Why does luteal insufficiency occur in ovulatory dysfunctional uterine bleeding?

Ovulatory dysfunctional uterine bleeding often occurs in women of childbearing age. Although the patient has ovulation function, the corpus luteum function is abnormal. Why is this?

Since follicles develop and ovulate during the menstrual cycle, but progesterone secretion is insufficient during the luteal phase or the corpus luteum declines prematurely, the endometrial secretion response is poor. The healthy development of the corpus luteum depends on sufficient levels of BH and the ovaries must also have a good response and secrete sufficient steroid hormones. It is currently believed that luteal insufficiency is caused by multiple factors.

(1) Neuroendocrine regulation dysfunction can lead to FSH deficiency in the follicular phase, slowing follicle development and reducing estrogen secretion.

(2) Although the LH pulse frequency increases, the peak value is not high. LH deficiency causes incomplete corpus luteum development after ovulation and reduced progesterone secretion.

(3) An abnormal FSH/LH ratio can also cause dysfunction of the gonadal axis, resulting in poor follicular development and incomplete corpus luteum development after ovulation, leading to insufficient endometrial secretory response. Sometimes the corpus luteum secretory function is normal, but the duration is short. Some patients also show increased blood prolactin levels when the corpus luteum function is insufficient.

In addition, physiological factors such as menarche, after childbirth and before menopause may also cause dysfunction of the hypothalamic-pituitary-ovarian axis, leading to luteal insufficiency.