the Root Causes of Luteal Phase Deficiency in Women

The underlying factors of luteal phase deficiency?

Hello Dr.
Chang, I had surgery to remove my ovary last July, and afterwards, I received six injections of Leuprolide.
My first menstrual period after the surgery was in February of this year, and I didn't have my second period until three months later in May.
About two weeks after this second period ended, I experienced five days of light bleeding (one day with dark red blood).
My physician mentioned that this could be due to ovulatory bleeding or luteal phase deficiency.
I have a few questions:
1.
If this is ovulatory bleeding, but my basal body temperature did not rise, does that mean I may not have ovulated?
2.
If it is luteal phase deficiency, isn't the source of the corpus luteum derived from the pituitary gland and ovaries? Does this indicate that there may be an issue with my ovulatory function?
3.
Could the surgery and Leuprolide injections have caused a decline in ovarian or pituitary function?

moss, 40~49 year old female. Ask Date: 2011/06/12

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the presence of a chocolate cyst can inherently disrupt ovarian function.
After surgery, the administration of injections or oral medications to prevent recurrence may cause the ovaries to rest for a period of time.
Following the cessation of medication, it may take some time for the menstrual cycle to become regular again.
During this transitional phase, hormonal instability can lead to irregular bleeding, and there may not necessarily be a luteal phase.
Generally, things tend to stabilize after a few months, and this does not necessarily affect endocrine function.
It is advisable to follow your physician's assessment and recommendations for management, and stability should be achievable after some time.
Thank you! Wishing you peace and health, Dr.
Chang.

Reply Date: 2011/06/12

More Info

Understanding luteal phase deficiency (LPD) is crucial for women experiencing menstrual irregularities and fertility issues. LPD is characterized by insufficient progesterone production during the luteal phase of the menstrual cycle, which can lead to various symptoms, including irregular bleeding, difficulty in maintaining pregnancy, and even infertility.

To address your questions:
1. Ovulation and Basal Body Temperature (BBT): The absence of a significant rise in BBT after ovulation typically indicates that ovulation may not have occurred. In a normal cycle, ovulation is followed by an increase in progesterone, which raises the BBT. If your BBT does not show this increase, it suggests that ovulation may not have taken place, leading to what is known as anovulation. Anovulation can be caused by various factors, including hormonal imbalances, stress, significant weight changes, or underlying medical conditions.

2. Luteal Phase Deficiency and Hormonal Sources: The luteal phase is regulated by hormones produced by the ovaries and the pituitary gland. After ovulation, the ruptured follicle transforms into the corpus luteum, which secretes progesterone. If there is insufficient progesterone, it can lead to a shortened luteal phase and inadequate preparation of the uterine lining for potential implantation of a fertilized egg. If you are experiencing symptoms of LPD, it may indicate that your ovulation is not functioning optimally, which could be due to issues with ovarian function or hormonal signaling from the pituitary gland.

3. Impact of Surgery and Medication: Surgical procedures, such as the removal of ovarian cysts, can impact ovarian function. Additionally, medications like leuprolide (often used for conditions like endometriosis) can suppress ovarian function temporarily. This suppression can lead to a decrease in estrogen and progesterone levels, affecting ovulation and the luteal phase. If your menstrual cycle has become irregular following surgery and treatment, it is possible that your ovarian reserve or function has been affected, which could contribute to LPD.

In summary, it is essential to monitor your menstrual cycle closely and consider further evaluation by a healthcare provider specializing in reproductive endocrinology. They may recommend hormone testing to assess levels of progesterone, estrogen, and other relevant hormones, as well as imaging studies to evaluate ovarian function. Treatment options may include lifestyle modifications, hormonal therapies, or fertility treatments, depending on the underlying cause of your symptoms.

If you have been trying to conceive for over a year without success, it is advisable to seek a fertility evaluation. This may include tests to assess ovulation, hormone levels, and the health of the reproductive organs. Early intervention can be beneficial in addressing any underlying issues and improving your chances of conception.

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