Name
LUTEAL PHASE DYSFUNCTION
DESCRIPTION
DETAIL
CAUSES OF LUTEAL PHASE DYSFUNCTION - ABNORMAL FOLLICLE DEVELOPMENT - ABNORMAL LUTEINIZATION - UTERINE ABNORMALITIES - HYPOCHOLESTEROLEMIA -------------------------------------------------------------------------- D.D. : - HYPERPROLACTINEMIA* ULTRA SOUND EXAM - FOR DEMONSTRATION OF OVULATION OR FOLLICULAR STUDY * ENDOMETRIAL BIOPSY - Urinary LH kits provide a useful test to estimate the appropriate timing of an endometrial biopsy (EB). Following a positive test finding, ovulation occurs within 24-26 hours. The EB should be performed on the 12th day of a 14-day luteal phase. * SERUM PROGEATERONE - SINGLE SAMPLE IS NON DIAGNOSTIC & TAKING MULTPLE SAMPLES IS EXPENSIVE & INCONVENIENT
TYPENOTES
MEDICAL TREATMENT : Hyperprolactinemia and hypothyroidism cause LPD through hypothalamic-pituitary dysfunction. Bromocriptine and levothyroxine, respectively, are used to treat LPD in women with these conditions. In women without hyperprolactinemia and hypothyroidism, vaginal progesterone is advocated to supplement endogenous progesterone production. The vaginal suppository or gel is preferred over both the oral and intramuscular forms because of superior endometrial progesterone concentrations. Vaginal suppositories are less expensive but are messier than the vaginal gel. Progesterone should be continued for 8-10 weeks to cover the time of the ovarian-placental shift. Clomiphene citrate corrects LPD by improving folliculogenesis and the resultant luteal phase following ovulation. Successful treatment with gonadotropins and human chorionic gonadotropins (HCGs) probably results from superovulation rather than from a correction of LPD. Following any of these treatments, the patient should have a repeat EB to determine that LPD has been corrected. DRUG TREATMENT : 1. HORMONE REPLACEMENT : TO RESTORE OVARIAN FUNCTION - BROMOCRIPTINE - Used if hyperprolactinemia is the underlying pathology causing LPD. Tablets can be used vaginally in patients who cannot tolerate adverse GI effects. - LEVOTHYROXINE - If LPD is caused by hypothyroidism, correction of endocrine disease results in normal luteal phase. - CLOMIPHENE CITRATE - Stimulates release of pituitary gonadotropins. Improves folliculogenesis and, therefore, the luteal phase. Works best in biopsies that are lagging 1 week behind the date of endometrial sampling. - CABERGOLINE - Long-acting dopamine receptor agonist with high affinity for D2 receptors. Prolactin secretion by anterior pituitary predominates under hypothalamic inhibitory control exerted through dopamine. - PROGESTERONE - Progesterone supplementation may be administered PO, IM, or vaginally. Oral progesterone is metabolized rapidly in liver, and the metabolites have little effect on endometrial activity. When administered IM, fails to achieve adequate levels of endometrial progesterone compared with vaginal forms. Vaginal progesterone is DOC for LPD; this is because of the proximity of the uterus to where the medication is delivered. Vaginal gel 8%, either qd or bid, is better tolerated compared to suppository form. Gel also provides increased receptor sites in the endometrium compared with suppository. Treatment begins 2 days after ovulation as determined by ovulation predictor kit. Correction of LPD can be confirmed by repeat EB. - FOLLITROPINS : Improve folliculogenesis, which increases total progesterone. This remains an expensive method associated with increased patient discomfort because medication is administered SC.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
ULTRA SOUND OBSTETRICS, SERUM PROGESTERONE( FEMALE- FOLLICULAR PHASE), COMPLETE BLOOD COUNT, BIOPSY