Exercise -> LPD?

tweetyknicks · October 2013

I'm posting today because I'm feeling lonely and unaccountably sad. Might have something to do with impending AF (temp dropped by 0.6F this morning and CM is tinged with brown, so I know what's coming tonight). Might also be that I have not been able to talk to anyone in real life about TTC.

My 52-year-old husband had a vasectomy reversal in early January of this year (I'm 28). I realize that it may take a while for his numbers to get where they should be, especially since his vasectomy was more than 10 years old. Based on his reading of medical literature, he should start getting good numbers right about now. It'll probably be a couple of weeks before we know for sure.

In the mean time I think I have figured out why my luteal phase symptoms seemed screwy. When I increased exercise, my luteal phase shortened from 12-14 days to 10 days and then to 9 days with a lot of spotting since 7 dpo. This is a pretty classic progression of a luteal phase defect (LPD) that could turn into anovulation and eventually amenorrhea. During the cycle that had a 9-day luteal phase, ovulation was late and my progesterone tested at 2.3 ng/ml at 7 dpo.

This past cycle I backed off of my exercise routine a bunch (which usually includes powerlifting and interval training). I had my doctor order another progesterone test and it came back at 9.62 ng/ml at 6 dpo--much better!. My luteal phase is still a little short this cycle (about 11 days), but I think recovery from the side-effects of strenuous exercise may be more complete next cycle.

I think I will try a few other things to improve our chances in the coming month(s), like drinking more water.

My biggest challenge, though, will be stress management. My PhD dissertation is due on Nov. 1, so that is a source of constant stress. On top of that, my MIL was in a recovery/retirement home for the past three months after ankle surgery and DH is seven weeks out from a massive rotator cuff reconstruction. While DH was in the sling for six weeks post-op, I had to help more with cooking so he didn't overtax his left shoulder. It was starting to hurt when he tried to do everything himself because he couldn't even use his right had to help stabilize anything. Now the MIL is at home and DH can drive himself around and use his right arm a bit. That takes some of the load off of me because he can visit and help his mom independent of me now. (For those curious, we did manage to BD throughout his recovery. Yay creativity!)

What I learned about stress is that to some degree all kinds of stress are the same. They all increase cortisol production, which may inhibit the production of other hormones like progesterone and estrogen. Since I tend to be very sensitive to changes in my environment, I think my body quickly responds to changes like these.

Has anyone else run into problems like this with stress and/or exercise?

How do you all manage stress?

~tweetyknicks

nswain85 · October 2013

I'm afraid I can't offer too much advice on the med. parts but I would just suggest trying to relax in whatever way and whenever possible. Maybe try yoga or a meditation parctice to help you center and calm down. Deep breathing is also very helpful! Good luck!

Ceridwen21 · October 2013

I've never heard of exercise impacting LP. Maybe try the PP suggestion of something less strenuous like yoga or pilates?

tweetyknicks · October 2013

Thank you all for your replies.

RE: dissertation...

Defense comes two weeks after I send my dissertation to my committee. I tried this in December of last year already and the department head told me my dissertation was not in fit shape the day before I was supposed to defend. I knew I was having problems with my advisor, but I didn't think it'd get that bad. For a long time it would give me a lot of anxiety to deal with my PhD department in any way. This time is more stressful than last time because I'm afraid that the same thing will happen again.

RE: exercise...

By powerlifting I mean deadlifting about 235 lbs. and squatting nearly 200 lbs., among other things. Circuit and interval training was also pretty intense, as in 45 minutes of body-weight exercises with 30 second to 2 minute breaks. I did this 5-6 days a week, sometimes on top of jujitsu practice. It's more than the usual fitness routine. I'm working with my trainer now on a less strenuous program that is still in character with the activities I've been doing. I never did get to the point of having no cycles because of exercise, but I may have done that with other stress (when my dad was being treated for cancer and I shared caretaking responsibilities with my mom). It is of course possible that something else is responsible for screwing up my cycles, but exercise is the least expensive and least medicated factor to test.

Here are some references if anyone is interested:

De Souza, M. J., 2003. Menstrual Disturbances in Athletes: A Focus on Luteal Phase Defects. Medicine & Science in Sports & Exercise, 1553-1563.

**figure 2. shows the progression from regular menses to no menses

**figure 5. shows qualitative changes in reproductive and metabolic hormones in exercising women relative to sedentary women

De Souza, M. J., R. J. Toombs, J. L. Scheid, E. O'Donnell, S. L. West, and N. I. Williams, 2010. High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Human Reproduction, 25 (2), 491-503.

*figure 2. shows menstrual cycle characteristics of non-exercising (A) and exercising (B) women. about half of exercising women in this study showed some sort of menstrual disfunction.

Wise, , L. A., K. J. Rothman, E. M. Mikkelsen, H. T. Sorensen, A. H. Riis, and E. E. Hatch, 2012. A prospective cohort study of physical activity and time to pregnancy. Fertility and Sterility, 97 (5), 1136-1142.

**connects vigorous exercise to longer time until pregnancy and moderate exercise to shorter time until pregnancy

RE: relaxing...

Deep breathing or meditation may be things to try. It's been recommended to me that yoga would not be a good option since it tends to focus on flexibility and I already have hypermobile joints. I started strength training so my muscles could hold my joints together since the connective tissue doesn't do it so well.

-tweetyknicks

Spinning42 · October 2013

Wow that's intense! I do spinning am my heart ranges 155-180 and I thought that was a lot. I was working out almost everyday lady month and my LP was shorter and I O'd later. This month I took more rest days and I had a longer LP... Not sure if its just a coincidence.
I have seem in many place that a women in a normal weight range that worked out a lot lowered he chance by 42% each month.
I wish there was a definitive answer for this.

tptbabe · October 2013

***dirty lurker***

Actually, I have noticed a huge correlation between my exercise level, weight, and my LP. When we were TTC our daughter, I had a very short LP (between 4-6 days). And since having her, I've noticed that whenever I work out more in a cycle, it's shorter. Also, whenever I've had a few extra pounds on, I've had a longer LP, or when I work out less during a cycle, the same thing happens (this is a trend noticed over several years of charting). We discovered this spring that I have Hashimotos (and subsequent hypothyroidism). We're still trying to get my Synthroid dosage right, but since my TSH levels have evened out some, my LP is 14-15 days! Now, of course I'm not saying that this is the case for you, but it's what I've noticed for myself. If it turns out that your progesterone *is* too low, an RE will run a gamut of tests to figure out *why* it's too low and treat that, and/or give you a progesterone supplement so that you can get and sustain a pregnancy.

As for your DH, make sure when he gets his repeat SA (which they should do every few months after a reversal) that they test for anti-sperm antibodies. It's very common in post-vasectomy patients, and can cause issues with TTC. (It's actually our biggest obstacle to getting pregnant, even though DH has never had a vasectomy.) Most places don't test for it, so you'll have to ask!

No advice on the PhD thing, but good luck with that!

nikiswimr · October 2013

This is very interesting to me. As best as I can figure out, I am currently anovulatory (and have had amenorrhea since I came off of OCP). I called my Ob/Gyn who had suggested I was working out too much and should cut back/gain 5 lbs. I didn't review the literature, but was feeling like that may be an oversimplification. However, from your sources, maybe not. I run 10-14 miles on weekends, intervals and a short run during the week, and do 2-3 days of P90x/Insanity. Maybe cutting back is the answer (unfortunately). Like you, my job/training is also very stressful, which could certainly be contributing. I'm currently waiting for an appointment with my Ob/Gyn to see if more testing is indicated.

tweetyknicks · October 2013

@nikiswimr: From what I've gathered, everyone reacts differently (of course). My guesses for myself are based on statistics and having some sense of how my body tends to react to things. I'm not a medical doctor, but it might be worth a try to see what happens.

tweetyknicks · October 2013

@bbg676: I totally understand using exercise to deal with stress. I'm trying to figure out a substitute since I'm not allowed to work out hard enough to relieve stress. So far I've only found mediocre success. Sorry I can't be of more help there.

My LP is longer during my low exercise cycles**. In the worst case (at least that I have a chart for) ovulation was late and my luteal phase was 7 days. You can see on the Aug. 5 chart that It looked like I should ovulate around day 24-25, but I didn't untiul a week later and even that was weak. That's when my progesterone tested at 2.3 ng/ml in what was supposed to be the middle of my LP.

In the most clearly defined month (April 26, which happened to be the second month after I cut back on exercise), my LP was very clearly defined and about 13 days long (the vertical red line may be a day or two early--BBT can actually be imprecise). After the screwed up cycle with the week-long LP, I cut back on exercise again to see if it would make a difference. Lo and behold, progesterone measured in at 9.62 ng/ml on Oct. 11 (7 dpo), ovulation was at day 20 (about normal for me) and my LP was back up to a more respectable 11-12 days (Sept. 15 chart).

____________________________________

**Something to keep in mind when measuring the length of your LP is that your measuring BBT only once per day. I wouldn't consider a change of a day as significant because that could just be a result of ovulation being a day off or your BBT not quite lining up with the changes you're looking for at ovulation and the end of the LP. In my case, the change was more than a day or two, so I considered it significant.

tweetyknicks · October 2013

@MeatandBandP: My O estimate is also based on CM and other symptoms that aren't listed. Even if my O date was off, progesterone was still much lower during that cycle and below the minimum listed for the lab test at any time during the LP.

BeanQueen83 · October 2013

I know I am very sensitive to stress, too. I had a chemical pregnancy last month and then was furloughed 2 weeks during the government shut down. The doc said it was ok to try again right away but all the stress delayed my ovulation by almost 10 days. I've also noticed my BBT is lower post-O every month. I'm not sure, but I think it may be due to decreased physical activity. I know some is supposed to be good, but not too little, not too much. I'd say take it a little easier than normal. You want your body to know that it is a safe place for a baby to grow. For stress reduction I like yoga and meditation. Also just taking some time to do things I enjoy, like knitting and reading.

tweetyknicks · October 2013

@BeanQueen83: Sorry to hear about the chemical. I haven't experienced that, but it sounds like it'd be a bit of a roller coaster for a week or so.

My temps tend to be lower when I exercise heavily as well. I think it's a sign of the metabolic impact of exercise that may also be related to lower progesterone during the LP. One question I have been unable to answer so far is if post-ovulation BBT can give some relative indication of progesterone levels. For example, if in one cycle BBT increases from an average of 97.4F to 98.4F and in the next cycle it increases from 97.3F to 98.0F, does that mean that progesterone was lower in the second cycle since BBT was lower post-ov and there was less of a temperature increase after ovulation?

Regarding the amount of physical activity, several hours a week of moderate exercise is supposed to be good. By moderate, they mean that you can still carry on a normal conversation. (That sounds more like light exercise to me, but as long as I know what they're talking about the terminology is irrelevant.) The one study I found that directly compared moderate and vigorous exercise found that moderate exercise is beneficial and vigorous exercise is detrimental. Granted, a single study does not mean it is an undeniable fact, but in the absence of better information it is something to consider. Based on what some talks with health professionals, the difference in effect based on exercise intensity may be because the metabolic impact of vigorous exercise is bigger and it's harder to keep up with the energy requirements of heavy exercise.

I'm glad you found ways to handle stress. I definitely agree with taking time out to enjoy life. I'm still going on weekly date nights with DH, though a couple of them have been cut short so I could finish a computer program that might take a day or two to run or some other task that if I just put in a little more time it will save me a bunch of time later. Tonight is date night again and we can finally plan our honeymoon! (We got married in March.) Next week I might coax him into going to a corn maze :-P. Probably the biggest thing I can do to relax is just get out of the house and away from his boys (17 and 21) and the mess.

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