Luteal phase deficiency in regularly menstruating women: prevalence and overlap  in identification based on clinical and biochemical diagnostic criteria

Karen C Schliep; Sunni L Mumford; Ahmad O Hammoud; Joseph B Stanford; Kerri A Kissell; Lindsey A Sjaarda; Neil J Perkins; Katherine A Ahrens; Jean Wactawski-Wende; Pauline Mendola; Enrique F Schisterman

doi:10.1210/jc.2013-3534

Reproductive Endocrinology · Luteal Phase

Luteal phase deficiency in regularly menstruating women: prevalence and overlap in identification based on clinical and biochemical diagnostic criteria

Schliep KC, Mumford SL, Hammoud AO, Stanford JB, Kissell KA, Sjaarda LA, Perkins NJ, Ahrens KA, Wactawski-Wende J, Mendola P, Schisterman EF

Published June 2014 The Journal of Clinical Endocrinology and Metabolism, 99(6), E1007-E1014

DOI 10.1210/jc.2013-3534 PMID 24606080 PMC PMC4037737

RRM Academy Synopsis

Short luteal phase in 8.9%, low progesterone 8.4% of ovulatory cycles

A cohort of 259 healthy women with regular cycles showed a short luteal phase in 8.9% of cycles and low luteal progesterone in 8.4%. Only 4.3% of cycles met both. The two measures overlapped only partly.

Key Findings

Researchers analyzed 463 ovulatory cycles. Of these, 41 (8.9%) had clinical luteal phase deficiency, a luteal phase shorter than 10 days.
Biochemical luteal phase deficiency, meaning low luteal progesterone, appeared in 39 cycles (8.4%). Twenty cycles (4.3%) met both criteria.
Eight women (3.4%) had clinical luteal phase deficiency in both of their cycles, and five women (2.1%) had biochemical luteal phase deficiency in both.
Estradiol was lower before ovulation (both P ≤ .001) and after it (P = .03 and P = .02) with either type, adjusted for age, race, and percentage body fat.
Lower LH and FSH throughout the cycle went with clinical luteal phase deficiency only (P ≤ .001).

Interpretation

This cohort study followed 259 healthy women aged 18 to 44 with regular cycles. None had a history of infertility treatment, endometriosis, or polycystic ovary disease. Each woman contributed one or two cycles, timed with a home fertility monitor. Estradiol was lower both before and after ovulation with either type of luteal phase deficiency, after adjusting for age, race, and body fat. Lower LH and FSH throughout the cycle went with the clinical type only. The authors call for more research on what each type means clinically.

RRM Context

Luteal phase length can be measured only once ovulation is identified. Here, a fertility monitor supplied that timing. The authors note that endometrial biopsy and basal body temperature are no longer considered reliable tests for this condition. Estradiol was also lower before ovulation. RRM examines the whole cycle, including the follicular phase.

Our editorial summary of this paper, not the article's abstract.

Abstract

Context

Although adequate luteal hormone production is essential for establishing pregnancy, luteal phase deficiency (LPD) is poorly characterized among eumenorrheic women.

Objective

We assessed the prevalence and overlap of two established LPD diagnostic criteria: short luteal phase duration less than10 days (clinical LPD) and suboptimal luteal progesterone of 5 ng/mL or less (biochemical LPD) and their relationship with reproductive hormone concentrations.

Design, Setting, and Participants

We conducted a prospective study in western New York (2005-2007) following 259 women, aged 18-44 years, for up to two menstrual cycles.

Results

Among ovulatory cycles with recorded cycle lengths (n = 463), there were 41 cycles (8.9%) with clinical LPD, 39 cycles (8.4%) with biochemical LPD, and 20 cycles (4.3%) meeting both criteria. Recurrent clinical and biochemical LPD was observed in eight (3.4%) and five (2.1%) women, respectively. Clinical and biochemical LPD were each associated with lower follicular estradiol (both P ≤ .001) and luteal estradiol (P = .03 and P = .02, respectively) after adjusting for age, race, and percentage body fat. Clinical, but not biochemical, LPD was associated with lower LH and FSH across all phases of the cycle (P ≤ .001).

Conclusions

Clinical and biochemical LPD were evident among regularly menstruating women. Estradiol was lower in LPD cycles under either criterion, but LH and FSH were lower only in association with shortened luteal phase (ie, clinical LPD), indicating that clinical and biochemical LPD may reflect different underlying mechanisms. Identifying ovulation in combination with a well-timed luteal progesterone measurement may serve as a cost-effective and specific tool for LPD assessment by clinicians and researchers.

Topics

Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Diagnostics › Hormone Testing › Serum Panels

Karen C Schliep, Sunni L Mumford, Ahmad O Hammoud, Joseph B Stanford, Kerri A Kissell, Lindsey A Sjaarda, Neil J Perkins, Katherine A Ahrens, Jean Wactawski-Wende, Pauline Mendola, Enrique F Schisterman

K Schliep, S Mumford, A Hammoud, Joe Stanford, Joey Stanford, J Stanford, K Kissell, L Sjaarda, N Perkins, Kathy Ahrens, Kate Ahrens, Katie Ahrens, K Ahrens, J Wactawski-Wende, P Mendola, E Schisterman

PMID 24606080 24606080 DOI 10.1210/jc.2013-3534 10.1210/jc.2013-3534 Schliep et al. 2014, Schliep 2014

Keywords

Progesterone, Estradiol