Hyperprolactinemia is characterized by an increased blood prolactin level. This is the hormone responsible for stimulating the growth of a woman’s breasts during pregnancy and starting breast milk production after childbirth.
Inadequate prolactin secretion in women can cause ovulation disorders, menstrual cycle changes, infertility and breast milk production that is unrelated to breastfeeding (galactorrhea).
Knowing the causes of hyperprolactinemia is critical when it comes to treatment selection in order to achieve pregnancy with minimal wear. Oral medications such as bromocriptine are usually used. If these measures are not enough, the best option is In-Vitro Fertilization (IVF)
What is hyperprolactinemia?
Hyperprolactinemia is characterized by an increased blood prolactin level in a woman who is not pregnant or breastfeeding.
Prolactin is a hormone secreted by the pituitary gland; its main functions are to stimulate the growth of a woman’s breasts during pregnancy and starting breast milk production after childbirth.
Inadequate secretion of prolactin in women can cause ovulation disorders, changes in menstrual cycles, infertility and breastmilk production unrelated to breastfeeding (galactorrhea).
Learn more about hyperprolactinemia with one of our specialists:
Main symptoms of hyperprolactinemia
Amenorrhea or menstrual period absence, and galactorrhea or breastmilk production unrelated to breastfeeding are the main clinical manifestations of hyperprolactinemia. Approximately 75 percent of patients with both symptoms have hyperprolactinemia.
Other symptoms of hyperprolactinemia are:
- Anovulation or ovulation absence
- Amenorrhea or menstrual period absence
- Opsomenorrhea or delayed menstrual periods
- Headaches. Usually the pain is located below the eyes, on the forehead
- Visual disorders
- Decreased libido
- Hirsutism or unwanted hair growth. This symptom occurs when hyperprolactinemia is associated with polycystic ovarian syndrome (PCOS)
- Recurrent pregnancy loss
Hyperprolactinemia can be caused by several factors:
- Physical factors. – Prolactin level can be increased transiently or permanently for reasons like sleep deprivation, pregnancy, lactation, breast manipulation, excessive physical activity and stress.
- Derived from other conditions. – It is common to find high levels of prolactin as a secondary effect of other diseases like hypothyroidism, polycystic ovarian syndrome, multiple sclerosis, lupus, chronic renal failure and liver cirrhosis. Hyperprolactinemia can also be caused by chest wall irritation or burn due to trauma
- Prescription drugs side effects. – Hyperprolactinemia can be caused as a side effect by psychotropic, blood pressure or estrogen related drugs. Other prescription drugs that affect dopamine receptors such as metoclopramide (which is widely used) can also cause this condition.
- Hypophysis gland tumors. – Also known as adenomas, these tumors are the reason of about 30 percent of hyperprolactinemia cases. These tumors are benign, but stimulate an excessive prolactin secretion by interfering with dopamine production and transportation, which is the hormone responsible for inhibiting prolactin secretion in normal conditions.
How is hyperprolactinemia diagnosed?
If you suffer from menstrual cycle disorders, galactorrhea or any of the other aforementioned hyperprolactinemia symptoms, the suggested actions would be:
- Performing a blood test to determine your prolactin blood level. This test must be performed during early morning hours, in a rested condition from at least half an hour before. This test can be performed at any time of the menstrual cycle
- If the first analysis shows high prolactin levels, it should be repeated to confirm the diagnosis of hyperprolactinemia.
- If prolactin levels are still high in the second test, common causes of hyperprolactinemia (such as pregnancy and the use of prescription drugs that increase prolactin secretion) must be ruled out before undertaking further studies. Your doctor will also perform tests to rule out conditions such as hypothyroidism, in which a prolactin excess is secreted to compensate for thyroid malfunction and the consequent lack of thyroid hormone
- Finally, if all other possible causes have been ruled out, you must submit to an MRI or a CAT scan to rule out a pituitary gland tumor (or adenoma).
Treatments to achieve pregnancy in patients suffering from hyperprolactinemia
Knowing the causes of hyperprolactinemia is critical when it comes to treatment selection in order to achieve pregnancy with minimal wear. Currently, there are highly effective solutions for every hyperprolactinemia cause.
If your high prolactin level is caused by a prescription drug, your doctor will ask you to suspend its use and help you find other options. However, if hypothyroidism is the cause, your specialist will prescribe a synthetic thyroid hormone in order to normalize your prolactin levels.
In any case, treatment of hyperprolactinemia should begin with oral medications such as bromocriptine and cabergoline. Your doctor will ask you to take a low dose and gradually increase it until your prolactin level returns to normal. The use of these prescription drugs has a very favorable prognosis, as well as a positive effect on reducing pituitary tumors, galactorrhea remedying and menstrual period and fertility resuming in a short time.
If these measures are not enough however, the best option is In-Vitro Fertilization (IVF), which offers high success rates by making possible to fertilize the patient’s eggs under controlled laboratory conditions to generate embryos, which are selected to place the best quality ones back into the woman’s uterus.
In the few rare cases in which prolactin increase is caused by larger than 10 millimeter pituitary tumors and in which conditions do not improve with medication, the possibility of surgery or radiotherapy treatment should be evaluated.