Luteal Phase Defect |

Luteal Phase Defect

By: Jill Blakeway, M.S. L. Ac. | Author's Archive | Bio

Overnight one of my patients “facebooked” me to let me know she’d had her baby – a happy reminder of all the reasons I love my job. Helping couples to conceive is rewarding and interesting work.

When a patient first consults me I ask lots of questions, some of which may seem off-topic, but together they give me a picture of their internal landscape and from there the detective work begins. Sometimes I manage to spot something very simple that may be getting in the way of conceiving and an example of this is a luteal phase defect.

Your luteal phase is the time from ovulation until your period starts. A normal luteal phase should be 14 days which gives a fertilized egg enough time to implant and start to signal to your body that it’s there. A luteal phase lasting less than 12 days is too short for this to happen and the uterine lining begins to slough off before a fertilized egg has had a chance to implant and initiate the hormonal changes necessary to sustain a pregnancy. This is a common endocrine disorder and is present in many of the women I see who are having trouble conceiving. Researchers estimate that more than 1/3 of women who are suffering from early pregnancy loss have a luteal phase disorder.

Another indicator of a luteal phase defect is low progesterone in the second half of the cycle. It’s possible to have a completely normal 14 day luteal phase and still have low progesterone levels which mean that the endometrium can’t develop and function properly and a fertilized egg will have problems implanting and being sustained. A short luteal phase or spotting before your period could be a sign of low progesterone and it is a good idea to contact your doctor for further testing.

In our book Making Babies: A Proven 3-Month Program for Maximum Fertility Dr. David suggested the following tests for women who think they may be suffering from luteal phase defect.

Testing serial progesterone levels during a single cycle – 7, 9 and 11 days after ovulation.
Testing prolactin levels – elevated prolactin can lead to inadequate progesterone
Testing thyroid function – hypothyroidism can lead to low progesterone
Checking for polycystic ovarian syndrome – low progesterone levels commonly occur in women with PCOS

If progesterone levels are low your doctor may prescribe supplemental progesterone or a follicle stimulating drug in the follicular phase on the grounds that a strong follicular phase can lead to higher progesterone in the luteal phase.

In Chinese medicine we interpret luteal phase defect as an imbalance of the whole cycle, not just the luteal phase. Western medicine recognizes this too which is why doctors sometimes combine intervention in the luteal phase (progesterone supplementation) with support in the follicular phase (clomid). The luteal phase is governed by yang energy, which develops from yin energy which is dominant in the follicular phase. The transformation of yin to yang happens through the movement of qi and blood at ovulation. An interruption in the flow at any point in the cycle can show up as a luteal phase defect. This is where the detective work comes in and as an acupuncturist I try to identify the root cause of the problem as I make my Chinese diagnosis.

Too little yin in the first half of the cycle can lead to too little yang in the second half of the cycle. This would be termed yin and/or blood deficiency in Chinese medicine.
Stagnation at ovulation can affect the hormonal transition and thus the transition of yin to yang. This would be termed qi and/or blood stagnation in Chinese medicine
Too little yang can affect both the hormone transition at ovulation and the quality of the luteal phase. this would be termed yang and/or qi deficiency in Chinese medicine.

Based on these different diagnoses I adapt my acupuncture treatments and create a specially tailored herbal formula for each patient, which along with any treatment suggested by the patient’s doctor can significantly improve or correct a luteal phase defect.

Often all it takes for conception to occur is bit of detective work combined with Eastern and Western medicine working together to correct a small but significant imbalance. Then before I know it I’m waking up to baby pictures on Facebook and the satisfaction of seeing another patient become a Mom.

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. • The information on this website is designed for educational purposes only. It is not intended to be a substitute for medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your doctor. Please consult a doctor with any questions or concerns you might have regarding your condition. • Jill Blakeway, M.S. L. Ac. © September 2010

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Shaun says:

February 8, 2011 at 7:42 AM

Hi im 30 and have been trying to conceive woth my husband for a year now never been pregnant. When is the proper time to test for progesterone? My primary doctor tested my progesterone during my period and told me my progesterone was low not even the minimum of what it should be at that point in my cycle. I went to a fertility doctor and she told me my levels were fine. Every month I feel like I could be pregnant then my period arrives a couple of days late or early with really huge clots. Is it possible I’m miscarrying. I purchased chasteberry capsules and I’m ready to take them. I understand it may take a few months to work but I don’t know if I should wait to take them and wait a few months then try to conceive or take them now and still continue to try to conceive. Please help desperately want to be a mommy of a healthy baby. Thank you for your time.

Jill Blakeway, M.S. L. Ac. says:

February 26, 2011 at 10:06 AM

Hi Shaun,

Thanks for your question. In our book Making Babies we suggest that women have a serial progesterone test in their luteal phase – not just one test. It is very possible that you are having chemical pregnancies on the months when you feel pregnant and there could be a number of reasons for this including but not limited to fluctuating progesterone levels.

I would take the herbs while you continue to try to conceive. At the YinOva Center we also give our patients a specially tailored formula for both halves of their cycle which helps a lot so if you can it would be helpful to see a local acupuncturist/herbalist.

I would also try to find an RE who is willing to do further testing and pursue a diagnosis in your case.

Good luck

Jill

Amanda says:

March 23, 2011 at 3:56 PM

Hi Jill,
I read in your book to take 16 drops of chasteberry extract two times per day from ovulation until period starts. I was wondering, is chasteberry safe for pregnancy? Do I continue taking it once I get a positive test?
Thank you

March 27, 2011 at 5:23 PM

Hi Amanda,

Thanks for your question about chasteberry. You should stop taking it when you are pregnant as it has then done it’s job. At the YinOva Center we prefer our pregnant patients to take as few herbs as possible.

Holly says:

June 2, 2011 at 7:56 PM

Hi Jill,

I have a question regarding the Chasteberry. I read your book and fall into the “stuck” type, my luteal phase has been 11 days for the past four months, My progesterone level was read at CD21 and was 6.9(not sure if that was exactly 7 days after ovulation),should I try the Chasteberry, and evening primrose oil? I also bought the red raspberry tea, Just want to make sure I’m getting the timing/dosage right,

Thank you!

June 13, 2011 at 3:16 PM

Hi Holly,

Thanks for getting in touch. You may want to try the chasteberry and see if you can get your luteal phase to lengthen by 1 or 2 days.

As for EPO – only use it if you suffer from PMS otherwise it’s not necessary.

June 17, 2011 at 3:25 PM

Thank you for your response Jill, I really appreciate it!

One question though: would you recommend taking the Chasteberry my entire cycle? I’m currently ovulating at CD 17 with an 11 day luteal phase.
I have been taking it the 2nd half of my cycle and this is the best I’ve felt in a long time, my PMS symptoms & mood have been great, so should I continue after menstruation?

Thanks again! and Thanks for your wonderful book!
Holly

Steph says:

August 3, 2011 at 4:43 PM

Been studying the Making babies book. This is the second time that I have had secondary infertility. Due to low progesterone levels my doc started me on 50 of chlomid. My progesterone went from 2.9 to 8.9, I guess this is a good improvement but indicates that I not ovulating. I was wondering if it is safe for me to take vitex while taking chlomid? If so, how much and when? Also, we are on a tight budget and I am trying to maximize my use of acupuncture. When do you think is the most pertinent time for me to have a treatment?
Steph:)

August 5, 2011 at 1:18 PM

Hi Steph,

Thanks for getting in touch and thanks for reading our book. I’m afraid I can’t give you precise advice about vitex never having met you. Here at the YinOva Center we take a very personalized approach to herbalism and prescribe different herbs and in different dosages for each patient. I can tell you that as a general rule I usually use vitex in cases where the patient has a short luteal phase because of a sluggish ovulation. By that I mean an LH surge that is not immediately followed by a temperature rise on BBT. I don’t use it routinely in cases where there is no ovulation. Hope this helps.

As for acupuncture. When I’m trying to save my patient’s health dollars I usually treat them ever other week. Once in the follicular phase of their cycle to help with follicle development and once in the luteal phase of their cycle to promote implantation.

Good luck!

Lacey says:

August 18, 2011 at 12:17 PM

Hi Jill, I purchased Making Babies last fall and have been vigilantly following your counsel therein. Unfortunately we have not been successful with conception yet. It has only been ten months and I know I cannot be considered for further testing until after one year. My question for you is, can you recommend someone good to see in Utah. I live in a small town in northern Utah and would love some advice on who to contact in the next few months regarding fertility. Up to this point I have been seeing a CNM. Any advice you can offer will be greatly appreciated. The book offers so much hope and I am grateful I stumbled upon it. Thanks Jill-
Lacey

August 29, 2011 at 6:45 AM

HI Lacey,

Thanks for getting in touch and thanks for reading our book. I’m so sorry to hear that you haven’t conceived yet.

I don’t know any practitioners in Utah but would suggest that when the time comes to get testing you see an RE rather than an OB/GYN or CNM. As for an acupuncturist/herbalist this website may help you http://www.nccaom.org/find-an-acupuncture-practitioner-directory

August 29, 2011 at 12:30 PM

Thank you so much for getting back to me. I really appreciate it. I was reading the book again this weekend, third time around. I will check the link above, thank you. I will also see what I can find for an RE here in Utah. Thanks again so much, take care-

Alex says:

September 7, 2011 at 4:41 PM

I’ve been recommending your book to so many friends. I’ve really enjoyed reading it as it’s simple enough to understand yet it doesn’t feel like you have ‘dumbed down’ technical talk for us readers.

I wanted to ask you advice if that’s ok.
Both my husband and I are 30.
I have always always had irregular menstrual cycles.
I was pregnant for 9 weeks but miscarried in Jan 2011. There was no heartbeat on the ultrasound. I had no bleeding at all. All I had was bad morning sickness (nausea, very very tired, I slept all day, found it hard to run or do any excercise etc).
I had a D&C in February and had heavy AF in April, light in May, an early AF in June (which was more like post D&C procedure ie v v heavy and brown and lots of clots), July normal AF and August normal AF with a 33 day cycle. i hav had little cervical mucus since my D&C and am very dry.

Due to your book I started Acupuncture at the beginning of my last cycle. I am also on herbs too. She is working on my headaches, tiredness, circulation and uterus flow.

I didn’t ovulate this month (according to my OPK) and I didn’t have any cervical mucus.

I suspect I have PCOS or LPD but I don’t know. Will my acupuncturist be able to solve my fertility issues going on the info above or is it best to get a confirmation of what may be wrong with me from a GP as well? Am I crazy (& too young) to ask for blood tests from my Doctor?

Thanks a mill
Alex

September 10, 2011 at 6:53 AM

Hi Alex,

Thanks for getting in touch and thanks for reading the book. I’m so glad you found it helpful.

I’m sorry to hear about your miscarriage. I know how distressing that can be.

Without having met you its hard to give you specific advice. Your miscarriage may have been random and unlucky and may not reflect a deeper problem. But given your menstrual history, if you were my patient, I would suggest you see your doctor for more testing. At 30 you do have time to sort things out (which is great) but I do think it would help to have all the facts. That should help your acupuncturist help you too.

September 10, 2011 at 10:32 AM

Thank you for getting back to me. I have another question. What does it mean if one has a BBT temp increase w/o fever, but never had a temperature drop nor a positive LH test? CM was good for a couple of days prior to the spike.
Thank you for your help.
Steph

September 12, 2011 at 8:20 AM

Let me ammend that to having a positive LH test on the same day as a temperature rise…

September 25, 2011 at 7:55 AM

HI Steph,

Thanks for your question. Some people don’t have a temperature drop prior to their LH surge and its normal for them. If the CM was good prior to the temperature rise then you are fine and although it makes it trickier to predict when you’re going to ovulate if you judge it by CM you should get your timing right.

Hope this helps,

Kate says:

January 4, 2012 at 9:30 PM

I loved Making Babies and have recommended it to so many friends! My hubby and I have been ttc for 7 months- I’m 32. We’ve had all of the preliminary / less invasive fertility tests done, including 7 dpo progesterone test which was normal (as were my other hormones and tests, and his SA). I have had a luteal phase that’s naturally 10 – 11 days for a few years now. I am seeing a great acpuncturist in my area, and taking Fertil Aid and B complex to try to lenghten it. With those supplements, I’ve had one 14, one 13, and one 12 day luteal phase recently, but this past cycle was back to 11.

My question to you is – do you think that my inability to conceive so far is related to luteal phase defect or low progesterone despite my test being normal on 7 dpo? Should I demand a sequential test right now? What would I do to improve my progesterone levels further if that’s the cuplrit, given that i’m already taking Vitex (in the Fertil Aid) and B6? (I’m taking 100 mcg / day)?

Also, I consistently have twinges and strange feelings on my left side, that only started when we started TTC. They’re throughout my cycle – ovulation type pains sometimes, and then when I am on my period, I feel pinches and crampier on the left, and sometimes around what would be implantation time I feel twinges too, always on the left. I had an HSG that was wide open. Is this anything of note? The time I had my transvaginal ultrasound, it was the left side preparing to ovulate that month (which was no surprise to me!) – is it possibly i’m *only* ovulating on the left and is there a way to tell this? And if so is that a problem?

Thank you in advance for any advice or encouragement you could provide!

Best,

Kate

January 7, 2012 at 10:33 AM

HI Kate,

Thanks for getting in touch. Without having met you it’s hard to work out why you’re not conceiving or if your short luteal phase is the main issue. However I would definitely want to try to lengthen it so it is consistently over 12 days. That’s usually easy to do with Chinese herbs so you may want to ask your acupuncturists about that. The Fertile Aid and B6 are usually not enough to lengthen a luteal phase in my experience. In cases like yours I often give a separate follicular and luteal formula. At the YinOva Center we tend to get these formulas custom made for each patient.

Your pain on the left side is hard to diagnose from afar although I can tell you that lots of women have this kind of pain and it turns out to be nothing to worry about. Usually I think people who are TTC are more conscious of their pelvic area and then they feel their descending colon. To tell if you’re only ovulating on the left you would need a sonogram each month but if you are it’s not necessarily a problem.

Hope this helps. Good luck!

Brooke says:

March 14, 2012 at 6:53 PM

I have been reading this thread on Luteal Phase Defect and think I could have this condition. Currently I am not seeing an accupuncturist but would like to start. I have seen one before but not in my current location. Can you recommend how to find a good fertility L Ac where I live? I live in the pacific northwest, so they are abundant here, but I”m not sure where to start.

Thank you,
Brooke

March 18, 2012 at 10:50 AM

Hi Brooke,

Dr Lee Hullender Rubin in Portland is fantastic. I hope that helps:)

Marie says:

March 26, 2012 at 3:20 PM

I have read your book and found it extremely helpful. My husband and I are on our 5th cycle of trying to conceive. I chart my cycles and my luteal phase is right around 10 days (with some spotting on the 10th day). I have mentioned this to my doctor, and she doesn’t seem concerned. She seems to be in the camp of “give it a year.” However, given the fact that I chart my cycles and time intercourse accordingly, and that I know I have a short luteal phase, it seems like a waste of time to wait a year to dig deeper (and I’m 31 and hope to have more than one child). Do you have any advice for how to approach my doctor if her response continues to be “wait a year and then talk to me?”

Also, I started acupuncture last cycle. In your experience, if I have a luteal phase defect, could acupuncture be enough to help lenthen it or do I need to couple it with herbs or something else?

Thanks for your advice!

March 31, 2012 at 2:45 PM

Hi Marie,

I do think a luteal phase of 10 days should be investigated and in my own practice I wouldn’t advise someone to wait a year before sorting it out. Sometimes acupuncture on its own is enough to lengthen the luteal phase and sometimes women need the herbs as well. Here at the YinOVa Center we also like our patients to have a Western medical diagnosis so we know what we’re working with and whether Chinese medicine can help. The most common reason (but not the only reason) for a short luteal phase is low progesterone so I would ask your doctor if its OK for you to have a serial progesterone test where your progesterone is measured several times after ovulation.

May 5, 2012 at 1:31 PM

Dear Jill:

I just bought the eBook for “Making Babies” and am excited to read it. I just turned 40 and have been TTC for 8 months. I suspect I have LPD since my cycles have gone from 35 days down to 25 days progressively since I got off the Birth Control pill, and my periods seem to come a little earlier each time. I used the ClearBlue Fertility Monitor for several months and that seemed to indicate I was ovulating, so I guess that’s good… but the Luteal Phase being short seems to be an issue. :(

I have an appointment with the Fertility specialist at my OBGYN (Downtown Women) coming up but since I’m in NYC I’m extremely interested in visiting your center too. Does your practice help with this type of issue, and do you take insurance?

Thanks so much,

Amanda

May 8, 2012 at 7:35 AM

HI Amanda,

Thanks for getting in touch. Our practice does treat a short luteal phase. We use a combination of acupuncture and Chinese herbs often in conjunction with progesterone prescribed by your doctor. We don’t take insurance, I’m afraid, but we can give you the kind of receipt that has billing codes on it, so if you are covered for out-of-network acupuncture you may be able to claim back the cost of your visit.

Regards,

Luteal Phase Defect

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