Day 1 means your period is starting. Day 14 means you're ovulating and Day 29 becomes Cycle Day 1. Therefore, all nice and tidily written, the average woman has a 28 day cycle.
Which means she has a 14 day Luteal Phase.
Contrary to the textbooks is the real nature of the menstrual cycle.
Every woman is different. Every cycle of the same woman is vastly different, even if she has a 'normal' pattern of fertility.
Cycle Day 1 starts her period, her bleeding should cease sometime between Cycle Day 5 and Cycle Day 8 and this begins her follicular phase.
This is the most important phase of the entire menstrual cycle. Secondary to that is not ovulation itself, but the luteal phase.
What is the Luteal Phase?Before ovulation the brain sends chemical signals to the ovaries to begin ripening follicles. One ovary may be dominant for that cycle or both ovaries may begin ripening follicles.
As the body begins pushing more Lutenizing Hormone the follicles slow down with only one follicle continuing to ripen.
The LH hormone peaks and the follicle ruptures, hopefully at the most optimal time, sending the ovum from the follicle and away from the ovary towards the fallopian tube.
But this isn't the end of the follicle. The follicle reseals and begins swelling in size. It becomes a cyst full of fluid and changes to the course of the hormones for the rest of the cycle.
This Corpus Luteum, or yellow body, Cyst produces the progesterone needed to sustain pregnancy and delay the onset of Menses so that the fertilized egg can implant into the uterine lining.
If implantation is not successful the CL Cyst begins to break down, shrinking in size and the uterine lining begins to fall away from the uterus, initiating Menses.
The Luteal PhaseIt is imperative the Luteal Phase is of an adequate length to allow time for the ovum to travel down the fallopian tubes, to mix with sperm and create an embryo. The embryo must have time to travel down the tubes into the uterus and penetrate the uterine lining and implant into the uterus wall.
If the Luteal Phase is too short, perfectly normal and healthy embryos may not have sufficient time to implant into the uterus and Menses starts prematurely causing an infertile cycle.
Luteal Phase DefectAnother of fertility's hotly contested spectrum is the Luteal Phase Defect.
Some specialists say that if a perfectly normal embryo was conceived it should have no trouble implanting into the uterine wall anywhere from 2 days past ovulation (on the early side of average) to 8 days past ovulation and that late implantation (anything more than 10 days past ovulation) suggests an abnormal, unhealthy embryo.
Some specialists say that because every woman's body is unique and we all have uniquely shaped uterus that it is perfectly acceptable for an embryo to implant anywhere from 4 to 10 days after ovulation.
Most agree delayed implantation of CD10 onwards is indicative of an unhealthy pregnancy.
So what is Defective?If we rely on the textbook definition of the Luteal Phase, being 14 days, anything below 14 and anything greater than 14 is defective.
Most specialists now say that up to 16 days post ovulation is 'normal' but only if a woman is showing consistent and acceptable ovulation.
What they don't take into consideration is the length of the follicular phase.
If your follicular phase is 15 days and you ovulate on CD20, you should, naturally, have a longer luteal phase.
Example 1CD 1 -- period begins
CD 7 -- bleeding stops
CD 20 -- ovulation
CD 35/ CD 1 -- period begins
Total cycle length: 34 days
LP Length: 14 days
Example 2CD 1 -- period begins
CD 4 -- bleeding stops
CD 13 -- ovulation
CD 25/ CD 1 -- period begins
Total Cycle Length: 24 days
LP Length: 12 days
The DefectI think it's such a hideous term, defect, and when applied to the menstrual cycle it really isn't appropriate.
I know of several women who jumped to conclusions about the LP Defect and over supplemented Vitamin B6 causing hot flashes and total loss of their menstrual cycle.
If you are noticing strong ovulation and a luteal phase of less than 10 days then I would, without hesitation, begin looking for ways of extending the cycle.
If you are noticing that you don't have strong ovulation and often wonder if you are ovulating at all, I would begin working from the start of the cycle to help the follicular stage and see if this helps extend the LP.
Causes of Luteal Phase DefectAccording to Baby Hopes.Com the three main causes of luteal phase defect include poor follicle production, premature demise of the corpus luteum, and failure of the uterine lining to respond to normal levels of progesterone. These problems occur at different times during the cycle but can also be found in conjunction with each other.
1. Poor follicle production occurs in the first half of the cycle. In this case, the woman may not produce a normal level of FSH, or her ovaries do not respond strongly to the FSH, leading to inadequate follicle development. Because the follicle ultimately becomes the corpus luteum, poor follicle formation leads to poor corpus luteum quality. In turn, a poor corpus luteum will produce inadequate progesterone, causing the uterine lining to be adequately prepared for the implantation of a fertilized embryo. Ultimately progesterone levels may drop early and menses will arrive sooner than expected resulting in luteal phase defect.
2. Premature failure of the corpus luteum can occur even when the initial quality of the follicle/corpus luteum is adequate. In some women the corpus luteum sometimes does not persist as long as it should. Here, initial progesterone levels at five to seven days past ovulation may be low; even if they are adequate, the levels drop precipitously soon thereafter, again leading to early onset of menses and hence a luteal phase defect.
3. Failure of the uterine lining to respond can occur even in the presence of adequate follicle development and a corpus luteum that persists for the appropriate length of time. In this condition, the uterine lining does not respond to normal levels of progesterone. Therefore, if an embryo arrives and tries to implant in the uterus, the uterine lining will not be adequately prepared, and the implantation will most likely fail.
Detective WorkIt will take some detective work to expose a true Luteal Phase Defect.
1) You must chart your cycle for both temperature and cervical fluid.
2) You must confirm ovulation either through temperature, cervical fluid and opk or with a progesterone blood test from your doctor.
3) You must chart your temperature through your luteal phase.
4) You must have at least 2 cycles with less than 10 days of the luteal phase.
If you are noticing 10 days or more then you do not have the luteal phase 'defect' and just have your own unique LP.
This article from INCIID is a very good page to help explain LPD.
What Can You Do?I think your first step is to visualize a longer luteal phase. Visualize that the egg travels through the tube, meets the sperm, conceives your precious embryo and rushes, not just travels, but rushes to meet the lining.
It burrows with tremendous force and implants successfully. And I would do this visualization from ovulation until your period begins (unless it doesn't!).
Secondary to the visualizations is supplementation.
Most specialists do not tend to jump on a progesterone supplementation but some do and I believe a woman looking into a LP issue should consider Vitamin B6 (in addition to her normal B complex). Let's look into Vitamin B6 first.
Vitamin B6Vitamin B6 is also known as pyridoxine, and is water soluble. It can be found in yeast, whole grains, legumes, liver, eggs, cereal, meat and fish. Along with providing the body with reactions of amino acid metabolism, it also has some benefits we can see and feel; it helps to regulate blood sugars, alleviates PMS and morning sickness. It is excreted totally from the body after about 8 hours.
Lori Ramsey, at Suite 101 gives her perspective on using Vitamin B6 to help extend her LP. She write:
"I've read it is recommended to take 100-200 mg of vitamin B6 a day to help with luteal phase defects. However, just 63 mg did the trick for me. Perhaps it would be smart to start out with smaller doses to see if it would work and increase it if it doesn't. Always check with your practitioner or doctor before taking megadoses of any vitamin. Vitamin B6 helps to normalize hormone levels thus normalizing the luteal phase."
What You Should Be Looking ForVitamin B Complex
Dosage: 1 pill each morning with food.
Comments: Look for a B-50 complex with 50 mcg vitamin B12 and biotin; 400 mcg folic acid; and 50 mg all other B vitamins.
Warnings: High doses of some B vitamins can be toxic and/or cause nerve damage. Vitamin B6 may prevent the drug levodopa from working properly and folic acid and Vitamin B6 have been show to interfere with some anticonvulsants.
Vitamin B6
Dosage: 50 mg a day.
Comments: 200 mg daily over long term may cause nerve damage.
Warnings: When consumed in higher than recommended doses, vitamin B6 has been show to interfere with some anticonvulsants such as carbamazepine, gabapentin, and phenytoin, and the drug Levodopa, used to treat Parkinson's disease. High doses of B6 can cause nerve damage.
Source
Progesterone SupplementationWhat is Progesterone?Kevin Stitch explains progesterone much better than I could:
"Progesterone is a hormone produced by the ovaries that helps maintain a normal menstrual cycle. By preparing the lining of the uterus for implantation by the embryo, Progesterone also plays a critical role in maintaining the early weeks of a pregnancy. At approximately the eighth week of a normal pregnancy, the placenta takes over the role of producing Progesterone for the remainder of the pregnancy. Progesterone helps relax the muscles in the lining of the uterus, and also helps the breasts to develop in preparation for milk production after the birth of a baby."
The only way to test for progesterone is through a simple blood test. Most doctors order this test on CD21, but as we know, not all women would be 7dpo then, when the test is most commonly ordered. Some doctors even call it a CD21 test which shows a blatant lack of respect for you as a patient.
I always advise women to count out 7 dpo and go get the blood test then NOT on CD21 as is most commonly written on your lab sheet. If your numbers come back very low it suggests there was not active ovulation, even if you felt ovulation sensations or had fertile cervical mucous. Most doctors would want to force ovulation and would suggest a medicated cycle, most often starting with Clomid or Femara.
If, however, your test indicates ovulation occurred but your progesterone is very low, supplementation might be offered. A level less than 14 ng/ml indicates that progesterone production in the luteal phase is inadequate.
Supplementation can be in the form of pills, injections or the more popular suppositories. These are taken after ovulation has occurred and either taken about 2 weeks or sometimes until the 10th to 12th week of pregnancy.
There is an over the count (OTC) version called Natural Progesterone Cream or to those in the know, NPC. Some may find an alternative made from Wild Mexican Yam.
What is NPC (Natural Progesterone Cream)?Dr John R. Lee, M.D, a world class expert on progesterone and women's hormones, noted that a natural hormone program worked better than conventional, mainstream medicine to help women cope with menopause.
Doctors working in reproduction found that this progesterone cream also works well to support the body in the luteal phase.
Micronized progesterone is progesterone run through an ointment mill to reduce the size of the progesterone pieces. In general, smaller progesterone pieces are more effective since they are more easily absorbed.
Natural progesterone has the consistency of powdered sugar. In progesterone that is not micronized, some of the "pieces" can be too large to be absorbed. Also, if pieces of the progesterone are not milled to a smaller, consistent size, this can lead to a grittiness in the progesterone cream.
What are the directions for using NPC natural progesterone body cream?Suggested Use:
* For best results, use approximately ¼ tsp. of NPC natural progesterone body cream per application (scoop enclosed). Apply once or twice daily for the last 10 to 14 days prior to your period.
* Apply to hairless areas of skin, such as inner wrists, upper arms, behind knees or upper chest. Rotate application areas to avoid saturation.
* Rub in thoroughly.
* For topical use only. Do not exceed the recommended daily usage. Follow all directions.
Who Needs to Supplement Progesterone?When a woman undergoes an IVF cycle she has the ovum aspirated from the follicles. Therefore her body never accepts that ovulation has occurred and the Corpus Luteum Cyst never forms, so in fact, she has NO real source of progesterone until her body is pregnant and supporting a growing baby.
Therefore she must, absolutely must, supplement progesterone. This progesterone supplementation is absolutely vital to ensure an embryo has the opportunity to implant into the uterus, otherwise her body assumes there has been no fertilization and Menses would begin.
If a woman has shown to have low progesterone during medicated cycles sometimes progesterone will be prescribed, however, it is greatly contested whether low progesterone is a sign of the body lack of ability to produce progesterone or whether the body would miscarry the pregnancy since it does not want to produce progesterone to support the pregnancy.
Some doctors feel the answer lies in getting a stronger ovulation and most patients do note that they have higher progesterone levels during medicated cycles (non IVF).
If you wish to supplement with NPC you MUST discuss this with your doctor.
Does Progesterone Supplementation Prevent Miscarriage?The short answer is no. Nothing can truly prevent miscarriage.
In some women, however, progesterone supplementation is absolutely vital to ensure an embryo has the opportunity to implant into the uterus.
Dr. Amy writes:
"There is a small group of miscarriages that can be prevented. These miscarriages are causes by a progesterone deficiency (luteal phase defect). Progesterone is needed to support the growth of a pregnancy. In the early weeks of pregnancy, the mother’s body produces the progesterone. By about 8-9 weeks of pregnancy, the placenta usually takes over the production of progesterone. Women who don’t produce enough progesterone in the early weeks of pregnancy may have repeated miscarriages. These miscarriages can be prevented by progesterone supplements...
Measuring progesterone levels at the beginning of pregnancy may show dropping levels of progesterone before a miscarriage. However, it seems more likely that levels drop because the pregnancy is no longer growing, not because the dropping levels cause the miscarriage. Therefore, taking progesterone supplements will not prevent the miscarriage."
Visualization Exercise
1 comment:
The information that you provided was thorough and helpful. I will have to share your article with others.
White Lotus Clinic
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