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| {{Short description|The latter part of the menstrual cycle associated with ovulation and an increase in progesterone}} | |||
| ] | ] | ||
| The '''luteal phase''' (or '''secretory phase''') is the latter phase of the ] (in humans and a few other animals) or the ] (in other ]). It begins with the formation of the ] and ends in either pregnancy or ]. The main hormone associated with this stage is ], which is significantly higher during the luteal phase than other phases of the cycle.<ref>Bagnell, C. 2005. "Animal Reproduction". Rutgers University Department of Animal Sciences.</ref> Some sources define the end of the luteal phase to be a distinct "ischemic phase".<ref></ref> | |||
| The ] is on average 28 days in length. It begins with ] (day 1–7) during the ] (day 1–14), followed by ] (day 14) and ending with the '''luteal phase''' (day 14–28).<ref name=":02">{{Citation|last1=Reed|first1=Beverly G.|title=The Normal Menstrual Cycle and the Control of Ovulation|date=2000|url=http://www.ncbi.nlm.nih.gov/books/NBK279054/|work=Endotext|editor-last=Feingold|editor-first=Kenneth R.|place=South Dartmouth (MA)|publisher=MDText.com, Inc.|pmid=25905282|access-date=2021-09-20|last2=Carr|first2=Bruce R.|editor2-last=Anawalt|editor2-first=Bradley|editor3-last=Boyce|editor3-first=Alison|editor4-last=Chrousos|editor4-first=George}}</ref> while historically, medical experts believed the luteal phase to be relatively fixed at approximately 14 days (i.e. days 14–28),<ref name=":02" /> recent research suggests that there can be wide variability in luteal phase lengths not just from person to person, but from cycle to cycle within one person.<ref>{{Cite journal |last=Henry |first=Sarah |last2=Shirin |first2=Sonia |last3=Goshtasebi |first3=Azita |last4=Prior |first4=Jerilynn C |date=25 September 2024 |title=Prospective 1-year assessment of within-woman variability of follicular and luteal phase lengths in healthy women prescreened to have normal menstrual cycle and luteal phase lengths |url=https://academic.oup.com/humrep/article/39/11/2565/7775370 |journal=Human Reproduction |volume=39 |issue=11 |pages=2565-2574 |via=Oxford Academic}}</ref> The luteal phase is characterized by changes to hormone levels, such as an increase in ] and ] levels, decrease in ]s such as ] (FSH) and ] (LH), changes to the ] to promote ] of the fertilized egg, and development of the ]. In the absence of fertilization by sperm, the corpus luteum degenerates leading to a decrease in progesterone and estrogen, an increase in FSH and LH, and shedding of the endometrial lining (menses) to begin the menstrual cycle again.<ref name=":02" /> | |||
| ⚫ | ==Hormonal events== | ||
| After ovulation, the pituitary hormones ] and ] cause the remaining parts of the dominant follicle to transform into the ]. It continues to grow for some time after ovulation and produces significant amounts of hormones, particularly progesterone,<ref name="isbn0-07-303120-8"/> and, to a lesser extent, ]. Progesterone plays a vital role in making the ] receptive to ] of the ] and supportive of the early pregnancy; it also has the side effect of raising the woman's ].<ref name="tcoyf">{{cite book | first=Toni | last=Weschler | year=2002 | title=Taking Charge of Your Fertility | pages=361–2 | edition=Revised | publisher=HarperCollins | location=New York | isbn=0-06-093764-5 }}</ref> | |||
| ⚫ | == Hormonal events == | ||
| Several days after ovulation, the increasing amount of estrogen produced by the corpus luteum may cause one or two days of fertile ], lower basal body temperatures, or both. This is known as a "secondary estrogen surge".<ref>Wescler, pp.310,326</ref> | |||
| After ] and release of the ], the ]–] (FSH) and ] (LH) are released and cause the remaining parts of the dominant ] to transform into the ]. It continues to grow during the luteal phase after ovulation and produces significant amounts of hormones, particularly progesterone, and, to a lesser extent, ] and ]. Progesterone plays a vital role in making the ] ] to ] of the ] and supportive of early pregnancy. High levels of progesterone inhibit the follicular growth. The increase in estrogen and progesterone also lead to increased basal body temperature during the luteal phase.<ref>{{Cite journal|last1=Zhang|first1=Simeng|last2=Osumi|first2=Haruka|last3=Uchizawa|first3=Akiko|last4=Hamada|first4=Haruka|last5=Park|first5=Insung|last6=Suzuki|first6=Yoko|last7=Tanaka|first7=Yoshiaki|last8=Ishihara|first8=Asuka|last9=Yajima|first9=Katsuhiko|last10=Seol|first10=Jaehoon|last11=Satoh|first11=Makoto|date=2020-01-24|title=Changes in sleeping energy metabolism and thermoregulation during menstrual cycle|journal=Physiological Reports|volume=8|issue=2|pages=e14353|doi=10.14814/phy2.14353|issn=2051-817X|pmc=6981303|pmid=31981319}}</ref> | |||
| The ] that occurs during ovulation triggers the release of the oocyte and its cumulus oophorus from the ovary and into the fallopian tube and triggers the oocyte to divide and enter metaphase of meiosis II (46 or 2n chromosome) and extrude its first polar body. The oocyte will only continue through meiosis and extrude its second polar body once it is fertilized. Ovulation occurs ~35 hours after the beginning of the LH surge or ~10 hours following the LH surge. Several days after ], the increasing amount of estrogen produced by the corpus luteum may cause one or two days of fertile ], lower basal body temperatures, or both. This is known as a "secondary estrogen surge".<ref>{{Cite journal|last=Kelly|first=Thomas|date=2002|title=Plutarch|url=http://dx.doi.org/10.1080/03612759.2002.10526169|journal=History: Reviews of New Books|volume=30|issue=3|pages=126|doi=10.1080/03612759.2002.10526169|s2cid=216557803|issn=0361-2759}}</ref> | |||
| The hormones produced by the corpus luteum also suppress production of the FSH and LH that the corpus luteum needs to maintain itself. With continued low levels of FSH and LH, the corpus luteum will atrophy.<ref name="isbn0-07-303120-8"/> The death of the corpus luteum results in falling levels of progesterone and estrogen. These falling levels of ovarian hormones cause increased levels of FSH, which begins recruiting follicles for the next cycle. Continued drops in levels of estrogen and progesterone trigger the end of the luteal phase: menstruation and the beginning of the next cycle.<ref name="tcoyf" /> | |||
| The hormones released by the corpus luteum suppress production of the FSH and LH from the anterior pituitary gland. The corpus luteum relies on LH activation on its receptors in order to survive. The loss of the corpus luteum can be prevented by implantation of an ]: after implantation, human embryos produce ] (hCG),<ref>{{Cite journal|last1=Wilcox|first1=Allen J.|last2=Baird|first2=Donna Day|last3=Weinberg|first3=Clarice R.|author3-link=Clarice Weinberg|date=1999-06-10|title=Time of Implantation of the Conceptus and Loss of Pregnancy|journal=New England Journal of Medicine|language=en|volume=340|issue=23|pages=1796–1799|doi=10.1056/NEJM199906103402304|pmid=10362823|issn=0028-4793|doi-access=free}}</ref> which is structurally similar to LH and can preserve the corpus luteum. If implantation occurs, the corpus luteum will continue to produce progesterone for eight to twelve weeks, after which the ] takes over this function.<ref>{{Cite book|last=Curtis|first=Glade B.|url=https://www.worldcat.org/oclc/43541212|title=Your pregnancy week by week|date=1999|publisher=Element|others=D. F. Hawkins|isbn=1-86204-396-5|edition=|location=Shaftesbury|oclc=43541212}}</ref> In the absence of fertilization, hCG is not produced and the corpus luteum will atrophy in 10–12 days (Luteolysis or luteal regression). The death of the corpus luteum results in falling levels of progesterone and estrogen. The drop in ovarian hormones releases negative feedback on LH and FSH, thereby increasing LH and FSH concentrations and leading to shedding of the endometrium and another round of ovarian follicle selection.<ref name=":12">{{Citation|last1=Holesh|first1=Julie E.|title=Physiology, Ovulation|date=2021|url=http://www.ncbi.nlm.nih.gov/books/NBK441996/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=28723025|access-date=2021-09-20|last2=Bass|first2=Autumn N.|last3=Lord|first3=Megan}}</ref> | |||
| The average length of the human luteal phase is fourteen days (2 weeks). Between ten and sixteen days is considered normal, although luteal phases of less than twelve days may make it more difficult to achieve pregnancy. While luteal phase length varies significantly from woman to woman, for the same woman the length will be fairly consistent from cycle to cycle.<ref>Weschler, p.47</ref> | |||
| == Uterine events == | |||
| The loss of the corpus luteum can be prevented by implantation of an ]: after implantation, human embryos produce ] (hCG).<ref name="wilcox">{{cite journal | author=Wilcox AJ, Baird DD, Weinberg CR | title=Time of implantation of the conceptus and loss of pregnancy | journal=New England Journal of Medicine | volume=340 | issue=23 | pages=1796–1799 | year=1999 | pmid=10362823 | doi=10.1056/NEJM199906103402304}}</ref> hCG is structurally similar to LH and can preserve the corpus luteum.<ref name="isbn0-07-303120-8"/> Because the hormone is unique to the embryo, most ]s look for the presence of hCG.<ref name="isbn0-07-303120-8">{{cite book | |||
| During the follicular phase in the menstrual cycle, the uterine endometrium is in the proliferative phase which is characterized by an increase in circulating estrogen produced by the developing follicle. Increased estradiol alters the endometrial lining and promotes proliferation of epithelial cells, thickening of the tissue, and elongation of the spiral arteries that provide nutrients to the growing tissue. Estrogen also makes the endometrium more sensitive to progesterone in preparation for the luteal phase.{{cn|date=September 2023}} | |||
| |author=Losos, Jonathan B.; Raven, Peter H.; Johnson, George B.; Singer, Susan R. |title=Biology |publisher=McGraw-Hill |location=New York |year=2002 |pages=1207–09 |isbn=0-07-303120-8}}</ref> If implantation occurs, the corpus luteum will continue to produce progesterone (and maintain high basal body temperatures) for eight to twelve weeks, after which the ] takes over this function.<ref>{{cite book |author=Glade B. Curtis |title=Your Pregnancy Week by Week |publisher=Element Books Ltd |location= |year=1999 |pages= |isbn=1-86204-396-5 |chapter=Week 4 |chapterurl=http://www.mdadvice.com/library/urpreg/wbw4.htm |accessdate=2008-09-07}}</ref> | |||
| After ovulation and during the luteal phase, the uterine endometrium is in the secretory phase which is characterized by the production of progesterone from the growing corpus luteum. Progesterone inhibits endometrial proliferation, and preserves uterine tissue in preparation for fertilized egg implantation. At the end of the luteal phase, progesterone levels fall and the corpus luteum atrophies. The drop in progesterone leads to endometrial ischemia which will subsequently shed in the beginning of the next cycle at the start of menses.<ref name=":02"/> This last stage in the luteal or secretory phase may be called the '''ischemic phase''' and lasts just for one or two days.<ref name="libretexts">{{cite web |title=26.6B: Ovarian Cycle |url=https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book%3A_Anatomy_and_Physiology_(Boundless)/26%3A_The_Reproductive_System/26.6%3A_Physiology_of_the_Female_Reproductive_System/26.6B%3A_Ovarian_Cycle |website=Medicine LibreTexts |access-date=14 September 2022 |language=en |date=24 July 2018}}</ref> | |||
| ==Luteal phase defect== | |||
| Luteal phase defect (LPD) occurs when the luteal phase is shorter than normal, progesterone levels during the luteal phase are below normal, or both. LPD is believed to interfere with the implantation of embryos. The ] of ] works primarily by preventing ], but is also known to cause LPD.<!-- | |||
| --><ref name="Diaz, S. et al.">Diaz, S. et al. ''Relative contributions of anovulation and luteal phase defect to the reduced pregnancy rate of breastfeeding women.'' <u>Fertility and Sterility</u>. 1992 Sep;58(3):498-503. PMID 1521642.</ref> | |||
| == Symptoms == | |||
| LPD is a spectrum. There is unruptured luteinized follicle syndrome (ULFS), short luteal phases (e.g. 9 days instead of 14) and follicular nonresponsiveness to ]. The second two varieties can be stabilized by taking high dose progesterone suppositories or injections till one gets a positive pregnancy test, and then continuing for another 8-10 weeks until placenta is self-sufficient. Some people have seen normalisation with high dose B6. | |||
| Changes in the level of progesterone during this phase may cause typical symptoms of ] (PMS), such as: | |||
| * Anxiety | |||
| * Headaches | |||
| * Mood swings | |||
| * Irritability | |||
| * Tender breasts | |||
| * Weight gain | |||
| * Trouble sleeping | |||
| * Changes in sexual desire | |||
| * Bloating | |||
| * Emotional stresses | |||
| ⚫ | == References == | ||
| ULFS can be treated by high dose hCG at ovulation, or by IVF | |||
| {{Reflist}} | |||
| Diagnostics are by ultrasound, day 21 progesterone test, and length of luteal phase | |||
| ⚫ | ==References== | ||
| <references/> | |||
| {{Reproductive physiology}} | {{Reproductive physiology}} | ||
| {{Menstrual cycle}} | {{Menstrual cycle}} | ||
| {{Authority control}} | |||
| {{DEFAULTSORT:Luteal Phase}} | {{DEFAULTSORT:Luteal Phase}} | ||
| ] | ] | ||
| ] | |||
| ] | |||
| ] | |||
| ] | |||
Latest revision as of 11:53, 12 December 2024
The latter part of the menstrual cycle associated with ovulation and an increase in progesterone
The menstrual cycle is on average 28 days in length. It begins with menses (day 1–7) during the follicular phase (day 1–14), followed by ovulation (day 14) and ending with the luteal phase (day 14–28). while historically, medical experts believed the luteal phase to be relatively fixed at approximately 14 days (i.e. days 14–28), recent research suggests that there can be wide variability in luteal phase lengths not just from person to person, but from cycle to cycle within one person. The luteal phase is characterized by changes to hormone levels, such as an increase in progesterone and estrogen levels, decrease in gonadotropins such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), changes to the endometrial lining to promote implantation of the fertilized egg, and development of the corpus luteum. In the absence of fertilization by sperm, the corpus luteum degenerates leading to a decrease in progesterone and estrogen, an increase in FSH and LH, and shedding of the endometrial lining (menses) to begin the menstrual cycle again.
Hormonal events
After ovulation and release of the oocyte, the anterior pituitary hormones–follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are released and cause the remaining parts of the dominant follicle to transform into the corpus luteum. It continues to grow during the luteal phase after ovulation and produces significant amounts of hormones, particularly progesterone, and, to a lesser extent, estrogen and inhibin. Progesterone plays a vital role in making the endometrium receptive to implantation of the embryo and supportive of early pregnancy. High levels of progesterone inhibit the follicular growth. The increase in estrogen and progesterone also lead to increased basal body temperature during the luteal phase.
The LH surge that occurs during ovulation triggers the release of the oocyte and its cumulus oophorus from the ovary and into the fallopian tube and triggers the oocyte to divide and enter metaphase of meiosis II (46 or 2n chromosome) and extrude its first polar body. The oocyte will only continue through meiosis and extrude its second polar body once it is fertilized. Ovulation occurs ~35 hours after the beginning of the LH surge or ~10 hours following the LH surge. Several days after ovulation, the increasing amount of estrogen produced by the corpus luteum may cause one or two days of fertile cervical mucus, lower basal body temperatures, or both. This is known as a "secondary estrogen surge".
The hormones released by the corpus luteum suppress production of the FSH and LH from the anterior pituitary gland. The corpus luteum relies on LH activation on its receptors in order to survive. The loss of the corpus luteum can be prevented by implantation of an embryo: after implantation, human embryos produce human chorionic gonadotropin (hCG), which is structurally similar to LH and can preserve the corpus luteum. If implantation occurs, the corpus luteum will continue to produce progesterone for eight to twelve weeks, after which the placenta takes over this function. In the absence of fertilization, hCG is not produced and the corpus luteum will atrophy in 10–12 days (Luteolysis or luteal regression). The death of the corpus luteum results in falling levels of progesterone and estrogen. The drop in ovarian hormones releases negative feedback on LH and FSH, thereby increasing LH and FSH concentrations and leading to shedding of the endometrium and another round of ovarian follicle selection.
Uterine events
During the follicular phase in the menstrual cycle, the uterine endometrium is in the proliferative phase which is characterized by an increase in circulating estrogen produced by the developing follicle. Increased estradiol alters the endometrial lining and promotes proliferation of epithelial cells, thickening of the tissue, and elongation of the spiral arteries that provide nutrients to the growing tissue. Estrogen also makes the endometrium more sensitive to progesterone in preparation for the luteal phase.
After ovulation and during the luteal phase, the uterine endometrium is in the secretory phase which is characterized by the production of progesterone from the growing corpus luteum. Progesterone inhibits endometrial proliferation, and preserves uterine tissue in preparation for fertilized egg implantation. At the end of the luteal phase, progesterone levels fall and the corpus luteum atrophies. The drop in progesterone leads to endometrial ischemia which will subsequently shed in the beginning of the next cycle at the start of menses. This last stage in the luteal or secretory phase may be called the ischemic phase and lasts just for one or two days.
Symptoms
Changes in the level of progesterone during this phase may cause typical symptoms of pre-menstrual syndrome (PMS), such as:
- Anxiety
- Headaches
- Mood swings
- Irritability
- Tender breasts
- Weight gain
- Trouble sleeping
- Changes in sexual desire
- Bloating
- Emotional stresses
References
- ^ Reed, Beverly G.; Carr, Bruce R. (2000), Feingold, Kenneth R.; Anawalt, Bradley; Boyce, Alison; Chrousos, George (eds.), "The Normal Menstrual Cycle and the Control of Ovulation", Endotext, South Dartmouth (MA): MDText.com, Inc., PMID 25905282, retrieved 2021-09-20
- Henry, Sarah; Shirin, Sonia; Goshtasebi, Azita; Prior, Jerilynn C (25 September 2024). "Prospective 1-year assessment of within-woman variability of follicular and luteal phase lengths in healthy women prescreened to have normal menstrual cycle and luteal phase lengths". Human Reproduction. 39 (11): 2565–2574 – via Oxford Academic.
- Zhang, Simeng; Osumi, Haruka; Uchizawa, Akiko; Hamada, Haruka; Park, Insung; Suzuki, Yoko; Tanaka, Yoshiaki; Ishihara, Asuka; Yajima, Katsuhiko; Seol, Jaehoon; Satoh, Makoto (2020-01-24). "Changes in sleeping energy metabolism and thermoregulation during menstrual cycle". Physiological Reports. 8 (2): e14353. doi:10.14814/phy2.14353. ISSN 2051-817X. PMC 6981303. PMID 31981319.
- Kelly, Thomas (2002). "Plutarch". History: Reviews of New Books. 30 (3): 126. doi:10.1080/03612759.2002.10526169. ISSN 0361-2759. S2CID 216557803.
- Wilcox, Allen J.; Baird, Donna Day; Weinberg, Clarice R. (1999-06-10). "Time of Implantation of the Conceptus and Loss of Pregnancy". New England Journal of Medicine. 340 (23): 1796–1799. doi:10.1056/NEJM199906103402304. ISSN 0028-4793. PMID 10362823.
- Curtis, Glade B. (1999). Your pregnancy week by week. D. F. Hawkins. Shaftesbury: Element. ISBN 1-86204-396-5. OCLC 43541212.
- Holesh, Julie E.; Bass, Autumn N.; Lord, Megan (2021), "Physiology, Ovulation", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 28723025, retrieved 2021-09-20
- "26.6B: Ovarian Cycle". Medicine LibreTexts. 24 July 2018. Retrieved 14 September 2022.
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