight gain, low libido, changes to mood, anxiety or depression, breast tenderness, and headaches or migraines. If you think you may have low progesterone, you can ask your doctor to test your levels during your luteal phase, it's usually tested about 7 days after ovulation.

Keep in mind, it is possible to have low progesterone levels without your luteal phase becoming shortened, so you may identify with several of these symptoms without any change to your luteal phase.

How to treat LPD

There are two main approaches to treating LPD, and they aren't mutually exclusive.

My approach is a holistic one, always looking to address the root of the issue, to boost ovarian function and progesterone production, to help your body function better so the luteal phase lengthens on its own and a healthy pregnancy is possible. I typically do this with a combination of acupuncture, herbal medicine, and diet.

The other approach is to supplement progesterone so the body isn't burdened to make enough of it's own. Especially if you've suffered from miscarriages before or bleeding in early pregnancy, this may be the appropriate treatment, depending on the opinion of your doctor. As I said, you can use the holistic and supplemental approaches concurrently.

What to learn more?

I discuss Luteal Phase Deficiency, along with a ton of other topics in Foundations of Fertility - my 6-week masterclass in all things fertility. In fact, we cover hormones and common hormonal imbalances, diet, supplements, herbs, Chinese medicine, cycle charting, and how to evaluate your own fertility. If you're serious about trying to conceive this course is for you!