Reproductive Endocrine Disorders
Stanley R. Resor, Henn Kutt in The Medical Treatment of Epilepsy, 2020
Inadequate luteal phase refers to less than normal progesterone secretion during the second half of the cycle, regardless of whether ovulation does or does not occur (18–20). It can be documented by one or preferably more findings including (1) a failure of the basal body temperature to rise by 0.7°F for at least 10 days during the second half of the menstrual cycle, (2) a serum progesterone level of less than 5.0 ng/ml during the midluteal phase, generally measured between days 20 and 22 of a 28-day cycle, and (3) a biopsy which shows underdeveloped secretory endometrium 8–10 days after ovulation. Serum estradiohprogesterone ratios and seizure frequencies tend to be higher than in normal ovulatory cycles during the second half of these cycles (17,21), and seizure exacerbation may extend from day 8 of one cycle to day 2 of the next (16).
The Endocrinology of Recurrent Pregnancy Loss
Howard J.A. Carp in Recurrent Pregnancy Loss, 2020
Luteal phase aberrations have been reported in the past to account for up to 35% of recurrent pregnancy losses (RPL) [9]. However, there is no consensus as to the methods to be used to diagnose luteal phase deficiency. Although serum progesterone levels below ≤12 ng/mL have been associated with increased risk of miscarriage [10], serum progesterone levels can vary up to ten times between blood sampled at a pulse peak or nadir. Luteal phase deficiency was originally thought to arise from insufficient production of progesterone by the corpus luteum and subsequent inadequate endometrial maturation to allow appropriate placentation. Luteal phase defect may also be due to reduced follicular development, diminished progesterone production by the corpus luteum, and a dysfunctional endometrial response to normal progesterone levels.
Causes and risk factors
Janetta Bensouilah in Pregnancy Loss, 2021
It has long been thought that many cases of miscarriage are secondary to an underlying endocrine imbalance, but the evidence for a clear causal link remains elusive. Luteal phase deficiency has traditionally been the focus of research in this area, and refers to insufficient progesterone secretion by the corpus luteum, resulting in inadequate preparation of the endometrium for implantation and a subsequent failure to maintain early pregnancy. However, studies have shown that there are similarities between luteal phase progesterone profiles and endometrial biopsy findings in both successful pregnancies and those that are lost.12 In cases of sporadic miscarriage with luteal phase deficiency, it is not likely to be repeated, and there is no convincing evidence that treatment of the luteal phase defect improves pregnancy outcome.10
Progestogens and pregnancy loss
Published in Climacteric, 2018
The classical experiments of Csapo and colleagues showed that lutectomy before 7 weeks causes miscarriage due to the fall in progesterone levels after lutectomy22. Mifepristone, a progesterone receptor antagonist, leads to fetal death and placental separation. Low progesterone levels have been found in recurrent miscarriage with delayed endometrial ripening compared to normal endometrial ripening23,24. Progesterone levels have even been used to make prognoses about the continued development of pregnancy7,25,26. However, a diagnosis of luteal insufficiency based on progesterone levels is problematic. Progesterone secretion is pulsatile. Blood may be drawn for progesterone levels at a pulse peak or nadir. Additionally, low hormone levels may be a consequence of miscarriage rather than the cause. After embryonic death, there is no villous circulation. Trophoblastic failure after villous circulatory failure results in low human chorionic gonadotropin (hCG) levels. Without hCG stimulation, the corpus luteum will fail to secrete progesterone. Hence, expulsion of the embryo will occur. In these cases, low progesterone will explain the mechanism of abortion but not that of embryonic death, nor the cause of miscarriage.
A survey of influencing factors of missed abortion during the two-child peak period
Published in Journal of Obstetrics and Gynaecology, 2021
Guifang Gong, Caixin Yin, Yanqing Huang, Yan Yang, Ting Hu, Zhiqin Zhu, Xuan Shi, Yan Lin
The reasons for above results may be as follows: For pregnant woman with advanced age, the body condition is not conducive to the growth of foetus. The luteal insufficiency belongs to endocrine factors. The low luteal progesterone level is easily to cause adverse pregnancy decidua, leading to the miscarriage (Cohen-Overbeek et al. 1990). The semen abnormality and reproductive organ abnormality will lead to the poor quality of fertilised eggs (Michel et al. 1989; Hamamah and Fignon 1996). The contact of toxic during pregnancy and bad life habits will directly affect the foetal development (Thomason et al. 1995). For example, if the pregnant woman is exposure to tobacco, the amounts of carbon monoxide enter the blood, which reduces the oxygen supply for the foetus, and affects the normal development of foetus (Ness et al. 1999). In addition, the alcohol will affect the development of foetal central nervous and growth of various tissue cells (Mamedaliyeva and Aimbetova 2012). Previous study has found that, the repeated artificial abortion is also the risk factor of missed abortion (Zhang et al. 2011). However, the present study finds that, it no statistical significance between observation and control group. The reason may be related to relatively small sample size.
The pharmacotherapeutic management of premenstrual dysphoric disorder
Published in Expert Opinion on Pharmacotherapy, 2023
Nancy Ciccone, Maya B. Kovacheff, Benicio N. Frey
Despite the fact that the current diagnostic criteria were only established and validated in 2013, there has been a fairly consistent body of research spanning almost three decades showing that this clinical condition is triggered by (normal) fluctuations of ovarian hormones in the luteal phase of the menstrual cycle. Perhaps more importantly, converging evidence shows that PMDD is associated with higher risk for suicide/suicidal behavior and higher rates of other co-morbid psychiatric disorders, which really highlight the severe burden of this condition. From a pharmacological perspective, 33 controlled trials have clearly demonstrated efficacy of serotonin-based antidepressants as the first-line treatments of PMDD. Interestingly, opposite to what is observed in the treatment of major depression and anxiety disorders where there is a typical time lag of 2–4 weeks before significant treatment response is observed, clinical trials with intermittent use of antidepressants (luteal phase only) have also shown separation from placebo. This finding suggests that antidepressants probably act through a different mechanism in PMDD, a knowledge that health practitioners largely lack.
Related Knowledge Centers
- Estrogen
- Follicular Phase
- Gonadotropin
- Luteinizing Hormone
- Menstrual Cycle
- Menstruation
- Ovulation
- Progesterone
- Endometrium
- Follicle-Stimulating Hormone