Patient's question:
Luteal phase deficiency, is the "luteum" a substance or something else?Doctor's answer:
Hello: The corpus luteum is a richly vascularized glandular structure formed rapidly from the ovary after ovulation. If unfertilized, it is called a menstrual corpus luteum; if fertilized, it becomes a pregnant corpus luteum.Formation and Regression of the Corpus Luteum: After ovulation, the rupture in the ovary is closed. Due to the rupture of blood vessels in the follicular membrane, blood flows into the cavity and forms a blood clot, creating a corpus albicans (early corpus luteum). The rupture is quickly sealed by fibrin, leaving behind granulosa cells in the remaining follicular wall. Under the influence of luteinizing hormone, these cells rapidly proliferate and enlarge, appearing yellow due to the presence of yellow granules in their cytoplasm, which are called granulosa lutein cells. Some theca cells also undergo luteinization, hence the name theca lutein cells. Subsequently, connective tissue and capillaries around the corpus luteum proliferate and invade the central blood clot, forming partitions that give the corpus luteum a mottled appearance. At this stage, the ovary begins to atrophy. The corpus luteum reaches full maturity 8–9 days after ovulation, with a diameter of 1–3 cm, and is then called a mature corpus luteum. If the egg is fertilized, the corpus luteum persists for 3–4 months before regressing, becoming a pregnant corpus luteum. If the egg is unfertilized, the corpus luteum begins to regress, with reduced blood vessels and atrophic cells, fading yellow and decreasing secretion function. Menstruation typically occurs 4–6 days later. At this point, the ovary begins to develop a new follicle, starting a new cycle.
In clinical practice, Western medicine classifies disorders in corpus luteum formation and regression into two types: incomplete corpus luteum development and incomplete corpus luteum regression. We define a normal luteal phase as 12–16 days. In women with incomplete corpus luteum development, the clinical presentation includes a luteal phase that is too short (about 9–11 days) or a normal luteal phase length but insufficient function, with a basal body temperature rise of less than 0.5°C (indicating low progesterone secretion). As a result, the endometrium may shed prematurely due to luteal dysfunction or early regression. Clinically, this manifests as spotting before menstruation, early menstrual onset, and variable menstrual flow. Additionally, women of reproductive age may experience early miscarriage, habitual miscarriage, or infertility due to insufficient luteal function. Because the corpus luteum is underdeveloped and cannot secrete enough progesterone, the endometrium remains in the early secretory phase before menstruation, with poor secretion and mild bending of the spiral arteries, making conception difficult. In women with incomplete corpus luteum regression, the corpus luteum fails to regress on schedule or regresses incompletely, continuing to secrete small amounts of progesterone. This prevents the endometrium from shedding at the normal time. Clinically, this presents as a normal menstrual cycle but prolonged menstruation (up to 9–10 days or longer), with moderate flow. The basal body temperature shows a biphasic pattern but drops only during menstruation.
For treating this condition, Western medicine commonly uses hormone therapy, such as progesterone or human chorionic gonadotropin (HCG).