Progesterone levels and short luteal phase

[sausageface]

I'll try and keep this as short as possible!
I've had my very initial tests from the gp, bloods and internal ultrasound, my catch up about the results with the gp is on Monday.

Scan showed one ovary looking polycystic (I've been told this doesn't mean for sure that I have pcos) but the problem I have is with my day 21 blood test timing.

My cycles average 32 days, but can be 30/31/32 on average with the very occasional anomaly of 27 or 35 for example. When tracking ovulation, 99% of the time I'd get my peak on day 22, regardless of the length of my cycle (I'm assuming this points to no ovulation occurring?)
My problem lies with the bloods having to be done 7 days prior to my period, so they were done on day 23, just 1 day after I'd of expected my peak if I'd of tracked this month. With a shorter than average luteal phase should I be having my day 21 bloods taken at a different time? As you can see, 7 days before period only takes me to my expected ovulation basically!
My gp seems quite knowledgable but would be great to have some info of my own to go to her with on this situation when we speak on Monday.
I do have copies of all my progesterone results too if it's any help at all!
Thanks in advance!

@sausageface that’s an interesting one, the main reason for the progesterone test is to check if you’ve ovulated. If you have then the follicle that released the egg will become the corpus luteum and will produce progesterone that will be in a certain range. It needs time to do that. GP notebook which is what your Gp is probably looking at says “assessment of ovulation - mid-luteal progesterone - taken seven days prior to menses e.g. day 21 of 28 day cycle or day 25 of 32 day cycle”. I thought that the luteal phase tends to stay quite consistent at 14 days, but in your case you’re describing getting your period 8-10 days after ovulating. You could try the standard 7 day before the expected period as your GP suggests and see if it falls into the normal range (indicating that you’ve ovulated), if it’s not in range then you might want to try another time or get some advice from a specialist given your cycles.

I would not get too hung up on timings for a day 21 test. A day 21 progesterone test (which is a standard test) is only part of it; having that done a day or so either side should not affect the result markedly.
The hormones that actually kickstart the ovulation process are LH and FSH. If these are awry then ovulation will be affected. Those hormone levels are measured at the start of the cycle around or on day 2.

Did the person comment on the appearance of the other ovary?.

What were the levels of progesterone measured to date?.

Thanks both @AttilaTheMeerkat and @Gardenlady543 for your reply's! I've attached the photos below.

The first reading is a day 3 reading. The second is a day 25 reading of what turned out to be a 27 day cycle... typically this was the most 'normal' cycle I've experienced in my memory, with ovulation symptoms happening around day 16ish if I remember rightly. The next 2 readings were taken on day 20 and day 23, the cycle length is yet unknown as af hasn't arrived yet. Ovulation symptoms on day 22 like usual for me.

Hope that makes sense! I can cope with facing the fact I might not be ovulating of course, I'm still quite practical at this stage! But is there also a possibility with ovulation symptoms on day 22, that's I might not of released my egg by day 23? It's hard for me to find info online about what my levels should be at any point of my cycle other than 7 days before my period so your insight is most welcome!

Oh and sorry @AttilaTheMeerkat, in regards to other ovary she said that one's fine, as is my uterus. Just one is enlarged and looking polycystic, there was also currently a cyst at the time too

Hi @sausageface I had a similar issue - my cycle is ~28 days so my GP wanted to do day 21 bloods because they are just told to do 7 days before AF. But I don't ovulate until about day 18-19, so day 21 is only 2DPO for me. When I saw a specialist I asked and he said no, it should be 5-7 days after ovulation. So he did day 24 for me and it came back normal - even though only 4 days before AF.

Obviously a 10 day LP is a problem in its own right which is now being treated!

Have you had any treatment for short LP?

@GlassLily thanks for this! My gp has written to gynaecology for advice, I must chase that up actually! Interestingly she said the result that came back the most normal was the one that ended up being only 2 days before my period came, so the 7 days post ovulation makes sense (and makes me feel that I must be ovulating, which my body made me think I did anyway but I suppose we never know until they test!)

Can I ask what they've done to treat your short luteal phase? I've been diagnosed with pcos since this but I'm not sure that specifically causes issues with LP.

@sausageface I treated myself with a vitamin B complex, and the first month I took that I had a CP! Then the following month I had a CP again. I then got a prescription for 200mg progesterone daily from 3DPO to 12DPO (continue taking if BFP) and I have just had my first cycle. I got to 12DPO which is great, but I don't know how much is down to the B complex (because of the CPs I can't compare).

The Dr wants 14 days LP so my progesterone dose is being doubled for next cycle.

(I haven't been diagnosed with PCOS)

I also spoke to my GP about whether progesterone would really help because my day 24 progesterone was totally normal - she explained that the two are unrelated and you can have normal progesterone from ovulation, but it still drops off too early causing a short LP and early miscarriage.

Have you tried B complex?