Overview of hyperprolactinemia
Hyperprolactinemia is a symptom of excess prolactin, a hormone that causes milk production in a woman’s breasts. This hypersecretion can be caused by a prolactin-secreting tumour (prolactinoma), pregnancy, or the use of various drugs, especially psychotropic drugs, or a large pituitary tumour that shrinks the rest of the gland. In most cases, changes in the structural cycle lead to an early evaluation and diagnosis of hyperprolactinemia, and thus many premenopausal women present with small tumours (macroprolactinomas, <1 cm in size).
Prolactin is a hormone produced by the pituitary gland. Helps stimulate and maintain the production of breast milk. Hyperprolactinemia describes an excess of this hormone in a person’s body. This condition is most common during pregnancy or when the mother is producing milk to breastfeed.
Using medications for certain conditions or specifications can cause hyperprolactinemia in anyone. The causes and effects of high prolactin levels vary depending on a person’s gender.
Symptoms of hyperprolactinemia
The symptoms of hyperprolactinemia are different in men and women. Since prolactin levels affect milk production and the production cycle, it is difficult to detect in men. If a person has an erection problem, their doctor may recommend a blood test to check for more prolactin.
Symptoms in women:
- Irregular periods
- change in the flow of the structure
- break in the structure cycle
- Loss of libido
- Breastfeeding (Galactorrhea)
- Sore breasts
- Vaginal dryness
Symptoms in men:
- Abnormal breast enlargement (gynecomastia)
- Loss of sexual desire
- Vision change
- Reader survey
Causes of hyperprolactinemia
An increased level of prolactin may be caused by a variety of secondary conditions. Most often, hyperprolactinemia is caused by pregnancy, and it is common.
According to a 2013 study, pituitary tumours can cause up to 50 per cent of hyperprolactinemia. Prolactinoma is a tumour that forms in the pituitary gland. These tumours are generally not cancerous. But they cause different characteristics depending on the gender of a person.
Other causes of hyperprolactinemia include:
- Acid H2 blockers such as cimetidine (Tagamet).
- Antihypertensive medications such as verapamil (Colon, Isoptin, and Veron).
- Antidepressant medications are desipramine (norepinephrine) and clomipramine (Anafranil).
- Cirrhosis or severe scarring of the liver.
- Cushing syndrome, which is caused by high levels of a hormone called cortisol.
- Infection, tumour, or injury of the hypothalamus.
- Antidepressants such as metoclopramide (Primperan, Reglan).
How does hyperprolactinemia affect fertility and pregnancy?
Fertility and pregnancy depend on the proper balance of reproductive hormones. When one of those hormones is out of balance, fertility suffers.
Excess prolactin leads to irregular ovulation and affects the quality of the luteal phase or the second half of the menstrual cycle, negatively affecting fertility. Excess prolactin can also inhibit the secretion of follicle-stimulating hormone, or FSH, the hormone that stimulates the maturation of ovarian follicles. Without FSH there is no ovulation and without ovulation, it is impossible to get pregnant.
How does hyperprolactinemia affect pregnancy?
Some experts theorize that prolactin above normal levels during pregnancy increases the risk of miscarriage, although the link is not well established.
Treatment for hyperprolactinemia
Treatment is largely focused on getting prolactin levels back to normal. In the case of a tumour, surgery may be necessary to remove the prolactinoma, but this condition can often be treated with medication.
Treatment may include:
- Synthetic thyroid hormones
- Change of medication
- Prolactin-lowering drugs such as bromocriptine (Parlodel, Cycloset) or Cabergoline.
For drug-induced hyperprolactinemia, your healthcare provider may recommend trying a new drug or adding another to balance some of the effects of the first drug. In these cases, it is important to discuss concerns and priorities related to the management of side effects and other health problems.
For hyperprolactinemia caused by a benign tumour in the pituitary gland (prolactinoma), the doctor may prescribe medications that affect the function of dopamine (dopamine agonists). They may also prescribe hormone therapy in the form of hormonal contraceptives or hormone replacement therapy (HRT).
Where the tumour cannot be treated with medications or hormones, the doctor may recommend surgery. When treating this cause of hyperprolactinemia, the healthcare provider needs to know the status of a person’s pregnancy and their intentions, as some medications used to treat tumours can affect the pregnancy or the developing fetus.
When to call a doctor
If you are having trouble getting pregnant, your doctor may do some tests to find out if hyperprolactinemia contributes to your fertility problems. Blood tests will reveal if you have high prolactin levels, and treatment will depend on the cause of the condition.
This makes it harder to get pregnant. The good news is that proper treatment can normalize prolactin levels, increasing your chances of getting pregnant.