Luteal phase

The female menstrual cycle is divided into four functional phases follicular, ovulatory, luteal, and menstrual.6 The follicular phase starts the cycle, and ovulation generally occurs on day 14. The luteal phase then begins and continues until menstruation occurs.6 The menstrual cycle is regulated by a negative-feedback hormone loop between the hypothalamus, anterior pituitary gland, and ovaries6 (Fig. 45-1). 

Symptoms are temporally associated with the last week of the luteal phase and remit with onset of menses. 

PMDD Clomipramine26 25-75 mg by mouth daily taken continuously or only during the luteal phase Dry mouth, fatigue, vertigo, sweating... 

SSRIs Citalopram 10-30 mg fluoxetine 10-20 mg fluvoxamine 50 mg paroxetine 10-30 sertraline 25-150 mg all agents are given by mouth daily and can be dosed continuously or during the luteal phase only26 Sexual dysfunction (reduced libido, anorgasmia), insomnia sedation, hypersomnia, nausea, diarrhea... 

Progesterone therapy either during the luteal phase of the menstrual cycle or for 21 days starting on day 5 after the onset of menses results in a 32% to 50% reduction in menstrual blood loss.29 Its use has not been shown to be superior to other medical treatments, including NSAIDs.29 In addition, it is not associated with any contraceptive benefit.33... 

The first-line therapeutic options for PMDD include the selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, fluvoxamine, sertraline, paroxetine, and citalopram. These agents can be given either continuously or only during the luteal phase of the menstrual cycle, i.e., initiated at the time of ovulation and discontinued on the first day of menses. 

The tricyclic antidepressant clomipramine also has been studied for PMDD. In placebo-controlled trials, both continuous daily dosing and luteal phase administration proved effective.17 Compared with the SSRIs, however, clomipramine has a less desirable side-effect profile with low tolerability. 

Luteolysis The structural and functional degradation of the corpus luteum that occurs at the end of the luteal phase in the absence of pregnancy caused by the hormones prostaglandin-2(X and oxytocin. Communication between the corpus luteum and uterine endometrium is necessary for luteolysis. 

Premenstrual dysphoric disorder Severe psychiatric mood disorder with marked affective symptoms causing significant interference in work or relationships that is temporally associated with the luteal phase and not caused by an underlying psychiatric disturbance. 

The median length of the menstrual cycle is 28 days (range 21 to 40). The first day of menses is day 1 of the follicular phase. Ovulation usually occurs on day 14 of the menstrual cycle. After ovulation, the luteal phase lasts until the beginning of the next cycle. 

Lumsden MA, West CP, Baird DT (1989a) Tamoxifen prolongs luteal phase in premenopausal women but has no effect on the size of uterine fibroids. Clin Endocrinol 31 335-343... 

Recent results indicate that the air-borne steroids 5a-androst-2-en-17p-ol and 5a-androst-2-en-17-one, which are present in the urine of female E. maximus during the luteal phase at levels that are increased 10- to 20-fold, could be responsible for the synchronization of estrus in females living in close social relationships [117]. The ketone has previously been identified as a product of the incubation of androsterone sulfate with human axillary bacterial isolates [118]. 

Metabolic clearance of caffeine is altered according to menstrual phase and hormonal status in women (Lane et al. 1992). Clearance is slower during the late luteal phase compared to the follicular phase, prior to the onset of menstruation. However, the size of the effect and significance in everyday activity remains in question. 

The results 68% of the women treated with extracts from the follicular phase of the menstrual cycle shortened their own current cycle by an average of 1.7 days. A different 68% of the women treated with extracts from the ovarian phase of the menstrual cycle lengthened their own current cycle by an average of 1.4 days. Finally, underarm extracts taken following ovulation, in the luteal phase, had no effect on the... 

Figure 19.6 A 28-day menstrual cycle. The approximate number of days for menstruation, ovulation and the follicular and luteal phases are shown.

Figure 19.12 Representation of changes in hormone levels during the menstrual cycle. Note that LH peaks about one day before ovulation. Oestrogen has two peaks one in the Luteal phase prior to LH surge and a smaller one in the follicular phase. Progesterone peaks in the follicular phase to stimulate development of endometrium.

---