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KMID : 0377619980630030281
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Korean Jungang Medical Journal
1998 Volume.63 No. 3 p.281 ~ p.294
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Luteal Phase Deficiency : Overdiagnosed and Undertreated
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Michael R. Soules
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Abstract
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Objectives :
·Appreciate the prevalence and pathophysiology of LPD
·Apply diagnostic methods properly.
·Select and monitor specific treatments for LPD.
Introduction :
The luteal(secretory) phase of the primate menstrual cycle is the period of tissue
between ovulation and the onset of menses. The luteal phase is best characterized by
progesterone secretion by the corpus luteum. Progesterone stimulates endometrial gland
maturation(secretion) and decidual transformation of the endometrial stroma, thus
providing the essential hormonal support implantation and the maintenance of early
pregnancy.
Given the complexity of corpus luteal physiology, there is considerable potential for
error which could result in inadequate corpus luteum function(Fig. 1)
In fact, inadequate corpus luteum function does occur and has been referred to as
luteal phase deficiency(LPD). Luteal phase deficiency(LPD). Luteal phase deficiency is a
"modem" disease that was first described in 19'19 but has only been generally accepted
as real within the last twenty years(1). LPD can be defined as : the clinical entity of
LPD is present when there is recurrent postovulatory deficiency in progesterone
production and/or progesterone effect from the corpus luteum leading to infertility and/or
habitual abortion.
(Synonymous terms that have been used for LPD include : "inadequate corpus
luteum", "luteal phase inadequacy", "luteal insufficiency" and "luteal phase defect". The
term "short luteal phase" has been used to describe a variant of LPD associated with
luteal Phase of decreased length).
In the vase majority of cases, LPD is a problem of inadequate progesterone secretion
by the corpus luteum although LPD may result from a decreased end-organ(e.g. uterine)
response to progesterone. In LPD, a woman's reproductive system functions well enough
to ovulate(qualitatively normal) but the corpus luteum functions below a physiologic
threshold sufficient for conception or pregnancy maintenance (quantitatively abnormal).
LPD may be the most common ovulatory abnormality in women but remains but
remains unrecognized in the vast majority who are not attempting to conceive. A
common pathogenesis is Postulated to exist for both infertility and habitual abortion ; it
consists of inadequate uterine stimulation and endometrial maturation insufficient for
implantation or early pregnancy maintenance. LPD is difficult to recognize since there
are not simple diagnostic tests. Therefore, it is probably grossly under-diagnosed.
Normal women, at the extremes of reproductive age, often experience "physiologic" LPD
; as the ovulatory system matures(post menarchal) or declines(premenopausal) LPD is
often present. Postpartum resumption of menstrual function is another circumstance
where LPD is Often present. Considering the fact that "stress" both physiologic(e.g.
occupational) and physical(e.g. exercise), can cause amenorrhea, it is reasonable to
postulate that LPD, as a less severe abnormality of ovulatory function, is even more
common under these circumstances(Fig. 2).
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