Looking at Luteal Phase Deficiency

Luteal phase deficiency (LPD) is a clinical diagnosis associated with an abnormal shorter length of time between ovulation and menses. A luteal phase shorter than 10 days is generally classified as LPD, (1) which has been implicated as a cause of reproductive health problems such as irregular menstrual bleeding, infertility, and recurrent pregnancy loss. (2) 

It’s important to note that LPD has also been described in fertile, normally menstruating women and a short luteal phase can occur in up to 5% of healthy fertile women.(2) LPD can result in insufficient progesterone exposure to maintain and thicken the lining of the endometrium in the lead up to menstruation which allows for normal embryo implantation to occur. (3)

With multiple causes, all with the commonality of decreased progesterone secretion or effect, (4) when it comes to LPD, being able to distinguish between what’s normal and what isn’t may take a trained eye.

Likely Causes of LPD

Examples of conditions that have been associated with LPD include: (1)(4)

• hypothalamic amenorrhea
• eating disorders
• excessive exercise
• significant weight loss
• stress
• obesity
• polycystic ovary syndrome (PCOS)
• endometriosis
• ageing
• thyroid dysfunction
• hyperprolactinemia
• postpartum
• perimenopause
• post menarche

Looking for Clues of LPD

Signs to watch for include: (2)

• menstrual cycle <21 days
• changeable shortened length of cycles
• premenstrual symptoms
• spotting in the lead up to menstruation
• difficulty conceiving
• history of early miscarriage

Looking for Natural Solutions

The way a natural healthcare practitioner provides treatment options for LPD will depend entirely on the individual. Diet advice, herbal and nutritional medicine and functional testing are all possible avenues, as well as integrative collaboration with a GP or reproductive health specialist in some cases. A Naturopath may also refer their patient to a TCM practitioner, as both acupuncture and Chinese herbs can be utilised to improve LPD.

Nutrients are often at the forefront of therapeutic strategies, since several nutrients are required for overall hormone health, ovulation and progesterone production. Zinc and selenium are 2 significant minerals that are indicated in LPD.

Zinc deficiency may contribute to hormone imbalances, as zinc is involved in hormone secretion, ovulation, fertilisation and progesterone binding. (5)(6) The risk of LPD and inadequate progesterone secretion may also be increased in women with inadequate selenium levels. (7) Vitamin C supplementation in the form of ascorbic acid has also been shown to significantly increase progesterone levels in LPD. (8)

Traditional Chinese Herbal Medicine (TCM)

TCM may be a useful strategy to improve the luteal phase of the menstrual cycle. In one study, patients with LPD were treated with different Chinese medicinal herbs at different phases of their cycle, with significant improvement in the luteal phase of endometrium lining and levels of progesterone. (9)

In the follicular phase, the treatment rationale was “nourishing the Kidney Yin, invigorating the Spleen and replenishing the Qi, promoting the blood circulation and enriching the Blood” to promote follicular development. For post-ovulatory treatment “invigorating the Kidney and strengthening the Yang” aimed to enhance the development of corpus luteum and maintain its function of progesterone secretion. (9)

Maybe its just a Phase

A healthy menstrual cycle includes ovulation and robust progesterone levels. Month to month, there can be subtle variables due to the impact of lifestyle factors like poor diet and high stress influencing outcomes. While many women can bounce back from one out of balance cycle, anything longer than 3 consecutive months signals something deeper to discover.

If you have been experiencing signs of LPD, consider working with a healthcare practitioner for guidance. The good news is that strategies for addressing LPD are associated with a high degree of treatment success.(10)

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