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What Is The Luteal Phase Of Menopause

What Treatments Are There For Symptoms Of Perimenopause

Luteal Phase: The Uterine Lining Phase
  • Bleeding problems: Before treatment is started, you should have a thorough check-up. If the abnormal bleeding is due to the hormonal changes of perimenopause, treatment can be started with estrogen and/or progesterone in the form of pills, shots, patches, or intrauterine device .
  • Hot flashes: Taking estrogen as pills, patches, gels, or sprays is very helpful in relieving hot flashes. Women who have a uterus should also take medications that protect against precancerous changes in the lining of the uterus that can come from the long-term use of estrogen alone. For some women, herbal medicines or acupuncture may help a little, but there is not much medical evidence that these work for all women. Finally, some medicines that are typically used for other reasons can also relieve hot flashes. They may also help women who have problems with their sleep or mood. Lifestyle changes, such as avoiding caffeine and alcohol, keeping the environment cool, and wearing lighter clothing, may reduce symptoms. Be sure to talk to your doctor about whether hormone therapy is the right choice for you.
  • Vaginal symptoms: Women often find relief for vaginal dryness and discomfort by using hormone medication . Vaginal moisturizers or lubricants can also help. Please be sure to talk to your doctor about any vaginal symptoms. These symptoms are some of the easiest to successfully treat and have the fewest side effects.

Revised 2015

Menopausal Transition And Medical Comorbidities

One in five women develop AD in the seventh decade of life. Late-onset AD is the most common form of dementia, and two thirds of late-onset AD patients are women. The higher longevity is one of the explanations for the late-onset AD in women however, increasing evidence suggests that longevity alone is not the only explanation, and there may be other underlying mechanisms. Recent multi-modality brain imaging studies have compared cognitively normal 40- to 60-year-old peri-menopausal and post-menopausal women versus age- and education-matched men. The studies indicate that as women go through menopause, multiple imaging findings indicative of AD endophenotype emerge, including reduced brain glucose metabolism in frontal cortex, increased amyloid- accumulation, and gray matter and white matter loss. The patterns of brain hypometabolism correlated with measured reduction in platelet mitochondrial cytochrome oxidase activity, which suggests the emergence of AD-like bioenergetic deficits in peri- and post-menopausal women . Further studies indicate that systemic inflammation and estrogen decline associated with peri-menopause can contribute to accumulation of A. Direct effects of E2 on neuronal A have been demonstrated, showing that E2 decreased the generation and secretion of A in primary neuronal culture and that administration of estrogen in estrogen-deprived mice reversed the elevated levels of brain A .

Can Menopause Cause Depression

Your body goes through a lot of changes during menopause. There are extreme shifts in your hormone levels, you may not be sleeping well because of hot flashes and you may be experiencing mood swings. Anxiety and fear could also be at play during this time. All of these factors can lead to depression.

If you are experiencing any of the symptoms of depression, talk to your healthcare provider. During your conversation, your provider will tell you about different types of treatment and check to make sure there isnt another medical condition causing your depression. Thyroid problems can sometimes be the cause of depression.

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Menopause And Immune Responses

Fig. 1

At the reproductive senescence/menopausal transition the ovarian failure is associated with release of extracellular vesicles containing inflammasomes, which may be responsible for low-grade systemic inflammation. This low-grade inflammation may compromise the blood-brain barrier , making the brain more susceptible to inflammation and neurodegenerative diseases

How Many Phases Arethere During The Menstrual Cycle

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There are just two menstrual cycle phases that occur during every monthly cycle. The first phase is the follicular phase or the proliferative phase. The follicular phase begins on Day 1 of the menstrual cycle when estrogen and progesterone levels are at their lowest.

During this phase, the uterine lining, or endometrial lining, is shed through menstruation and then begins a period of regrowth and thickening in preparation for an embryo should conception occur. This follicular phase lasts about 10 to 14 days, or until ovulation occurs, after which you pass into the luteal phase.

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Luteal Phase: Symptoms Causes And Hormones

Sylvia Kang

Banafsheh Kashani

MD, FACOG

Did you know that your menstrual cycle is divided into two phases? This fact is surprising yet essential information whether or not youre trying to conceive.

The luteal phase of your menstrual cycle immediately follows ovulation. Below youll learn all about:

  • Exactly what this phase is.
  • When it is and how long it lasts.
  • Hormonal changes that occur.
  • How it affects fertility.

Youll also find tips on monitoring your luteal phase. Read on to discover everything you need to know about this crucial part of your menstrual cycle.

Stages Of Reproductive Aging

Menstruation is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina as a result of periodic hormonal changes.

Menarche is the first menstruation, and menopause is the point in time when permanent cessation of menstruation occurs following the loss of ovarian activity . The term is derived from the Greek words men and pausis . Menopause is confirmed 12 months after the onset of amenorrhea.

The years prior to menopause are known as the perimenopausal transitional years. An older, more popular, and less precise term is climacteric , the expression derived from the Greek word for ladder and should be used only when talking to patients and in the lay press, not in scientific papers .

The 2001 Stages of Reproductive Aging Workshop proposed a new nomenclature and staging system for objectifying ovarian aging, including menstrual and quantitative hormonal criteria to define each stage, and has been reviewed and updated in 2011 . The STRAW+10 staging system is widely considered as the gold standard for characterizing reproductive aging through menopause.

It divides the adult female life into three main phases:

Reproductive

  • The menopausal transition

  • Postmenopause.

  • Stage

    The 2011 STRAW+10 staging system for reproductive aging in women.

    Adapted from Harlow et al. .

    STRAW+10 stages are outlined in the following paragraphs.

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    Whats Considered A High Estradiol Level

    Elevated estradiol levelsâtypically beyond 350 picograms per milliliter in adult women who have regular menstrual cyclesâcan occur with certain medical conditions that lead to overproduction of the estrogen hormone. Polycystic ovarian syndrome , in which there are many ovarian follicles simultaneously producing estradiol, is an example of how high estrogen levels can develop. Elevated levels of estradiol can also be the result of certain hormone supplements, liver disorders, or elevated levels of androgens .

    What Happens In The Follicular Phase

    Menstrual Cycle Phases | Female Reproductive System | Follicular Luteal Proliferative Secretory

    The follicular phase starts on the first day of your period. Typically, it takes up the entire first half of your menstrual cycle.

    This phase begins when your bodys hormone control center, the hypothalamus, sends a message to the pituitary gland at the base of your brain. The pituitary then releases follicle-stimulating hormone .

    FSH stimulates your ovaries to produce 5 to 20 tiny pods called follicles. Inside each follicle sits an immature egg. These follicles grow during this phase of your cycle.

    Eventually, one of these follicles becomes dominant. The other follicles start to wither away and are reabsorbed into your body.

    The follicle with the ripening egg increases your bodys production of estrogen. Higher estrogen levels make your uterine lining grow and thicken. The lining becomes rich in nutrients to prepare for a possible pregnancy.

    Rising estrogen levels also send a signal to your pituitary gland to slow FSH production.

    Meanwhile, levels of another pituitary hormone called luteinizing hormone surge. The rise in LH halts estrogen production and starts the process of ovulation, the next phase in the cycle.

    The follicular phase is often the longest part of your menstrual cycle. Its also the most variable phase. It begins on the first day of your period and ends when you ovulate.

    The average length of the follicular phase is 16 days . But it can last anywhere from 11 to 27 days depending on your cycle.

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    How Can I Find Out More About My Hormone Levels

    If youâre planning for pregnancy, or youâre just generally curious about your hormone levels, you can use the Everlywell at-home Womenâs Fertility Test to easily test your hormone levels from the comfort of your own home.

    With just a small sample of blood , you can check your levels of 5 different hormones related to fertility: estradiol, luteinizing hormone, follicle-stimulating hormone, total testosterone, and thyroid-stimulating hormone. And you receive your results securely onlineâso you can easily access insights on your hormone balance whenever you want.

    For an even more comprehensive look at your hormone levels, try the at-home Womenâs Health Test. By measuring 10 key hormones that play important roles in a womanâs health, the test can reveal a potential hormonal imbalance that may be keeping you from feeling your best.

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    What Hormonal Changes Occur During The Menopausal Transition

    Many of the symptoms a woman notices during the transition are due to changing hormone levels. These shifts can cause changes in the menstrual cycle and sleep, as well as hot flashes and vaginal dryness. Hormones work together to keep a balance. As hormone levels go up or down, they trigger the ovaries or pituitary gland in the brain to make more or less of other hormones. As a woman gets older, the hormonal balance changes.

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    How Is The Test Administered

    To administer an LH blood test, a health professional will draw a small amount of blood from you, most likely from your arm. The short procedure will be done in your doctors office or at a lab. The sample will then be analyzed for LH levels.

    To draw blood, a health professional will wrap your upper arm with an elastic band to make your veins easier to see. Theyll disinfect the skin and insert a needle into a vein on the inside of your arm. A tube attached to the needle will collect a small sample of your blood. The process is short and mostly painless.

    Your doctor may request that you have samples of blood drawn each day for several days. Because the amount of LH in the blood varies with your menstrual cycle, a few samples may be necessary to get an accurate measurement of your LH levels.

    Association With Changes In Whole

    Individual hormone levels in a late menopausal transition ...

    Adjusted mean integrated FSH was significantly increased in both types of anovulatory cycles compared with ovulatory cycles ) and was higher in cycles that did not end with a bleed compared with those that did .). Adjusted mean LH increased progressively from ovulatory to anovulatory cycles with bleeding to anovulatory/nonbleeding collections . Adjusted mean whole-cycle E1c was similar between ovulatory and anovulatory cycles ending with a bleed but was greatly decreased in anovulatory/nonbleeding collections . Mean Pdg was, by definition, markedly lower in both types of anovulatory cycles compared with ovulatory cycles .

    Mean daily patterns of FSH, LH, Pdg, and E1c in cycles without luteal function. , Anovulatory cycles ending with a bleed , anovulatory/nonbleeding collections. Anovulatory collections that did not end with a bleed were terminated at 50 d.

    For all collections, baseline age and time in study were associated with change in whole-cycle integrated hormones . For ovulatory cycles, FSH increased by an estimated 4.4% per year of baseline age and by 3.7% with each additional year on study. Pdg decreased significantly by 2.6% for each additional year of baseline age and by 5.4% with each additional year on study. LH was not significantly related to either baseline age or time on study . E1c decreased by 1.4% per year on study but did not vary by baseline age. Relationships were similar when both types of anovulatory cycles were added to the ovulatory ones.

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    How Is Basal Body Temperature Affected During The Luteal Phase

    Progesterone produced by the corpus luteum following ovulation causes a womans basal body temperature to rise slightly by around 0.3-0.6 degrees Celsius . It will remain elevated until your period comes when it will return to your bodys own baseline temperature. If you get pregnant, then your BBT may remain elevated beyond the day you expected your period to start.

    Measuring your throughout your cycle can help you tell if you have already ovulated and entered the luteal phase.

    What Is Perimenopause And When Does It Occur

    Perimenopause is the time that leads up to menopause, which is when a females menstrual period ends entirely . It is also when many new hormonal symptoms can surface such as trouble sleeping, weight gain, irritability, and mood swings.

    When the body approaches perimenopause it has fewer follicles producing estrogen and the lack of estrogen prevents ovulation from occurring. This creates one of the hallmark symptoms of perimenopause: irregular periods. A period may disappear for a cycle or two, or your bleeding may appear closer together or farther apart. You may also have menstrual cycles in which your ovaries dont release an egg . And without ovulation, there isnt an increase in progesterone, which typically follows ovulation.

    In perimenopause, progesterone is typically the first hormone to drop. Progesterone plays a major role in stress management and the reduction of anxiety. Progesterone promotes gamma-aminobutyric receptor production in the brain, which is the calming neurotransmitter. And the lower progesterone levels are, the more we are prone to irritability and anxiety. Lower progesterone levels may also cause sleep disturbances because of a lack of this calming hormone.

    As perimenopause continues, and estrogen levels fluctuate, symptoms of estrogen deficiency may also surface: hot flashes, night sweats, vaginal dryness, depression, fatigue, poor memory, brain fog, decreased concentration, stress incontinence, and .

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    How Do You Test Your Progesterone Level

    Progesterone spikes after ovulation and continues to rise for several days. Progesterone should be tested when progesterone is highest, in the middle of the luteal phase. Typically, doctors ask women to come in for a test on day 21 of their cycles, because in the average 28 day cycle, day 21 falls in the middle of the luteal phase.

    Your cycle, however, may not be the typical 28-day cycle with ovulation on day 14. Lets say you have a 35-day cycle, with ovulation on day 23. If you get your progesterone tested on day 21, it will be very low, because you havent ovulated yet. But if you tested on day 29, your levels might be perfectly normal. If you know when you ovulate and how long your luteal phase typically is, you can let your doctor know the right time to test your progesterone levels.

    Tracking Your Temperature To Determine Phase

    Luteal Phase Support – Case Files – by Dr. Sonia Malik

    To determine if youve ovulated and are in the luteal phase, you can try tracking your basal body temperature . This is your temperature right when you wake up, before you even get up to use the bathroom or brush your teeth.

    During the first part of your cycle, your BBT will likely hover between 97.0 and 97.5°F. When you ovulate, your BBT will go up because progesterone stimulates heat production in your body.

    Once youre in the luteal phase of your cycle, your basal body temperature should be about 1°F higher than it was during the follicular phase. Look for this temperature bump to tell you that youve ovulated and entered the luteal phase.

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    How To Control Menopause Hormone Levels

    In fact, there is no one magic pill that can control hormone levels in menopause. But, there is an efficient therapy that can eliminate most of these symptoms. Have you ever noticed that West women are more active at this age? They take hormone replacement therapy and live longer. The designated preparations contain estrogens and progesterone needed in our body in a small amount. So, hormone levels after menopause or during it will be stable, and women can feel comfortable.

    Keep in mind, there is one myth around this therapy aimed to affect hormone levels in menopause, that a woman will get fat from these hormones. It is completely untrue. A woman is gaining weight only because of a lack of estrogens that once were normal. Without them, fat accumulates.

    Accordingly, hormone therapy will help you to avoid such things, and menopause and hormone levels care will keep you fit. Moreover, doctors are trained enough to determine the right strength and dosages of a hormonal treatment so that a woman does not even notice any ailments or negative consequences. If you have a chance to undergo it, use this option because as of now it is the most efficient solution invented by dedicated experts for moderating and controlling hormone levels in menopause.

    Signs And Symptoms Of Menopause

    The hypoestrogenic state seen at menopause is manifested in many women by signs and symptoms of hormonal deficiency in tissues containing estrogen receptors, including the ovary, endometrium, vaginal epithelium, urethra, hypothalamus, and skin. The most common complaints are vasomotor disturbances characterized by hot flushes, genital atrophy, and psychologic symptoms. The decline in estrogen also causes an increased risk of osteoporosis.

    Vasomotor Flushes

    Vasomotor instability appears to arise not from a lack of estrogen but rather from its withdrawal. Estrogen-deficient patients with gonadal dysgenesis fail to develop hot flushes unless given estrogen replacement therapy that is subsequently withdrawn.22 Castrated women with androgen insensitivity experience vasomotor symptoms after the discontinuation of estrogen. Similarly, premenopausal women treated with the antiestrogen clomiphene and postpartum women with very low estrogen levels often complain of hot flushes.

    There is a subjective awareness of an impending hot flush, with an aura that may be perceived as a headache accompanied by heart palpitations occurring up to 4 minutes before the actual flush. The subjective sensation of the flush is followed by a change in skin conductance. There is then a rise in finger temperature that reflects cutaneous vasodilation .32,33,34 The pulse rate increases an average of nine beats per minute, and a rapid rise is seen in blood flow to the hand before the flush35 .

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