Why is the luteal phase so important?
I am writing this section as my luteal phase was preventing me from getting pregnant and I believe it was the cause of my first miscarriage. I have what is called a ‘luteal phase defect’ or ‘luteal phase deficiency’. This basically means that my luteal phase is too short. When I first started trying to conceive I had no idea what length it was but after charting my temperatures for a few months I discovered it was only 10/11 days long. This meant that I came on my period 11/12 days after I ovulated. The normal luteal phase length is around 12-16 days and so mine was a few days shorter than the normal range. Not only this but I would spot blood from as early as 5 days after I ovulated. After having my son my luteal phase decreased to just 8 days and after having my daughter it dropped to 7 days.
How can a short luteal phase affect your fertility?
The average length of time that a fertilised egg takes to travel down the Fallopian tubes and into the uterus is between 7 and 12 days. If you have a short luteal phase, then your lining has already started to come away before the egg has a chance to implant. The first time I got pregnant I had been spotting from a week after I ovulated and by day 12 when I got my positive pregnancy test I was spotting a lot. I had read online that light spotting during early pregnancy can be very normal so I didn’t think anything of it. I was still temping into week 5 of this pregnancy as I was still spotting and when my temperature had dropped one morning. I knew before it even happened that my progesterone levels had dropped and I was going to miscarry. That afternoon I started to get cramps and my period arrived.
Causes of a luteal phase defect?
A luteal phase defect is caused by a premature drop in progesterone levels. After you ovulate, the corpus luteum (the empty sac left by the released egg) produces progesterone which maintains your uterine lining for a fertilised egg. If you have a decrease in progesterone levels too soon after you ovulate then your lining will start to come away too early. You could have successfully managed to get the egg fertilised but by the time it starts to enter the uterus from the Fallopian tubes the lining is already coming away preventing the egg from implanting and establishing a successful pregnancy. I believe this is what happened in my case and the pregnancy was doomed from the beginning. So if you are asking yourself ‘why am I spotting before my period’? You could have a luteal phase defect.
Symptoms of a luteal phase defect.
A luteal phase defect often comes with shorter than normal cycles which makes sense. A short cycle would usually mean a shorter follicular phase and shorter luteal phase. You could however have a completely normal cycle length and assume you ovulate half-way through on day 14 or so, but actually you could have a longer follicular phase and a short luteal phase. You can also have long cycles like mine and have a very long follicular phase and a short luteal phase.
Luteal phase spotting is also a sign of lower than normal progesterone levels. This is why charting your temperatures is so useful and important if you have been struggling to conceive for a while. A short luteal phase can affect your fertility and can even cause early miscarriages which you obviously want to avoid. It is also easy enough to fix and there are several options.
Above is an example of my charts before having my son. As you can see I have a long follicular phase (22 days) and a short luteal phase (10 days). I ovulated late and I would come on my period 11 days after I ovulate.
Above is an example of my charts after having my son. As you can see my follicular phase was still very long and my luteal phase was short at just 8 days.
Above is an example of my charts after having my daughter. As you can see my follicular phase is still very long (34 days) and my luteal phase is even shorter at just 7 days.
Natural ways to lengthen your luteal phase.
I read up about this a lot and there are a few options you take before going on medication. Firstly you need know for sure that your luteal phase is short or not. You can calculate your luteal phase length by following the steps in the ‘chart your ovulation’ section.
Nutrition – Eating lots of dark green leafy vegetables can work wonders. Eating foods high in vitamin C or taking a vitamin C supplement may also help increase your progesterone levels. If you are taking a pre-conception vitamin, which I would recommend, then you will be covered. I took Pregnacare but there are plenty of alternatives. Just make sure that they contain the 400 micro grams of folic acid that you need (see fertility vitamins and herbs section). Essential fatty acids are also very important for progesterone production and can be found in a variety of foods such as seeds, nuts and certain fish such as salmon and sardines. You should also make sure you are getting enough cholesterol which is found in eggs, milk, butter, yogurt and coconut oil. Going on a low fat diet when trying for a baby should be avoided. A balance diet is needed. You should also check out the section on ‘fertility vitamins and herbs’ and read about antioxidants which could help with a luteal phase defect.
Vitamin B6 – You can try taking vitamin B6 which can increase your luteal phase length by balancing out your hormone levels. It does take quite a long time to take affect though so don’t expect it to happen within the first few cycles. Taking 50mg to 100mg daily is the recommended dose but you should take it as part of a vitamin B complex to prevent an unbalance in B vitamins. You can buy a good vitamin B complex containing 100mg on Amazon for around £15.
Mega Potency Vitamin B Complex 100mg Time Release 60 Tablets by Natures Aid
It is something I started taking once I discovered my luteal phase was short and it took a few months but I stopped spotting between ovulation and my period and my luteal phase lengthened by 1 day. I have just started to take it again as my luteal phase after having my daughter is only 7 days and my luteal phase has lengthened by 2 days (to 9 days) which is still very short, but I am hoping that it increases as the months pass. I will update this post as things progress. I am also taking Vitex so I am unsure if the effects are from the vitamin B complex or the vitex (see below).
Vitex (Chasteberry/angus castus) – This herb has many amazing qualities and can really help if you think you have issues with your hormone levels. It can help you ovulate sooner and it can increase your levels of progesterone after ovulation by stimulating the development of the corpus luteum which is what secretes progesterone. I took this for a few months when trying to conceive my son and and my luteal phase lengthened from 10 days to 11 days and my spotting reduced. It also helped to regulate my cycles a little more. For more information on this herb see the section on ‘Fertility vitamins and fertility herbs section‘ or my post on Vitex. The dose you need is 1000mg and you cannot buy this strength in the high street (a well known health food shop only sells 4mg tablets). You can but them online however and they are perfectly safe to use.
How short is too short? And when should you go to the doctor?
When I was trying for my son I had a 10-day luteal phase and I would have spotting throughout my luteal phase. Despite this I still managed to get pregnant twice. Both ended in a miscarriage and although I believe the first miscarriage was because of my short luteal phase I did get to 12 weeks with my second pregnancy. The baby didn’t have a heart beat at 12 weeks but I still had very little signs of a miscarriage and I had to have the abortion induced. It was a chromosome problem rather than a problem with my progesterone levels and although I did have a lot of spotting at the beginning of this pregnancy, it hung on in there and was able to implant properly. I used progesterone suppositories to conceive my son as my luteal phase spotting was getting worse and my gynecologist suggested I try them. The first cycle I used them I conceived my son. So after 16 months of stress, this seemed to be the key. I had no spotting and breezed through the pregnancy without any scares. .
After having my son my cycles took around 6 months or so to return as I was breastfeeding. I started to chart straightaway as I wanted to start trying for baby number 2 once my son was 11 months or so. I had no idea how long it was going to take me to fall pregnant again so wanted to start sooner rather than later. I have said previously that your luteal phase length rarely alters cycle to cycle and is pretty consistent. If you have irregular cycles it is more than likely that your follicular phase length is shortening or lengthening between cycles and not your luteal phase. I discovered however that after my son my luteal phase had got even shorter. I consistently had an 8-day luteal phase which is way too short to conceive. I decided to use the progesterone suppositories again. It took me 16 months to conceive my son and only 1 month to conceive my daughter as I took the progesterone suppositories on the first cycle that we tried for her. Once again I had no spotting and no problems throughout the pregnancy.
I got my cycles back when my daughter was around 6 months and although we have not decided if we want a third baby right now, I started to chart my cycles anyway. Disappointingly I now have a 7-day luteal phase which once again is even worse and too short to be able to conceive successfully. I have started to take vitex and vitamin B6 to try to lengthen it and surprisingly my luteal phase has lengthened to 9 days long (although I did spot for a few days before I came on). I will keep going with it and update this post as things progress. My latest chart is below.
What is the dose and how to use progesterone suppositories?
This will vary depending on the brand you are given and your doctor but here is what I was advised by my gynecologist and the instructions on how to take them – Cyclogest suppositories 200mg vaginally or rectally twice daily from day 14 of your cycle for 12 days each cycle. If you become pregnant then continue this treatment until about 14-16 weeks. My gynecologist was nice enough but her instructions did not take into account that my cycles are irregular in length. This is another reason when monitoring your cycles and your fertile signs is important. I did tell my gynecologist that I do not ovulate on the same day each cycle and definitely not on cycle day 14 like the ”average” women but she still advised me to start the progesterone on cycle day 14. On the cycles I conceived both my son and daughter I ovulated later than day 14 so I would have started the progesterone before I should of if I had followed her instructions. This could have messed everything up and prevented me from ovulating.
What I actually did was monitored my cycles and when I saw my fertile signs and got my positive ovulation test I waited for 3 mornings of high temperatures to confirm ovulation and then started to take them. So I took them on the morning of my 3rd high temperature (see chart your ovulation section). I actually could have started earlier as my ovulation pains are the strongest sign that I have ovulated but I wanted to be 100 % sure. I also planned to stop taking them 14 days after I ovulated and not 12 as I wanted to make sure I was not pregnant before stopping them. Although I got a positive pregnancy test 10 days after ovulation with my son, the tests were negative until 13 days after ovulation with my daughter. I could have stopped the progesterone too early and a sudden drop in progesterone by stopping the suppositories could have caused an early miscarriage. As some women don’t get their positive tests for 16 days or more after ovulation due to the egg implanting a bit late you could bring on a miscarriage by stopping it too early so be cautious. I would wait until 14 days after you have ovulated and if your tests are still negative you can stop. If you are not pregnant then your period will not arrive until you stopped taking the progesterone. I should arrive a day or so after stopping the suppositories. If you stop taking the suppositories and your period does not arrive after a few days then it would be wise to do a pregnancy test to make sure.
Side effects of taking progesterone.
Apart from feeling a bit warmer especially at night, I did not experience any negative side effects from using the progesterone suppositories. I was however using the suppositories vaginally and not rectally and they can be a bit messy. They are waxy in texture and are easy to insert just like a tampon but once inside you they melt. The advise I read online was to try to lie horizontally for half an hour or so after inserting them so that once they start to melt they coat your cervix and the inside of the vagina and can be absorbed into your bloodstream before leaking out. Throughout the day I would feel a sudden wet feeling from the leakage and if I didn’t wear a panty liner it would mark my knickers with an oil type stain. Obviously a small price to pay for being pregnant. It is also advised not to have sex straight after or soon after using them as it can irritate your man’s penis. Also, some women complain of irritation to their vagina but I didn’t experience this. Some women get nausea and head aches but again this depends on the individual.
Progesterone tablets, Progesteone injections, Progesteone creams and progesterone suppositories.
I read a lot of studies about the positives and negatives about each type of progesterone treatment and the suppositories seem to have the most success and are favored. The injections are very successful but it is unlikely that you would be prescribed the injections to do at home. The results from tablets seem to be a bit mixed and some studies suggest that although blood levels reach higher levels than the creams and suppositories their effects are poorer. The creams do not really increase the levels of progesterone in the blood but as you rub it into the thigh which is close to your uterus it could have some local effects on the uterus. Although the suppositories do not increase blood levels as high as the tablets or injections there is evidence to suggest that by inserting the suppository close to where it is needed (the uterus) it can have the biggest affect and this is why they are used more often in the UK with great success.
Will progesterone treatment prevent a miscarriage?
Progesterone treatment taken after ovulation and through the luteal phase can help maintain your uterus lining and therefore aid in implantation. If you carry on taking the progesterone for the first 16 weeks of pregnancy you are giving the baby every chance you can to survive and once the placenta takes over progesterone production at 16 weeks or so you can stop taking it. Although it can help a fertilized egg implant and it helps to develop and maintain a nutrient thick lining to feed the growing embryo, it is not 100% successful in preventing a miscarriage. If you are prescribed progesterone by your doctor they will probably tell you this. My thoughts are, if it is not going to do you or your baby any harm then it is better to try them than not. I truly believe if I had not used progesterone to help maintain my lining, I would not have my son or daughter here today and there are countless success stories online of women who have experienced the same success.
Will progesterone treatment sustain a none viable pregnancy?
There is a lot of studies done on the use of progesterone suppositories and although it can help sustain a healthy pregnancy it will not maintain a pregnancy that is not viable. If you get pregnant and there is a problem e.g. chromosomal issue, and your body would normally abort the pregnancy then it will do this despite you being on progesterone. The miscarriage may be delayed by a few days or weeks but if it is not meant to proceed and your body wants to abort the pregnancy then it will. This happened to a friend of mine who miscarried at 7 weeks despite being on cyclogest.
If you chart your ovulation and you discover you have a short luteal phase (shorter than 11-12 days) and you are struggling to get pregnant or if you have had reoccur ant early miscarriages along with spotting between ovulation and your period, then definitely speak to you GP as your issue could be easily solved with the use of progesterone suppositories.
Other reasons for spotting before your period.
Ovulation spotting- Spotting after ovulation or Mid cycle spotting can occur a few days after you have ovulated and I have experienced this a few times especially if my ovulation pain was particularly bad. It is nothing to worry about as 10% of women experience this at some point. It occurs because of a brief drop in estrogen levels when an egg is released from an ovary. This spotting usually happens around 10-14 days before your period is due if you have a normal luteal phase length.
Implantation bleeding – Spotting during your luteal phase can occur because of a luteal phase defect but if your cycles and luteal phase are of normal length and you never usually have spotting at this time in your cycle it could be implantation bleeding. Light spotting of brown or pink ( and sometimes red) discharge around 6-12 days after ovulation could indicate implantation and can be an early sign of pregnancy. When the egg attaches to the uterus it is called implantation and as this happens a small amount of blood may be shed. This blood can pass through the cervix and the vagina and you may see it after you wipe. This is implantation bleeding and you can look up images of implantation bleeding on google images to get an idea of what it may look like.
Vascular cervix – I haven’t found much about this online but when I went to see my doctor about my spotting and early period after ovulation she examined my cervix. I had ovulated a few days prior and she said that my cervix was very vascular. She said that the blood vessels are often more visible, prominent and more dense during the luteal phase due to the effects of progesterone levels being higher. Pregnant women also have this as their progesterone levels are very high and their cervix becomes engorged with blood. If you have a vascular cervix during your luteal phase then any light trauma e.g. through sex, could cause you to have some spotting. If you experience spotting after sex then this could be the problem but you should definitely have yourself checked out if you experience any abnormal spotting throughout your cycle just in case. when I was on the contraceptive pill called ‘Cilest’, which is a progesterone only pill, I would spot now and then after sex but I didn’t go to my GP as I had had several smears and all was normal. It is usually nothing to worry about but it is better to get checked anyway.
There are many other reasons that can cause spotting at times other than when you are on your period and I have listed a few more below. If you are concerned about abnormal spotting then you should go to your GP for a chat about it. Below is a list of other causes of abnormal menstrual spotting.
– Cervical erosion (cervical ectropion).
– Polycystic Ovary Syndrome (PCOS).
– Cervicitis – Inflammation or infection of the cervix .
– A Sexually Transmitted Disease (STD)
– An ovarian cyst.
– Uterine Fibroids.
– Uterine Polyps
– Pelvic Inflammatory Disease (PID).
– Ectopic pregnancy.
– Malignant cancer – make sure you always have a smear test when advised to.