This article will look at the causes of low progesterone in the luteal phase.
Reduced levels of this hormone is considered a symptom of incorrect functioning of the ovaries. This condition is medically referred to as a luteal phase defect (LPD). An insufficient level of progesterone in this period contributes to the creation of negative conditions on the surface of the inner layer of the uterus for the implantation of a fetal egg into it. In view of this, even in the event of fertilization, the woman's menstruation will occur.
This is the danger of low progesterone in the luteal phase.
Basic concepts
This phase begins in the second part of the menstrual cycle and lasts approximately 14 days after ovulation occurs, immediately after which the corpus luteum forms. It is responsible for the production of progesterone, which is necessary before the placenta begins to form. If fertilization does not occur, the woman beginsmenstruation. In some cases, the cycle changes, due to the low concentration of the hormone. The main reasons for this phenomenon should be clarified by a specialist.
What is the rate of progesterone in the luteal phase?
Within the normal range, the level of the hormone varies from 7.0 to 56.5 nmol/l. If the concentration of the hormone is below this indicator, we are talking about its insufficiency.
Let's look at the main causes of low progesterone in the luteal phase.
Reason for development
The production of progesterone by the corpus luteum is necessary for the normal process of implantation and embryo formation. But sometimes the production of this hormone decreases, which is due to a number of possible reasons.
If low progesterone is found in the luteal phase of the menstrual cycle, it is necessary to conduct an appropriate diagnosis, which will reveal abnormalities in the hormonal background. It is possible that the patient produces this hormone in a normal amount, however, the mucous membrane of the uterus reacts to it incorrectly. In other words, DLF is a pathological phenomenon in which the uterine endometrium does not develop correctly. Because of this, progesterone levels decrease in the luteal phase, which creates an obstacle for the ovum, preventing it from successfully implanting.
A number of factors are known that can cause abnormal progesterone production processes and provoke the development of luteal phase dysfunctions. They can be divided into three main categories: organic, functional and iatrogenic.
So, let's take a look firstfunctional causes of low progesterone in the luteal phase.
Functional reasons
The list of functional causes that can reduce the production of progesterone includes conditions caused by dysfunction of the reproductive system. The main factors in this are:
- Savage Syndrome. This condition is characterized by the cessation of menstruation and the occurrence of infertility in women under 35 years of age. The ovaries at the same time lose sensitivity to sex hormones that stimulate the production of eggs. A similar disease manifests itself as a prolonged violation of menstrual functions. Hormone therapy is needed to help restore menstruation and progesterone production for conception.
- Syndrome of hyperinhibition in the ovaries - the absence of menstrual bleeding, due to medical effects on the inhibition of the gonadotropic functions of the ovaries. What else can trigger very low progesterone in the luteal phase?
- Stein-Leventhal syndrome, which is accompanied by irregular or absent ovulation, increased production of estrogen, which inhibits the production of progesterone.
- Ovarian exhaustion syndrome. These organs, due to a number of factors, begin to function incorrectly, resulting in the onset of premature menopause.
- Hypothyroidism, which is a pathological condition resulting from an insufficiency of hormones produced by the thyroid gland. In the secondary type of this disease, the hypothalamic-pituitary structure is damaged. The causes of low progesterone levels in the luteal phase can be difficult to determine.
- Pituitary hypogonadism, which is a syndrome characterized by insufficient functioning of the sex glands with impaired hormone production. Therapy of this pathology is based on the use of hormone replacement therapy.
- Hyperprolactinemia, which is caused by an increase in the levels of pituitary hormones, in particular prolactin. In women with a similar diagnosis, menstrual irregularities are noted, infertility develops.
The above reasons can provoke a decrease in the concentration of progesterone in the LF. The consequence of this is a violation of the ovulatory phase and reproductive function.
What other causes of low progesterone in the luteal phase are known?
Organic Causes
These reasons are due to pathologies of the reproductive organs and other systems that can affect the structure and functioning of the uterus. These include:
- uterine fibroids;
- Asherman syndrome;
- endometrial hyperplasia;
- uterine cancer;
- cirrhosis of the liver and hepatitis;
- endometritis.
With synechia inside the uterus, hypomenstrual syndrome or secondary amenorrhea may occur. Intrauterine synechia does not allow the fetal egg to attach to the endometrium, so conception becomes impossible.
The chance of getting pregnant decreases with the development of endometrial hyperplasia. The disease causes disruptions in the menstrual cycle, resulting in a lower level of progesterone in the LF.
Iatrogenic causes
Iatrogenic factors include conditions that are caused by medical interventions. Gynecological cleaning is carried out to establish the cause of the irregularity of menstruation, prolonged and heavy bleeding in fibroids, hyperplasia, polyps. In this case, the specialist can disrupt the structure of the endometrium, after which synechia is formed, contributing to the imbalance of the hormonal background in the LF.
Aborting a pregnancy also entails similar hormonal problems. In order to restore it, hormone replacement therapy is often required. In some patients, the level of progesterone decreases, which becomes a factor in the development of infertility. Fertility after such manipulations is restored gradually, with the help of properly organized drug treatment.
Yellow body
Despite the fact that doctors have not yet fully studied the syndrome of low progesterone levels during LF, they say with great confidence that the main cause of this pathological condition is an abnormal corpus luteum or endometrial structure.
The corpus luteum, whose functions are impaired, for some reason is not able to function properly, which leads to insufficient production of progesterone. A number of factors are known that are responsible for the insufficient functionality of the corpus luteum or its absence. These include:
- Irregular development of follicles. Since the corpus luteum is formed from the same cells that make up the dominant follicle, its functioning may be impaired. Follicle formation can be impaired due to various factors, including nutrient deficiencies, free radical excess, and changes in metabolism.
- The level of hormones. For the proper process of maturation of the follicle, a special balance in the concentration of hormones is necessary. Anomalies in the hormonal background can disrupt the formation of follicles, the corpus luteum and the process of ovulation.
- Circulation. The processes of proper functioning of the corpus luteum are influenced by the nature of the blood flow. Anomalies in the formation of blood vessels and circulatory disorders are closely related to the formation of the corpus luteum during the luteal phase, and this reason has been proven by numerous studies.
- Abnormal uterine response to progesterone. Despite the normal production of progesterone, endometrial defects do not allow it to respond to this hormone. This leads to disruption of the formation of the uterine lining, which becomes an obstacle to the implantation of the embryo.
Symptoms of pathology
Low concentration of progesterone in the luteal phase is quite difficult to detect, especially in cases where a woman does not plan to conceive, does not undergo laboratory diagnostics, but is trying to get pregnant without medical intervention. Many are not even aware of such a diagnosis, because they do not knowcharacteristics of the menstrual cycle. Symptoms of low progesterone in the luteal phase are:
- problems conceiving;
- spontaneous miscarriages in the early stages;
- shortened menstrual cycles (less than 24 days);
- frequent episodes of PMS;
- ovulation that occurs early.
In the second phase, the woman should not experience pain, bleeding or diarrhea. If such signs are disturbing, difficulties with conception are found, then it is recommended to undergo an examination.
How is low luteal phase progesterone diagnosed?
Diagnosis
Due to insufficient understanding of pathophysiology and the lack of a unified method for diagnosing this pathological phenomenon, its treatment is usually difficult. During a diagnostic examination, the specialist initially collects an anamnesis, which should include the following information:
- case history;
- patient complaints;
- peculiarities of menstrual functions;
- OB/GYN history.
- features of living conditions;
- regularity of sexual intercourse.
Attention is also paid to the ratio of weight and height, the distribution of adipose tissue, body hair. Within a month, the patient is recommended to measure the basal temperature so that the specialist can correctly assess the onset of the luteal phase and ovulation.
Also performed gynecological examination, ultrasoundstudy. A prerequisite for adequate diagnosis is to conduct laboratory tests to determine the production of luteinizing and follicle-stimulating hormones, progesterone, estrogen, inhibin, 17-OH progesterone, TSH, testosterone.
In addition, you will need to donate blood for a coagulogram, to perform a biochemical analysis.
So, a woman's progesterone is below normal in the luteal phase. Treatment must be immediate.
Therapeutic interventions
The main goal of therapy for this pathology is to improve the quality of the corpus luteum and follicle, reduce the degree of oxidation and increase the level of progesterone. To do this, all the necessary therapeutic measures are carried out, which include some gynecological instrumental interventions (if necessary), for example, hysteroscopy, drug treatment in case of existing inflammatory processes in the reproductive system, hormone therapy to correct hormonal levels. Adjustment methods directly depend on the values of progesterone, the severity of its decrease, the concentration of other sex hormones is taken into account.
Advice to patients
It is very important not only to get the right treatment for low progesterone in the luteal phase, but also to follow the following recommendations:
- He althy diet. Meals should include whole foods, plenty of high-quality protein, fats, and lots of fruits and vegetables. Women are advised to drink plenty of water and avoid alcoholic beverages.caffeine and sugar.
- Avoid stress. In the luteal phase, a decrease in progesterone may be associated with prolonged or chronic stress. The body needs more progesterone to produce cortisol. This leads to the fact that during the LF period, progesterone is not enough to carry out its direct functions.
- Use of medications that help normalize the functioning of the adrenal glands and glands that produce cortisol, which can also be useful in increasing progesterone levels and stabilizing the luteal phase.
- Specialists recommend the use of special supplements to maintain progesterone: Wild Yam, Vitex, Melatonin and vitamin B6.
- Elimination of genital infections and inflammatory processes in the appendages and uterus. This is done by taking antibacterial medications.
- Compliance with hygiene and rules of intimate life. A woman is recommended to have a regular sexual life with a regular sexual partner, which will help to avoid many serious consequences in the form of sexually transmitted infections and violations of the vaginal microflora.
Standard therapy for progesterone below normal in the luteal phase is based on the use of medications. Vitamin complexes, the use of antiestrogens, the use of preparations of chorionic gonadotropin, follitropins - all this is recommended to be done at the same time. Complex treatment allows you to increase progesterone and prevent such serious consequences of this condition as infertility, miscarriage,placental insufficiency, oncological diseases of the endometrium and breast, the formation of polyps and fibroids.
